[Clinico-pathological and molecular aspects of diagnostic and prognostic value in gliomas]

INTRODUCTION

Diffuse infiltrative gliomas, the most common primary brain tumours, account for almost 80% of malignant brain tumours. 60-70% of gliomas are astrocytic and over 80% of these tumours is considered high grade malignancy (grade III and IV) according to current World Health Organization classification. Infiltrating gliomas include diffuse astrocytomas, oligodendrogliomas and oligoastrocytomas.

AIM

To review the clinical and histological features of cerebral gliomas, and molecular alterations that add relevant information for novel approaches in diagnosis, prognosis and treatment.

DEVELOPMENT

The current gold standard diagnosis of these tumours relies on histopathological classification, which provides a grading of malignancy as a predictor of biological behaviour. However emerging molecular abnormalities have been discovered in the last years and these molecular changes are playing an increasingly prominent role as predictive biomarkers or in the development of diagnostic and prognostic. Now the neuropathologist is in crossroads between pathology and molecular biology and he plays a significant role in implementation of treatments and/or clinical trials.

CONCLUSIONS

The study of proteomics and molecular biomarkers should complement the histopathological analysis and sometimes allows to determine direct or indirect predictive factors as well as the study of affected pathways which may become selective therapeutic targets.

[Usefulness of arteriography with multislice spiral computed tomography in the diagnosis of preocclusive stenosis of the cervical internal carotid artery]

INTRODUCTION

Distinction between near-occlusion and occlusion of the internal carotid artery (ICA) is relevant because patients can benefit from a surgical treatment in the first case. Digital subtraction angiography (DSA) is the best neuroimaging technique for its diagnosis but the possibility of related neurologic complications suggests the use of non-invasive tests. Ultrasound (US) and magnetic resonance angiography (MRA) have been proposed as alternative techniques of diagnosis. But these can provoke an erroneous diagnosis when a near occlusion of ICA is present. Multislice helicoidal computed tomographic angiography (MHCTA) can play a role in these situations.

CASE REPORTS

Case 1: patient diagnosed of occlusion of the left ICA by cervical US. Cerebral magnetic resonance suggested severe stenosis of intracavernous ICA. MHTCA showed carotid permeability. Case 2: patient diagnosed by cervical US of near occlusion and of occlusion/pseudoocclusion by enhanced RMA. MHCTA showed filiform patency of the cervical ICA. Case 3: a cervical US diagnosed moderate stenosis of the right ICA and severe of the left. Transcranial Doppler suggested near occlusion of the right ICA. MHTCA confirmed near occlusion of the right ICA.

CONCLUSION

MHCTA correctly diagnosed near occlusion in three patients in which minimally invasive techniques had discrepancies. MHTCA is a new diagnostic technique whose lack of dependence of flow makes a good alternative to confirm findings of US of the cervical ICA.

Adult-onset subacute sclerosing panencephalitis: clinico-pathological findings in 2 new cases

Subacute sclerosing panencephalitis (SSPE), an uncommon disease usually affecting children and adolescents, is caused by persistent measles infection that progresses to chronic infection with fatal outcome. The debut of this disease in adults is rare, with a small number of cases in the medical literature. This article presents the clinical, radiologic and post-mortem neuropathologic findings in 2 new cases of women with SSPE (1 of them during pregnancy), which showed very atypical clinical characteristics, presentation and evolution. The influence of pregnancy on the course of the disease was unfavorable, in keeping with earlier reports. Our patients showed a very prolonged biphasal clinical course, with a period of disease-free remission that lasted several years. Histological study disclosed features of inflammatory disease associated with others of a neurodegenerative nature, such as the formation of neurofibrillary tangles, which would relate SSPE with other tauopathies.

[Study of the hypoplasic internal carotid artery by use of multislice spiral computed tomography. Two case reports]

INTRODUCTION

Hypoplastic internal carotid artery (HICA) is a rare benign congenital malformation. Its angiographic image string sign is shared by entities that may be either medically or surgically treated. We report two cases diagnosed by helical computerized tomography (HCT).

CASE REPORTS

Case 1: woman diagnosed clinically and by magnetic resonance (MR) of Chiari I malformation with associated syringomyelia. An HCT of the craniocervical junction was done to rule out osseous malformations. An hypoplastic posterior fossa (PF) with small right carotid foramen was diagnosed. An arteriography with HCT was done that showed the carotid string sign. Case 2: a 82 years old hypertensive woman with left hemiparesia and homonymous hemianopsia was diagnosed of right temporooccipital infarct. An HCT arteriography disclosed occlusion of the right posterior cerebral artery, calcification of the left carotid siphon and stenosis of the right siphon. Bi and tridimensional reconstructions of the circle of Willis, cranial base and distal cervical carotid arteries showed an hypoplastic right carotid artery and foramen.

CONCLUSIONS

Multislice HCT is a recently incorporated diagnostic tool that allows a volumetric study in a short period of time, seconds. An angiographic study can be done intravenously in cases of vascular anomaly suspiction, hypoplastic carotid artery in the reported cases. HCT is the only current imaging tool that can diagnose this anomaly without the aid of other imaging studies.

Neonatal tumors of the CNS: a report of 9 cases and a review

Neonatal central nervous system (CNS) tumors are an uncommon and histologically heterogeneous group of neoplasms with different clinical and biological features from those arising in childhood. We report 9 cases in which a diagnosis of CNS tumor was confirmed by biopsy or autopsy during the years 1982-1997 in the Vall d'Hebrón Children's Hospital, Barcelona. Two cases were fetal tumors detected by fetal sonography, 3 patients were symptomatic in the first days after birth and 4 patients presented initial clinical signs in the first weeks or months of life. Eight lesions were supratentorial and 1 was located in the spinal cord. According to histologic types, there were 2 glioneuronal tumors, 1 anaplastic astrocytoma, 1 choroid plexus carcinoma, 1 immature teratoma, 1 craniopharyngioma, 1 hemangioblastoma, 1 astroblastoma and 1 hemangioendothelioma. Extensive review of the literature indicates that our cases of hemangioblastoma, astroblastoma and hemangioendothelioma are exceptional and one more of the very rare and isolated previously published cases.

[Disseminated acute encephalomyelitis with fatal evolution: clinicopathological study]

INTRODUCTION

Disseminated acute encephalomyelitis is a monophasic demyelinating disease which progresses rapidly and is often fatal. It is an autoimmune condition, mediated by T lymphocytes, in which the immune response is directed against the myelin antigens.

CLINICAL CASE

We describe the clinical, radiological and neuropathological findings in the case of a 31 year old woman who, ten days after complaining of a clinical condition of upper respiratory tract inflammation, presented with unilateral focal neurological signs, subsequent rapid deterioration of consciousness and death. On autopsy the neuropathological characteristics of disseminated acute encephalomyelitis were seen.

CONCLUSIONS

The relative rarity of this condition at the present time makes clinical diagnosis difficult. The differential diagnosis with other conditions may be difficult also. Thus, this disease often leads to a neuropathological diagnosis.