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Barreto JS, Gomez KNM, Dutra AP, De Azambuja AMP, Cristofani LM, Sanders FH, Petito C, Baraldi HE, Weltman E, Ferraciolli SF, Frassetto FP, Lucato LT, Rosemberg S, Filho VO. ATRT-06. Atypical Teratoid Rhabdoid Tumors (ATRT): results from a Single Institution in Brazil - São Paulo University. Neuro Oncol 2022. [PMCID: PMC9165313 DOI: 10.1093/neuonc/noac079.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: Atypical teratoid/rhabdoid tumor (AT/RT) is a rare, highly malignant tumor of the central nervous system with poor prognosis. Nowadays, multimodal management, including surgery, chemotherapy (CMT), radiation therapy (RT) and Bone Marrow Transplantation (BMT). The aim of this study was to assess the experience and survival in a center of reference of treatment in childhood cancer in Brazil. PATIENTS AND METHODS: Medical records of AT/RT patients who underwent surgery from 2008 to 2020 at a center of childhood cancer treatment (ITACI) in São Paulo University were retrospectively reviewed and statistically analyzed. RESULTS: Eight patients (2 males and 6 females) were presented with AT/RTs. Median age during presentation was 22 months (range, 0 - 6 years). Seven patients (88%) were < 18 months and one patient were >18 months. Tumor location was supratentorial in four patients, infratentorial in 2 patients. Kidney disease as the primary diagnosis in 2 patients (25%). Surgical treatment was performed in 4 patients. Seven children underwent total CMT and 3 children were treated with RT. Only 3 patients underwent Autologous Bone Marrow Transplantation (ABMT). The chemotherapy management protocol of the patients was variable: 2 patients received the EU-RHAB protocol, 2 patients received the HEAD START III protocol, 3 patients received chemotherapy in the ICE regimen (Ifosfamide + Carboplatin + Etoposide) and 1 patient received chemotherapy in the CDDP+CTX+VCR (Cyclophosphamide + Cisplatin + Vincristine) regimen. All patients had episodes of neutropenic fever when they received chemotherapy, requiring hospitalization and use of an antibiotic treatment. Among the 8 patients analyzed, all died. CONCLUSIONS: Despite progress in treatment, AT/RT of the CNS disease or primary kidney disease associated with a lack of standardization in a regimen contributes to the dismal prognosis. There is a high mortality in patients with AT/RT, similar to that found in the literature.
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Affiliation(s)
| | | | | | | | | | | | - Carlo Petito
- Fac Medicina USP - Neurocirurgia , São Paulo, SP , Brazil
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2
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Vitturi BK, da Rocha AJ, Rosemberg S. Cerebral venous thrombosis in a 6-year-old boy with sickle cell trait. Acta Neurol Belg 2020; 120:403-404. [PMID: 30488356 DOI: 10.1007/s13760-018-1054-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/26/2018] [Indexed: 02/02/2023]
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3
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Ortega RPM, Rosemberg S. Reply. Arq Neuropsiquiatr 2019; 77:598. [PMID: 31508690 DOI: 10.1590/0004-282x20190102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Sérgio Rosemberg
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo SP, Brasil
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4
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Vitturi BK, Rosemberg S, Arita FN, da Rocha AJ, Forte WCN, Tilbery CP. Multiphasic disseminated encephalomyelitis associated with herpes virus infection in a patient with TLR3 deficiency. Mult Scler Relat Disord 2019; 36:101379. [PMID: 31479858 DOI: 10.1016/j.msard.2019.101379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/31/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
We report a case of a 14-year-old girl that presented headache, amaurosis, drowsiness, fever, vomiting and diffuse reduction of muscle strength. She had been diagnosed with ADEM one year before and had a previous diagnosis of Toll-Like 3 receptor deficiency. Cerebrospinal fluid analysis revealed pleocytosis (28/mm3, 12/mm3 red blood cells, 70% lymphocytes cells, 2% monocytes cells, 28% neutrophils), normal total protein (38 pg/mL) and normal glucose level (53/mm3). Studies for CSF oligoclonal bands and serum anti-MOG were negative but polymerase chain reaction (PCR) testing was positive for herpes virus 1. In the first ADEM episode, PCR for herpes virus was also positive. Magnetic resonance imaging (MRI) of the brain revealed disseminated hyperintense lesions on T2-weighted and FLAIR images in the white matter of frontal, parietal and temporal lobes, corresponding to extensive asymmetric areas of demyelination that produced mass effect and gadolinium enhancement. Electroencephalography demonstrated irregular diffuse and generalized slow-wave activity with predominance in frontal region. The diagnosis of multiphasic disseminated encephalomyelitis (MDEM) triggered by herpes simplex virus was made. Herpes virus is a neurotropic virus that can cause a wide variety of neurological infection-triggered autoimmune disorders and that is particularly damaging to the central nervous system in situations of impaired immune system. TLR3 is expressed in astrocytes and dendritic cells of the central nervous system and is essential for natural immunity to herpes simplex. TLR3-deficient patients have already been described with herpes simplex encephalitis. TLR3 deficiency may predispose and explain autoimmune and demyelinating manifestations induced by herpes virus. The association of multiphasic disseminated encephalomyelitis triggered by herpes virus in a patient with TLR3 deficiency has not been previously reported in the literature.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | - Sérgio Rosemberg
- Department of Pediatric Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Fernando Norio Arita
- Department of Pediatric Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Antônio José da Rocha
- Department of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Charles Peter Tilbery
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Ortega RPM, Rosemberg S. Hereditary spastic paraplegia: a clinical and epidemiological study of a Brazilian pediatric population. Arq Neuropsiquiatr 2019; 77:10-18. [PMID: 30758437 DOI: 10.1590/0004-282x20180153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/15/2018] [Indexed: 11/22/2022]
Abstract
AIMS To investigate hereditary spastic paraplegia (HSP) in a pediatric Brazilian sample. METHODS Epidemiological, clinical, radiological and laboratory data were analyzed in 35 patients. RESULTS Simple HSP (HSP-S) was detected in 12 patients, and complicated HSP (HSP-C) was detected in 23 patients. The mean age of onset of symptoms was 2.9 years in HSP-S and 1.6 years in HSP-C (p = 0.023). The disease was more severe in HSP-C. There were no differences in sex, ethnic background, or family history between groups. Intellectual disability was the most frequent finding associated with HSP-C. Peripheral axonal neuropathy was found in three patients. In the HSP-C group, MRI was abnormal in 13 patients. The MRI abnormalities included nonspecific white matter lesions, cerebellar atrophy, thinning of the corpus callosum and the "ear of the lynx sign". CONCLUSIONS In children with spastic paraplegia, HSP must be considered whenever similar pathologies, mainly diplegic cerebral palsy, are ruled out.
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Affiliation(s)
| | - Sérgio Rosemberg
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brasil.,Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo SP, Brasil
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Uno M, Oba-Shinjo SM, Wakamatsu A, Huang N, Ferreira Alves VA, Rosemberg S, de Aguiar P, Leite C, Miura F, Marino RJ, Scaff M, Nagahashi-Marie SK. Association of TP53 Mutation, p53 Overexpression, and p53 Codon 72 Polymorphism with Susceptibility to Apoptosis in Adult Patients with Diffuse Astrocytomas. Int J Biol Markers 2018; 21:50-7. [PMID: 16711514 DOI: 10.1177/172460080602100108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clarification of TP53 alterations is important to understand the mechanisms underlying the development of diffuse astrocytomas. It has been suggested that the alleles of TP53 at codon 72 differ in their ability to induce apoptosis in human cancers. The aim of this study was to analyze the possible association of TP53 mutation, p53 overexpression, and p53 codon 72 polymorphism with susceptibility to apoptosis in adult Brazilian patients with diffuse astrocytomas. We analyzed 56 surgical specimens of diffuse astrocytomas for alterations of TP53, using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) direct sequencing. p53 and cleaved caspase 3 protein expression were assessed by immunohistochemistry. We found TP53 mutations in 19.6% (11 out of 56) of tumors tested, with the lowest mutation rate found in the cases of glioblastomas (8.8%) (p = 0.03). Only 16.1% of tumors tested showed cleaved caspase 3-positive staining, demonstrating that apoptosis is very inhibited in these tumors. All tumors having TP53 mutation and p53 accumulation had no expression of cleaved caspase 3. Additionally, no association was observed in tumors having proline and arginine alleles and expression of cleaved caspase 3. We concluded that clarification of the TP53 alterations allows a better understanding of the mechanisms involved in the progression of diffuse astrocytomas, and the allele status at codon 72 was not associated with apoptosis in these tumors.
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Affiliation(s)
- M Uno
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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7
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Barbosa K, Oba-Shinjo S, Uno M, Carvalho P, Rosemberg S, Aguiar P, Carlotti C, Malheiros S, Toledo S, Lotufo P, Marie S. Association of EGFR c.2073A>T Polymorphism with Decreased Risk of Diffusely Infiltrating Astrocytoma in a Brazilian Case-Control Study. Int J Biol Markers 2018; 23:140-6. [DOI: 10.1177/172460080802300302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidermal growth factor receptor (EGFR) gene overexpression has been implicated in the development of many types of tumors, including glioblastomas, the most frequent diffusely infiltrating astrocytomas. However, little is known about the influence of the polymorphisms of EGFR on EGFR production and/or activity, possibly modulating the susceptibility to astrocytomas. This study aimed to examine the association of two EGFR promoter polymorphisms (c-191C>A and c.-216G>T) and the c.2073A>T polymorphism located in exon 16 with susceptibility to astrocytomas, EGFR gene expression and survival in a case-control study of 193 astrocytoma patients and 200 cancer-free controls. We found that the variant TT genotype of the EGFR c.2073A>T polymorphism was associated with a significantly decreased risk of astrocytoma when compared with the AA genotype [sex- and age-adjusted odds ratio 0.51, 95% confidence interval 0.26–0.98]. No association of the two promoter EGFR polymorphisms (or combinations of these polymorphisms) and risk of astrocytomas, EGFR expression or survival was found. Our findings suggest that modulation of the EGFR c.2073A>T polymorphism could play a role in future therapeutic approaches to astrocytoma.
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Affiliation(s)
- K.C. Barbosa
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
| | - S.M. Oba-Shinjo
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
| | - M. Uno
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
| | - P.O. Carvalho
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
| | - S. Rosemberg
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo
| | - P.H.P. Aguiar
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
| | - C.G. Carlotti
- Department of Surgery, Division of Neurosurgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto
| | - S.M.F. Malheiros
- Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo
| | - S. Toledo
- Department of Pediatrics, Pediatric Oncology Institute, Federal University of São Paulo, São Paulo
| | - P. Lotufo
- Hospital Universitario São Paulo, University of São Paulo, São Paulo - Brazil
| | - S.K.N. Marie
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo
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Smid J, Studart A, Landemberger MC, Machado CF, Nóbrega PR, Canedo NHS, Schultz RR, Naslavsky MS, Rosemberg S, Kok F, Chimelli L, Martins VR, Nitrini R. High phenotypic variability in Gerstmann-Sträussler-Scheinker disease. Arq Neuropsiquiatr 2017; 75:331-338. [PMID: 28658400 DOI: 10.1590/0004-282x20170049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 12/20/2022]
Abstract
Gerstmann-Sträussler-Scheinker is a genetic prion disease and the most common mutation is p.Pro102Leu. We report clinical, molecular and neuropathological data of seven individuals, belonging to two unrelated Brazilian kindreds, carrying the p.Pro102Leu. Marked differences among patients were observed regarding age at onset, disease duration and clinical presentation. In the first kindred, two patients had rapidly progressive dementia and three exhibited predominantly ataxic phenotypes with variable ages of onset and disease duration. In this family, age at disease onset in the mother and daughter differed by 39 years. In the second kindred, different phenotypes were also reported and earlier ages of onset were associated with 129 heterozygosis. No differences were associated with apoE genotype. In these kindreds, the codon 129 polymorphism could not explain the clinical variability and 129 heterozygosis was associated with earlier disease onset. Neuropathological examination in two patients confirmed the presence of typical plaques and PrPsc immunopositivity.
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Affiliation(s)
- Jerusa Smid
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Adalberto Studart
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | | | | | - Paulo Ribeiro Nóbrega
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Neurologia, Fortaleza CE Brasil
| | | | - Rodrigo Rizek Schultz
- Universidade Federal de São Paulo, Seção de Neurologia Comportamental, São Paulo SP, Brasil
| | - Michel Satya Naslavsky
- Universidade de São Paulo, Instituto de Biociências, Centro de Estudos do Genoma Humano, São Paulo SP, Brasil
| | - Sérgio Rosemberg
- Universidade de São Paulo, Departamento de Patologia, Divisão de Neuropatologia, São Paulo SP, Brasil
| | - Fernando Kok
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Leila Chimelli
- Universidade Federal do Rio de Janeiro, Departamento de Patologia, Rio de Janeiro RJ, Brasil
| | | | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
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9
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Mayoral ÉE, Schultz R, Rosemberg S, Suzuki L, de Oliveira LAN, Kay FU. Thanatophoric dysplasia: case report of an autopsy complemented by postmortem computed tomographic study. Autops Case Rep 2014; 4:35-41. [PMID: 28580325 PMCID: PMC5448300 DOI: 10.4322/acr.2014.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/19/2014] [Indexed: 12/27/2022] Open
Abstract
Thanatophoric dysplasia (TD) is one of the most common lethal skeletal dysplasias, which was first designated as thanatophoric dwarfism and described in 1967. The authors report a case of a Caucasian girl with TD, born to a 31-year-old woman without comorbidities. The newborn presented respiratory distress immediately after delivery, progressing to death in less than 2 hours. An autopsy was carried out after postmortem tomographic examination. The autopsy findings depicted extensive malformations of the skeletal system and the brain. The aim of this report is to discuss the pathogenesis and correlate the morphologic features of TD that were disclosed at the tomography and the autopsy.
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Affiliation(s)
- Éber Emanuel Mayoral
- Pathological Anatomical Division - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP, Brazil
| | - Regina Schultz
- Pathological Anatomical Division - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP, Brazil
| | - Sérgio Rosemberg
- Department of Pathology - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP, Brazil
| | - Lisa Suzuki
- Institute of Child - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP, Brazil
| | | | - Fernando Uliana Kay
- Institute of Child - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP, Brazil
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Clara CA, Marie SKN, de Almeida JRW, Wakamatsu A, Oba-Shinjo SM, Uno M, Neville M, Rosemberg S. Angiogenesis and expression of PDGF-C, VEGF, CD105 and HIF-1α in human glioblastoma. Neuropathology 2014; 34:343-52. [PMID: 24612214 DOI: 10.1111/neup.12111] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/24/2014] [Accepted: 01/25/2014] [Indexed: 12/29/2022]
Abstract
Glioblastoma (GBM), the most frequent and aggressive brain tumor, is characterized by marked angiogenesis directly related to invasiveness and poor prognosis. Hypoxia is considered to be an important stimulus for angiogenesis by inducing hypoxia-inducible factor 1-alpha (HIF-1α) overexpression that activates platelet-derived growth factor (PDGF) and VEGF. The aim of this study is to analyze the expression of PDGF-C, VEGF in endothelial and tumor cells of GBM and their relation to HIF-1α expression. Two hundred and eight GBM cases were studied by tissue microarray immunohistochemical preparation. Expression of HIF-1α, VEGF and PDGF-C was observed in 184 (88.5%), 131 (63%) and 160 (76.9%) tumor cases, respectively. The numbers of vessels were quantified by CD34, PDGF-C, VEGF and CD105 staining, and were in median 20, 16, 5 and 6, respectively. The GBMs that showed positive or negative expression for HIF-1α showed a median vascular density of 30 and 14, respectively, for CD34 (P < 0.015). Positive expression for HIF-1α was correlated with VEGF and PDGF-C expression in tumors (P < 0.001). There was a significant correlation between VEGF and PDGF-C expression in the cytoplasm of GBM tumor cells (P < 0.0001). We showed that VEGF expression in tumor cells was correlated with its expression in blood vessels (P < 0.0001). Endothelial cells with PDGF-C and VEGF positive expression were also positive for CD105 and their nuclei for Ki-67, confirming the neoangiogenic and proliferative influence of VEGF and PDGF-C. VEGF nuclear staining in tumor cells (P = 0.002) as well as nuclear staining for HIF-1α and VEGF (P = 0.005) correlated with survival. In summary, our present findings of the concomitant upregulation of PDGF-C with VEGF in GBM tumor cells and vessels further reinforce the benefit of using combined anti-angiogenic approaches to potentially improve the therapeutic response for GBM.
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Haddad LA, Rosemberg S. Call for awareness of the updated diagnostic criteria and clinical management for patients with tuberous sclerosis complex. Rev Assoc Med Bras (1992) 2014; 60:94-6. [DOI: 10.1590/1806-9282.60.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciana A. Haddad
- University of São Paulo, Brazil; Tuberous Sclerosis Alliance International Scientific Advisory Board, USA
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12
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Gualberto FAS, de Oliveira MI, Alves VA, Kanamura CT, Rosemberg S, Sato HK, Arantes BA, Curti SP, Figueiredo CA. Fulminant encephalitis associated with a vaccine strain of rubella virus. J Clin Virol 2013; 58:737-40. [DOI: 10.1016/j.jcv.2013.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 11/29/2022]
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Abstract
Holoprosencephaly (HPE) is a congenital defect of the brain, median structures, and face resulting from an incomplete cleavage of the primitive brain during early embryogenesis. The authors report a case of trisomy 13 syndrome diagnosed at prenatal follow up. The preterm newborn lived only 5 hours, and died because of severe respiratory failure. The autopsy findings disclosed facial, skull, limbs, cardiac, and cerebral malformations. Among the latter, the presence of alobar HPE, the central theme of this report, was evident. The most common nonrandom chromosomal abnormality in patients with HPE is trisomy 13. The most severe variant, namely alobar HPE, is shown in this case report. Discussion on this severe anomaly, along with the case report with details of Patau’s syndrome, is the goal of this report.
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Affiliation(s)
- Andressa Dias Costa
- Department of Pathology - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Regina Schultz
- Department of Pathology - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Sérgio Rosemberg
- Department of Pathology - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
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14
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Galatro TFDA, Uno M, Oba-Shinjo SM, Almeida AN, Teixeira MJ, Rosemberg S, Marie SKN. Differential expression of ID4 and its association with TP53 mutation, SOX2, SOX4 and OCT-4 expression levels. PLoS One 2013; 8:e61605. [PMID: 23613880 PMCID: PMC3628974 DOI: 10.1371/journal.pone.0061605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 03/11/2013] [Indexed: 02/07/2023] Open
Abstract
Inhibitor of DNA Binding 4 (ID4) is a member of the helix-loop-helix ID family of transcription factors, mostly present in the central nervous system during embryonic development, that has been associated with TP53 mutation and activation of SOX2. Along with other transcription factors, ID4 has been implicated in the tumorigenic process of astrocytomas, contributing to cell dedifferentiation, proliferation and chemoresistance. In this study, we aimed to characterize the ID4 expression pattern in human diffusely infiltrative astrocytomas of World Health Organization (WHO) grades II to IV of malignancy (AGII-AGIV); to correlate its expression level to that of SOX2, SOX4, OCT-4 and NANOG, along with TP53 mutational status; and to correlate the results with the clinical end-point of overall survival among glioblastoma patients. Quantitative real time PCR (qRT-PCR) was performed in 130 samples of astrocytomas for relative expression, showing up-regulation of all transcription factors in tumor cases. Positive correlation was found when comparing ID4 relative expression of infiltrative astrocytomas with SOX2 (r = 0.50; p<0.005), SOX4 (r = 0.43; p<0.005) and OCT-4 (r = 0.39; p<0.05). The results from TP53 coding exon analysis allowed comparisons between wild-type and mutated status only in AGII cases, demonstrating significantly higher levels of ID4, SOX2 and SOX4 in mutated cases (p<0.05). This pattern was maintained in secondary GBM and further confirmed by immunohistochemistry, suggesting a role for ID4, SOX2 and SOX4 in early astrocytoma tumorigenesis. Combined hyperexpression of ID4, SOX4 and OCT-4 conferred a much lower (6 months) median survival than did hypoexpression (18 months). Because both ID4 alone and a complex of SOX4 and OCT-4 activate SOX2 transcription, it is possible that multiple activation of SOX2 impair the prognosis of GBM patients. These observational results of associated expression of ID4 with SOX4 and OCT-4 may be used as a predictive factor of prognosis upon further confirmation in a larger GBM series.
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Lima EC, Otaduy MCG, Tsunemi M, Pincerato R, Cardoso EF, Rosemberg S, Aguiar PH, Cerri GG, Leite CC. The effect of paramagnetic contrast in choline peak in patients with glioblastoma multiforme might not be significant. AJNR Am J Neuroradiol 2013; 34:80-4. [PMID: 22766678 DOI: 10.3174/ajnr.a3181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE (1)H-MR spectroscopy is a useful tool in brain tumor evaluation. A critical point in obtaining representative spectra is the correct voxel positioning, which can be more accurate after Gd administration. Some experimental data suggested that Gd could cause Cho signal loss. Our aim was to evaluate the effect of Gd in the Cho peak area and width in patients with GBM. MATERIALS AND METHODS We performed multivoxel (1)H-MR spectroscopy before and after Gd administration in 18 patients with GBM. Quantification of Cho peak area and width in each voxel was completed, and the Cho mean and maximum values before and after Gd injection were calculated in the tumor and contralateral hemisphere. Choline peak area and width values obtained before and after contrast were compared, considering as separate entities enhancing and nonenhancing tumoral voxels and the contralateral hemisphere. RESULTS No statistically significant differences were found for the Cho peak area mean values in the tumoral voxels or contralaterally (P > .05). A tendency for an increase in the Cho peak width mean value was found in the tumoral enhancing voxels (P = .055). A statistically significant decrease was found for the mean value of the maximum Cho peak area in enhancing tumoral voxels (P = .020). No significant differences were found in the nonenhancing tumoral voxels or contralaterally (P > .05). CONCLUSIONS The injection of Gd before performing (1)H-MR spectroscopy might not significantly affect the Cho peak area in patients with GBM. The paramagnetic contrast seems to cause a different effect, depending on Gd enhancement.
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Affiliation(s)
- E C Lima
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil.
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Abstract
The parieto-occipital region of the brain is the most frequently and severely
affected in subacute sclerosing panencephalitis (SSPE). The basal ganglia,
cerebellum and corpus callosum are less commonly involved. We describe a patient
with SSPE confirmed by neuropathology based on brain magnetic resonance imaging
showing extensive basal ganglia involvement and no significant involvement of
other cortical structures. Though rarely described in SSPE, clinicians should be
aware of this involvement. SSPE should be kept in mind when changes in basal
ganglia signal are seen on brain magnetic resonance imaging with or without
involvement of other regions of the human brain to avoid erroneous etiological
diagnosis of other pathologies causing rapidly progressive dementia.
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Affiliation(s)
- Kelson James Almeida
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | | | | | - Sérgio Rosemberg
- Department of Pathology, School of Medicine of the University of São Paulo (FMUSP) São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
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17
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Muoio VMF, Shinjo SO, Matushita H, Rosemberg S, Teixeira MJ, Marie SKN. Extraneural metastases in medulloblastoma. Arq Neuropsiquiatr 2011; 69:328-31. [PMID: 21625760 DOI: 10.1590/s0004-282x2011000300012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 10/05/2010] [Indexed: 11/22/2022]
Abstract
Medulloblastoma is the most common childhood malignant tumor of central nervous system, but it may also occur in adults. It presents high invasive growth with spreading of tumor cells into the leptomeningeal space along the neuroaxis early in the course of the disease. Extraneural metastases are rare but frequently lethal, occurring only in 1 to 5% of patients, and are related, in the most of cases, to the presence of ventriculoperitoneal shunt. Here we characterize the clinical profile of five cases of medulloblastoma with systemic spreading of tumor cells, also comparing them to cases already described in the literature.
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18
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Uno M, Oba-Shinjo SM, Camargo AA, Moura RP, Aguiar PHD, Cabrera HN, Begnami M, Rosemberg S, Teixeira MJ, Marie SKN. Correlation of MGMT promoter methylation status with gene and protein expression levels in glioblastoma. Clinics (Sao Paulo) 2011; 66:1747-55. [PMID: 22012047 PMCID: PMC3180167 DOI: 10.1590/s1807-59322011001000013] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/30/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES 1) To correlate the methylation status of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter to its gene and protein expression levels in glioblastoma and 2) to determine the most reliable method for using MGMT to predict the response to adjuvant therapy in patients with glioblastoma. BACKGROUND The MGMT gene is epigenetically silenced by promoter hypermethylation in gliomas, and this modification has emerged as a relevant predictor of therapeutic response. METHODS Fifty-one cases of glioblastoma were analyzed for MGMT promoter methylation by methylation-specific PCR and pyrosequencing, gene expression by real time polymerase chain reaction, and protein expression by immunohistochemistry. RESULTS MGMT promoter methylation was found in 43.1% of glioblastoma by methylation-specific PCR and 38.8% by pyrosequencing. A low level of MGMT gene expression was correlated with positive MGMT promoter methylation (p = 0.001). However, no correlation was found between promoter methylation and MGMT protein expression (p = 0.297). The mean survival time of glioblastoma patients submitted to adjuvant therapy was significantly higher among patients with MGMT promoter methylation (log rank = 0.025 by methylation-specific PCR and 0.004 by pyrosequencing), and methylation was an independent predictive factor that was associated with improved prognosis by multivariate analysis. DISCUSSION AND CONCLUSION MGMT promoter methylation status was a more reliable predictor of susceptibility to adjuvant therapy and prognosis of glioblastoma than were MGMT protein or gene expression levels. Methylation-specific polymerase chain reaction and pyrosequencing methods were both sensitive methods for determining MGMT promoter methylation status using DNA extracted from frozen tissue.
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Affiliation(s)
- Miyuki Uno
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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19
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Uno M, Oba-Shinjo SM, Silva RD, Miura F, Clara CA, Almeida JRWD, Malheiros SMF, Bianco AM, Brandt R, Ribas GC, Feres H, Dzik C, Rosemberg S, Stavale JN, Teixeira MJ, Marie SKN. IDH1 mutations in a Brazilian series of Glioblastoma. Clinics (Sao Paulo) 2011; 66:163-5. [PMID: 21437454 PMCID: PMC3044578 DOI: 10.1590/s1807-59322011000100028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Miyuki Uno
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
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20
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Abstract
Central neurocytomas are uncommon, benign tumours of the central nervous system. These tumours have been recognised outside the limits of the cerebral ventricles and, in these instances, have been called as 'extraventricular neurocytomas'. The authors described a case of frontal neurocytoma and discuss the current knowledge on these infrequent neoplasms.
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Affiliation(s)
- Eberval G Figueiredo
- Division of Neurological Surgery, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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21
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Ferretti REDL, Jacob-Filho W, Grinberg LT, Leite REP, Farfel JM, Suemoto CK, Saldiva PHN, Rosemberg S, Pasqualucci CA, Nitrini R. Morphometric brain changes during aging: Results from a Brazilian necropsy sample. Dement Neuropsychol 2010; 4:332-337. [PMID: 29213707 PMCID: PMC5619068 DOI: 10.1590/s1980-57642010dn40400013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to establish the morphometric brain changes during aging
in a necropsy series from Brazil and determine whether sexual dimorphisms
interfere in these changes.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Division of Geriatrics, University of São Paulo Medical School, São Paulo SP, Brazil.,University of ABC
| | - Wilson Jacob-Filho
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Division of Geriatrics, University of São Paulo Medical School, São Paulo SP, Brazil.,Department of Pathology, University of São Paulo Medical School, São Paulo SP, Brazil
| | - Lea Tenenholz Grinberg
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Department of Pathology, University of São Paulo Medical School, São Paulo SP, Brazil.,Department of Neurology, University of California, San Francisco
| | - Renata Elaine Paraízo Leite
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Division of Geriatrics, University of São Paulo Medical School, São Paulo SP, Brazil
| | - José Marcelo Farfel
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Division of Geriatrics, University of São Paulo Medical School, São Paulo SP, Brazil
| | - Claudia Kimie Suemoto
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Division of Geriatrics, University of São Paulo Medical School, São Paulo SP, Brazil
| | | | - Sérgio Rosemberg
- Department of Pathology, University of São Paulo Medical School, São Paulo SP, Brazil.,São Paulo Autopsy Service
| | - Carlos Augusto Pasqualucci
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Department of Pathology, University of São Paulo Medical School, São Paulo SP, Brazil.,São Paulo Autopsy Service
| | - Ricardo Nitrini
- Brazilian Brain Bank of the Aging Brain Study Group - Laboratory of Medical Investigations 22 (LIM 22).,Department of Neurology, University of São Paulo Medical School, São Paulo SP, Brazil
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22
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Ferretti REDL, Damin AE, Brucki SMD, Morillo LS, Perroco TR, Campora F, Moreira EG, Balbino ÉS, Lima MDCDA, Battela C, Ruiz L, Grinberg LT, Farfel JM, Leite REP, Suemoto CK, Pasqualucci CA, Rosemberg S, Saldiva PHN, Jacob-Filho W, Nitrini R. Post-Mortem diagnosis of dementia by informant interview. Dement Neuropsychol 2010; 4:138-144. [PMID: 29213677 PMCID: PMC5619173 DOI: 10.1590/s1980-57642010dn40200011] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/20/2010] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. OBJECTIVES To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. METHODS A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. RESULTS Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. CONCLUSIONS The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- University of ABC
| | - Antonio Eduardo Damin
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Lilian Schafirovits Morillo
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
| | - Tibor Rilho Perroco
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Psychiatry,University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Flávia Campora
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Eliza Guccione Moreira
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Érika Silvério Balbino
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | | | - Camila Battela
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lumena Ruiz
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lea Tenenholz Grinberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- Department of Neurology, University of California, San
Francisco
| | - José Marcelo Farfel
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Renata Elaine Paraiso Leite
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Carlos Augusto Pasqualucci
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- São Paulo Autopsy Service
| | - Sérgio Rosemberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
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Teixeira MJ, Fonoff ET, Mandel M, Alves HL, Rosemberg S. Stereotactic biopsies of brain lesions. Arq Neuropsiquiatr 2010; 67:74-7. [PMID: 19330216 DOI: 10.1590/s0004-282x2009000100018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/03/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In the majority of cases, the correct treatment of brain lesions is possible only when the histopathological diagnosis is made. Several deep-seated lesions near eloquent areas are not safely approached by the classical neurosurgical procedures. These patients can get benefit by a minimally invasive procedure. METHOD We present a series of 176 consecutive patients submitted to stereotactic biopsies due to a great variety of brain lesions. RESULTS Histological diagnosis found in this series: glioma in 40.1% of the patients, other neoplasms in 12.2% and infectious or inflammatory diseases in 29.1 %. The result was inconclusive in 5.2% of the procedures. One patient died (0.6%) and two (1.2%) presented operative complications. The criteria, advantages and risks of the stereotactic biopsies are discussed. CONCLUSION The efficacy of the method is adequate and morbid-mortality rates were low.
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Affiliation(s)
- Manoel Jacobsen Teixeira
- Departamento de Neurologia, Faculdade de Medicina, Universidade Estadual de São Paulo, São Paulo, SP, Brazil
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24
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25
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Feitosa GF, Vieira RD, Moffa PJ, Amato R, Rosemberg S, Aiello VD. Case 6/2008: a 54 year-old male with hemiparesy and seizures since childhood evolving with heart failure 10 years after precordial pain and normal coronary angiography. Arq Bras Cardiol 2009; 91:399-407. [PMID: 19142367 DOI: 10.1590/s0066-782x2008001800011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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26
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Scrideli CA, Carlotti CG, Okamoto OK, Andrade VS, Cortez MAA, Motta FJN, Lucio-Eterovic AK, Neder L, Rosemberg S, Oba-Shinjo SM, Marie SKN, Tone LG. Gene expression profile analysis of primary glioblastomas and non-neoplastic brain tissue: identification of potential target genes by oligonucleotide microarray and real-time quantitative PCR. J Neurooncol 2008; 88:281-91. [PMID: 18398573 DOI: 10.1007/s11060-008-9579-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 03/26/2008] [Indexed: 12/27/2022]
Abstract
The prognosis of glioblastomas is still extremely poor and the discovery of novel molecular therapeutic targets can be important to optimize treatment strategies. Gene expression analyses comparing normal and neoplastic tissues have been used to identify genes associated with tumorigenesis and potential therapeutic targets. We have used this approach to identify differentially expressed genes between primary glioblastomas and non-neoplastic brain tissues. We selected 20 overexpressed genes related to cell cycle, cellular movement and growth, proliferation and cell-to-cell signaling and analyzed their expression levels by real time quantitative PCR in cDNA obtained from microdissected fresh tumor tissue from 20 patients with primary glioblastomas and from 10 samples of non-neoplastic white matter tissue. The gene expression levels were significantly higher in glioblastomas than in non-neoplastic white matter in 18 out of 20 genes analyzed: P < 0.00001 for CDKN2C, CKS2, EEF1A1, EMP3, PDPN, BNIP2, CA12, CD34, CDC42EP4, PPIE, SNAI2, GDF15 and MMP23b; and NFIA (P: 0.0001), GPS1 (P: 0.0003), LAMA1 (P: 0.002), STIM1 (P: 0.006), and TASP1 (P: 0.01). Five of these genes are located in contiguous loci at 1p31-36 and 2 at 17q24-25 and 8 of them encode surface membrane proteins. PDPN and CD34 protein expression were evaluated by immunohistochemistry and they showed concordance with the PCR results. The present results indicate the presence of 18 overexpressed genes in human primary glioblastomas that may play a significant role in the pathogenesis of these tumors and that deserve further functional investigation as attractive candidates for new therapeutic targets.
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Affiliation(s)
- Carlos A Scrideli
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil.
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27
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Espíndola AÁD, Matushita H, Pimenta JM, Fernandes ACDS, Rosemberg S, Reed UC. Brain tumors in the first three years of life: a review of twenty cases. Arq Neuro-Psiquiatr 2007; 65:960-4. [DOI: 10.1590/s0004-282x2007000600007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 08/23/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE AND METHOD: To review the clinical and neuropathological findings as well as the type of therapy and outcome in 20 infants under 3 years-old with central nervous system (CNS) tumor. They were treated at the Department of Neurology, "Hospital das Clínicas" University of São Paulo Medical School, from January 1997 to May 2001. RESULTS: Astrocytoma was the most common histological type (n=7), followed by ependymoma (n=3), medulloblastoma (n=2), craniopharyngioma (n=2) and desmoplastic ganglioglioma (n=2). The location of the tumor was predominantly supratentorial. Mean follow-up time was 20.2 months with recurrence in 7 cases. For each type of tumor we have emphasized the treatment currently recommended. CONCLUSION: Although follow-up time is not sufficient for analyzing survival, a trend of improvement in prognosis was noted, compared to another series of cases from our Institution that had been evaluated before 1990.
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Gasparetto EL, Leite CDC, Lucato LT, Barros CVD, Marie SKN, Santana P, Aguiar PHPD, Rosemberg S. Intracranial meningiomas: magnetic resonance imaging findings in 78 cases. Arq Neuro-Psiquiatr 2007; 65:610-4. [PMID: 17876400 DOI: 10.1590/s0004-282x2007000400012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 04/27/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To present the magnetic resonance (MR) imaging findings of 78 patients with meningiomas diagnosed in a single institution. METHOD: 78 patients with histological proven intracranial meningioma were studied. There were 52 female and 26 male patients (median=56 years). All MR imaging examinations were performed with 1.5-T MR imaging unit with standard protocol. The images were studied by two neuroradiologists, who reached the decisions regarding the findings by consensus. RESULTS: Most of the tumors showed low signal on T1- (60%) and high signl on T2- (68%) and FLAIR (69%) weighted images. Also, the lesions showed heterogeneous signal on T1 (60%), T2 (68%) and FLAIR (64%) sequences. After contrast administration, 83% (n=65) of the tumors presented acentuated and 17% (n=13) showed moderate enhancement. The tumors were located in the frontal lobe in 44% of the cases, in the parietal lobe in 35%, the occipital lobe in 19% and the temporal lobe in 12% of the patients. Areas of vasogenic edema around the tumors were seen in 90% of the cases. Twenty six per cent of the cases showed bone infiltration, and the dural tail sign was seen in 59% of the tumors. CONCLUSION: Intracranial meningiomas usually show heterogeneous low signal on T1- and high signal on T2-weighted and FLAIR images, with intense enhancement after contrast administration. The frontal and parietal lobes are commonly affected. In addition, brain edema, dural tail sign and bone infiltration are the most frequent associated findings.
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Affiliation(s)
- Emerson L Gasparetto
- Department of Radiology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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29
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Maia ACM, da Rocha AJ, da Silva CJ, Rosemberg S. Multiple cranial nerve enhancement: a new MR imaging finding in metachromatic leukodystrophy. AJNR Am J Neuroradiol 2007; 28:999. [PMID: 17569945 PMCID: PMC8134142 DOI: 10.3174/ajnr.a0526] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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30
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Gasparetto EL, Rosemberg S, Matushita H, Leite CDC. Ganglioneuroblastoma of the cerebellum: neuroimaging and pathological features of a case. Arq Neuro-Psiquiatr 2007; 65:338-40. [PMID: 17607440 DOI: 10.1590/s0004-282x2007000200029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 01/12/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To report a case of ganglioneuroblastoma of cerebellum, with emphasis to the neuroimaging and pathological findings. CASE REPORT: A one year and eight-month-old girl presented with a two-month history of hypoactivity and tremor in the legs. The MRI showed an enhancing cerebellar mass hypointense on T1 and hyperintense on T2-weighted images. The patient underwent a craniotomy with resection of the lesion. The histological and immunohistochemical studies defined the diagnosis of ganglioneuroblastoma. CONCLUSION: The MRI findings of our case showed no features which could help in the differentiation between ganglioneuroblastoma and the other common types of posterior fossa neoplasms in the pediatric population.
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Affiliation(s)
- Emerson L Gasparetto
- Department of Radiology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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31
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Takata K, Gasparetto EL, Leite CDC, Lucato LT, Reed UC, Matushita H, Aguiar PHPD, Rosemberg S. Astrocitoma subependimário de células gigantes em pacientes com esclerose tuberosa: achados em ressonância magnética de dez casos. Arq Neuro-Psiquiatr 2007; 65:313-6. [PMID: 17607434 DOI: 10.1590/s0004-282x2007000200023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 01/10/2007] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Relatar os achados de ressonância magnética (RM) em 10 casos de astrocitoma subependimário de células gigantes (ASCG) em pacientes com esclerose tuberosa (ET). MÉTODO: Foram estudados de forma retrospectiva 10 pacientes com ET e diagnóstico histológico comprovado de ASCG. Quatro pacientes eram do sexo masculino e seis do feminino, com idade média de 15,7 anos. Todos os pacientes foram investigados com RM, sendo os exames revisados por dois radiologistas, havendo decisão por consenso sobre os achados de imagem. Foram analisados os seguintes achados: localização, dimensões, intensidade de sinal em T1/T2, realce pós-contraste e outros achados associados. RESULTADOS: Todos os pacientes apresentaram lesão única sugestiva de ASCG, medindo entre 1,5 cm e 8 cm em seu maior diâmetro. Oito lesões foram encontradas junto ao forame de Monro (80%) e duas adjacentes ao corpo do ventrículo lateral (20%). Os tumores apresentavam nas imagens pesadas em T1 médio sinal (70%) e em T2 alto sinal (100%), com realce intenso após a administração do gadolínio (100%). CONCLUSÃO: Os astrocitomas subependimários de células gigantes em pacientes com ET em geral apresentam-se como lesão única próxima ao forame de Monro, com médio sinal nas imagens ponderadas em T1, alto sinal em T2 e realce intenso após a administração de contraste.
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Affiliation(s)
- Karina Takata
- Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Barbosa ER, Silveira-Moriyama L, Machado AC, Bacheschi LA, Rosemberg S, Scaff M. Wilson's disease with myoclonus and white matter lesions. Parkinsonism Relat Disord 2007; 13:185-8. [PMID: 16740400 DOI: 10.1016/j.parkreldis.2006.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 03/16/2006] [Accepted: 03/20/2006] [Indexed: 10/24/2022]
Abstract
White matter lesions (WML) and epilepsy have been occasionally seen in Wilson's disease. No cases of generalized myoclonus have been reported so far. We present a patient with psychiatric symptoms starting at age 16, followed by tremor, generalized dystonia and severe generalized myoclonus. In addition to classical findings, the MRI showed also extensive WML in temporal, parietal and frontal regions, preserving interhemispheric fibers. Necropsy revealed marked alterations of white matter, cortex and basal ganglia. We subsequently review the literature concerning WML and myoclonus in Wilson's disease.
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Affiliation(s)
- Egberto Reis Barbosa
- Department of Neurology, São Paulo University Medical School, R. Sergipe, 401-conj.311 R. 01234-001 Sao Paulo, SP, Brazil
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Abstract
Worldwide, about 40 million people are living with HIV and 50 million people have neurocysticercosis (NCC). About 5% of patients with HIV and the majority of patients with NCC develop recurrent seizures. Mechanisms of seizure production in HIV include mass lesions, meningitis, encephalitis, and ischemia. Seizures in NCC may occur at all stages of cyst development, from the vesicular and colloidal to the calcified stages. Seizures in HIV present special problems with regard to choice of antiepileptic drug (AED) and the potential for drug-drug interactions with antiretroviral (ARV) treatments. Newer AEDs with simpler pharmacokinetic profiles may be the preferred agents, particularly when protease inhibitors form part of ARV regimens. Seizures in NCC are easily controlled with the older AEDs. Although there has been some debate about the value of antiparasitic drugs in NCC, accumulating data suggest that the use of these agents in active disease decreases the risk for development of chronic epilepsy.
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Affiliation(s)
- A I Bhigjee
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, Mayville 4058, South Africa.
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34
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Grinberg LT, Ferretti REDL, Farfel JM, Leite R, Pasqualucci CA, Rosemberg S, Nitrini R, Saldiva PHN, Filho WJ. Brain bank of the Brazilian aging brain study group - a milestone reached and more than 1,600 collected brains. Cell Tissue Bank 2006; 8:151-62. [PMID: 17075689 DOI: 10.1007/s10561-006-9022-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Brain banking remains a necessity for the study of aging brain processes and related neurodegenerative diseases. In the present paper, we report the methods applied at and the first results of the Brain Bank of the Brazilian Aging Brain Study Group (BBBABSG) which has two main aims: (1) To collect a large number of brains of elderly comprising non-demented subjects and a large spectrum of pathologies related to aging brain processes, (2) To provide quality material to a multidisciplinar research network unraveling multiple aspects of aging brain processes and related neurodegenerative diseases. METHODS The subjects are selected from the Sao Paulo Autopsy Service. Brain parts are frozen and fixated. CSF, carotids, kidney, heart and blood are also collected and DNA is extracted. The neuropathological examinations are carried out based on accepted criteria, using immunohistochemistry. Functional status are assessed through a collateral source based on a clinical protocol. Protocols are approved by the local ethics committee and a written informed consent form is obtained. RESULTS During the first 21 months, 1,602 samples were collected and were classified by Clinical Dementia Rating as CDR0: 65.7%; CDR0.5:12.6%, CDR1:8.2%, CDR2:5.4%, and CDR3:8.1%. On average, the cost for the processing each case stood at 400 US dollars. To date, 14 laboratories have been benefited by the BBBABSG. CONCLUSION The high percentage of non- demented subjects and the ethnic diversity of this series may be significantly contributive toward aging brain processes and related neurodegenerative diseases understanding since BBBABSG outcomes may provide investigators the answers to some additional questions.
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Affiliation(s)
- Lea Tenenholz Grinberg
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, SP 01246-903, Brazil.
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35
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Bianco ADM, Madeira LV, Rosemberg S, Shibata MK. Cortical seeding of a craniopharyngioma after craniotomy: case report. ACTA ACUST UNITED AC 2006; 66:437-40; discussion 440. [PMID: 17015135 DOI: 10.1016/j.surneu.2005.12.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 12/29/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cortical seeding of a craniopharyngioma has been rarely reported. We present a case that ectopically recurred along the tract of a previous surgical route. METHODS A 27-year-old woman presented earlier with a suprasellar craniopharyngioma. A left frontotemporal craniotomy was done with subtotal resection of the tumor because it was strongly adhered to the optic chiasm. Histopathology confirmed the diagnosis of craniopharyngioma. Six months after, the patient presented with decreased visual acuity and diplopia. She was reoperated through the previous craniotomy with a total resection. One year after the second surgery, the patient presented with seizures that were difficult to control. Magnetic resonance imaging revealed a contrast-enhancing tumor with cystic and solid components on the left temporal lobe cortex. The primary tumor bed was intact. The patient was reoperated, and the temporal lobe tumor was totally removed. Histologic studies showed an adamantinomatous craniopharyngioma. The patient was free of neurologic abnormalities, and no new lesion was found in the magnetic resonance imaging performed 1 year after the last surgery. CONCLUSIONS Although craniopharyngiomas exhibit a benign histopathologic pattern, a total resection combined with careful inspection and irrigation of the surgical field is the optimal treatment for preventing local and ectopic recurrences. It is strongly recommended that the concerned patients have a long-term clinical and neuroimaging follow-up.
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36
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Otaduy MCG, Leite CC, Lacerda MTC, Costa MOR, Arita F, Prado E, Rosemberg S. Proton MR spectroscopy and imaging of a galactosemic patient before and after dietary treatment. AJNR Am J Neuroradiol 2006; 27:204-7. [PMID: 16418384 PMCID: PMC7976095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We describe how proton MR spectroscopy ((1)H-MR spectroscopy) was useful in elucidating the diagnosis of galactosemia in an undiagnosed 6-month-old infant. In vivo (1)H-MR spectroscopy of the brain showed a doublet at 3.7 parts per million, which was identified as galactitol (Gal-ol) by in vitro (1)H-MR spectroscopy of the urine. Galactosemia was subsequently confirmed by laboratory tests and treatment was initiated. A follow-up brain MR imaging and (1)H-MR spectroscopy study revealed resolution of white matter lesions and disappearance of Gal-ol peaks.
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Affiliation(s)
- M C G Otaduy
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo, Brazil
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37
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Nitrini R, Areza-Fegyveres R, Martins VR, Castro RMRPS, Landemberger MC, Huang N, Bacheschi LA, Bacheschi LE, Leite CC, Buchpiguel CA, Rosemberg S. Asymmetric cortical high signal on diffusion weighted-MRI in a case of Creutzfeldt-Jakob disease. Arq Neuro-Psiquiatr 2005; 63:519-22. [PMID: 16059609 DOI: 10.1590/s0004-282x2005000300028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High signal in the cerebral cortex and/or basal ganglia on diffusion-weighted magnetic resonance imaging (DW-MRI) has been described as a good diagnostic marker for sporadic Creutzfeldt-Jakob disease (sCJD). We report a case of sCJD with atypical clinical evolution and unusual DW-MRI findings. A 53-year-old man was seen with a 2-year history of a rapidly progressive dementia and cerebellar ataxia. Cerebrospinal fluid analysis, including the test for 14-3-3 protein, was normal. EEG did not show periodic activity. However, DW-MRI showed gyriform hyperintensity involving practically the entire cortical ribbon of the left hemisphere, whilst being limited to the posterior cingulate gyrus in the right hemisphere. DNA analysis showed no mutations or insertions in the prion protein gene, and homozigozity for methionine in codon 129. A subsequent brain biopsy confirmed the diagnosis of CJD. Thus, high signal on DW-MRI may be limited to the cerebral cortex and may present a very asymmetric distribution in sCJD.
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Affiliation(s)
- Ricardo Nitrini
- Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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38
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Abstract
Os objetivos deste estudo foram analisar as características epidemiológicas e clínicas de 243 crianças com hidrocefalia derivada, acompanhadas durante 1 a 27 anos, assim como identificar os fatores relacionados aos distúrbios psicomotores, epilepsia e ao óbito. A meningite pós-derivação e os distúrbios mecânicos do sistema foram as complicações mais freqüentes (22,3% e 30,7%, respectivamente). A média de derivação por paciente foi 1,47. Distúrbios motores graves ocorreram em 34,3%, déficit cognitivo em 58,5% e epilepsia em 43,6% dos pacientes. Os distúrbios motores correlacionaram-se positivamente com o grau da hidrocefalia. Houve maior incidência de déficit cognitivo e epilepsia nos casos de hidrocefalia pós-meningite. O óbito ocorreu em 52 pacientes e estes apresentaram um percentual maior de neoplasia do sistema nervoso central e de distúrbios motores na última avaliação, assim como de retirada da primeira derivação por meningite precoce, ocorrida até 2 meses após a derivação.
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Affiliation(s)
- Susana Ely Kliemann
- Departamento de Pediatria, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.
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39
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Neder L, Marie SKN, Carlotti CG, Gabbai AA, Rosemberg S, Malheiros SMF, Siqueira RP, Oba-Shinjo SM, Uno M, Aguiar PH, Miura F, Chammas R, Colli BO, Silva WA, Zago MA. Galectin-3 as an immunohistochemical tool to distinguish pilocytic astrocytomas from diffuse astrocytomas, and glioblastomas from anaplastic oligodendrogliomas. Brain Pathol 2005; 14:399-405. [PMID: 15605987 PMCID: PMC8096060 DOI: 10.1111/j.1750-3639.2004.tb00083.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The distinction of astrocytomas and oligodendrogliomas, mainly pilocytic astrocytomas (PILOs) from infiltrating astrocytomas and oligodendrogliomas (ODs), and high-grade oligodendrogliomas from glioblastomas (GBMs), poses a serious clinical problem. There is no useful immunohistochemical (IHC) marker to differentiate these gliomas, and sometimes the differential diagnosis between them is arbitrary. We identified galectin-3 (Gal-3) as a possible tool to differentiate them based on gene expression profiles of GBMs. We confirmed the differential expression in 45 surgical samples (thirteen GBMs; seven PILOs; 5 grade II ODs; 5 anaplastic oligodendrogliomas [AODs], including 2 Oligo-astrocytomas; 8 diffuse astrocytomas [ASTs], and 7 non-neoplastic samples) by quantification of Gal-3 gene expression by real-time quantitative PCR (rt-PCR). Higher expression of Gal-3 was observed in GBMs and PILOs than in OD, AODs and ASTs. The IHC expression of Gal-3 was evaluated in 90 specimens (fifteen PlLOs, fourteen ASTs, 10 anaplastic astrocytomas, fifteen GBMs, eleven ODs, fifteen AODs, and 10 dysembryoplastic neuroepithelial tumors). The mean labeling score for Gal-3 determined according to the percentage of labeled cells in the tumor bulk was significantly different in GBMs versus AODs and in PILOs versus ASTs. Hence, Gal-3 is differentially expressed in central nervous system tumors, making IHC detection of Gal-3 a useful tool in distinguishing between these gliomas.
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Affiliation(s)
- Luciano Neder
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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40
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Figueiredo EG, Gomes M, Vellutini E, Rosemberg S, Marino R. Angioleiomyoma of the cavernous sinus: case report. Neurosurgery 2005; 56:E411; discussion E411. [PMID: 15729782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Angioleiomyomas (ALMs) are relatively rare, benign, vascular soft tissue tumors that occur most frequently in the extremities of middle-aged individuals. To date, only two cases of intracranial ALMs have been described, both with little emphasis on the clinical, surgical, and radiological aspects. Neither of these reported cases of ALM involved the cavernous sinus. Furthermore, there is no previous intracranial ALM magnetic resonance imaging scan described in the literature. This report presents the first case of cavernous sinus ALM, emphasizing the clinical, radiological, and surgical aspects. CLINICAL PRESENTATION A 52-year-old man had a 2-year history of horizontal diplopia and frontal headache. Facial numbness and impaired visual acuity in the previous 6 months were also reported. Physical examination revealed paralysis of right Cranial Nerves III, IV, and VI. A decrease in optical acuity was also noted. Computed tomographic and magnetic resonance imaging scans demonstrated a mass lesion located in the right cavernous sinus, which enhanced homogeneously with administration of intravenous contrast medium. INTERVENTION A total resection was performed via a right frontotemporal craniotomy and a pretemporal approach with peeling of the middle fossa. The postoperative course was uneventful. Histological examination identified the ALM, with no recurrence noted during follow-up. CONCLUSION It is unknown why intracranial ALMs have not been reported more frequently in the literature. Although ALMs are a rare occurrence, misinterpretation of this lesion may also have contributed to the lack of reported cases. Before surgery, ALMs can be distinguished from meningiomas and schwannomas but not from hemangiomas. The prognosis of intracranial ALM is good, as suggested in this case as well as the two previously reported cases.
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Affiliation(s)
- Eberval Gadelha Figueiredo
- Division of Neurosurgery, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil.
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41
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Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Angioleiomyomas (ALMs) are relatively rare, benign, vascular soft tissue tumors that occur most frequently in the extremities of middle-aged individuals. To date, only two cases of intracranial ALMs have been described, both with little emphasis on the clinical, surgical, and radiological aspects. Neither of these reported cases of ALM involved the cavernous sinus. Furthermore, there is no previous intracranial ALM magnetic resonance imaging scan described in the literature. This report presents the first case of cavernous sinus ALM, emphasizing the clinical, radiological, and surgical aspects.
CLINICAL PRESENTATION:
A 52-year-old man had a 2-year history of horizontal diplopia and frontal headache. Facial numbness and impaired visual acuity in the previous 6 months were also reported. Physical examination revealed paralysis of right Cranial Nerves III, IV, and VI. A decrease in optical acuity was also noted. Computed tomographic and magnetic resonance imaging scans demonstrated a mass lesion located in the right cavernous sinus, which enhanced homogeneously with administration of intravenous contrast medium.
INTERVENTION:
A total resection was performed via a right frontotemporal craniotomy and a pretemporal approach with peeling of the middle fossa. The postoperative course was uneventful. Histological examination identified the ALM, with no recurrence noted during follow-up.
CONCLUSION:
It is unknown why intracranial ALMs have not been reported more frequently in the literature. Although ALMs are a rare occurrence, misinterpretation of this lesion may also have contributed to the lack of reported cases. Before surgery, ALMs can be distinguished from meningiomas and schwannomas but not from hemangiomas. The prognosis of intracranial ALM is good, as suggested in this case as well as the two previously reported cases.
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Affiliation(s)
- Eberval Gadelha Figueiredo
- Division of Neurosurgery, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil, and Barrow Neurological Institute, Phoenix, Arizona
| | - Marcos Gomes
- Division of Neurosurgery, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Sérgio Rosemberg
- Division of Pathology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raul Marino
- Division of Neurosurgery, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
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42
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Uno M, Oba-Shinjo SM, de Aguiar PH, Leite CC, Rosemberg S, Miura FK, Junior RM, Scaff M, Nagahashi Marie SK. Detection of somatic TP53 splice site mutations in diffuse astrocytomas. Cancer Lett 2004; 224:321-7. [PMID: 15914282 DOI: 10.1016/j.canlet.2004.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 10/15/2004] [Accepted: 10/18/2004] [Indexed: 11/23/2022]
Abstract
Alteration in TP53 is the most common genetic event reported for many tumors, including astrocytomas. The majority of studies, on analyzing TP53 mutations, have not included all splice junctions. Consequently, splice site mutations are thought to be relatively infrequent. TP53 were examined for mutations by polymerase chain reaction, single strand conformation polymorphism and direct sequencing in cases of diffuse astrocytomas. We found TP53 mutations in 17.8% (8 out of 45) of the tumors tested: 3 splicing, 3 missense and 2 silent mutations. We have shown that splice site mutations of TP53 are more frequent than previously reported. These findings emphasize the importance of thorough screening of TP53 mutations in gliomas.
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Affiliation(s)
- Miyuki Uno
- Department of Neurology, School of Medicine, University of São Paulo, Av. Dr Arnaldo 455, Cerqueira César, room 4110, 01246-903 São Paulo, SP, Brazil.
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43
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Nagae-Poetscher LM, Bibat G, Philippart M, Rosemberg S, Fatemi A, Lacerda MTC, Costa MOR, Kok F, Costa Leite C, Horská A, Barker PB, Naidu S. Leukoencephalopathy, cerebral calcifications, and cysts. Neurology 2004; 62:1206-9. [PMID: 15079028 DOI: 10.1212/01.wnl.0000119341.59445.cf] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe three cases of the rare syndrome of leukoencephalopathy, brain calcifications, and cysts. Conventional MRI, proton spectroscopy, and diffusion-weighted imaging yielded additional information on the disease. Imaging findings favor increased water content rather than a demyelinating process in the pathophysiology of this disease. Clinical features of Coats disease and consanguinity were also encountered.
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Affiliation(s)
- L M Nagae-Poetscher
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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44
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Radanovic M, Rosemberg S, Adas R, Miranda SC, Caramelli P, Caixeta L, Nitrini R. Frontotemporal dementia with severe thalamic involvement: a clinical and neuropathological study. Arq Neuropsiquiatr 2004; 61:930-5. [PMID: 14762593 DOI: 10.1590/s0004-282x2003000600008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Frontotemporal dementia (FTD) is the third-leading cause of cortical dementia after Alzheimer's disease and Lewy body dementia, and is characterized by a dementia where behavioral disturbances are prominent and appear early in the course of the disease. We report the case of a 58 year-old man affected by dementia with behavioral disturbances, in addition to rigid-hypokinetic and a lower motor neuron syndrome that were present at later stages of the illness. Neuroimaging studies showed frontotemporal atrophy. Neuropathological studies revealed intense thalamic neuronal loss and astrocytic gliosis, as well as moderate frontotemporal neuronal loss, astrocytosis and spongiform degeneration. Thalamic degeneration has previously been described among the wide group of neuropathological features of FTD. The aim of the present study is to show the clinical and neuropathological aspects of thalamic degeneration in FTD, along with its role in behavioral disturbances, a common finding in this condition.
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Affiliation(s)
- Márcia Radanovic
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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45
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Figueiredo EG, Matushita H, Machado AGG, Plese JPP, Rosemberg S, Marino R. Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report. Arq Neuro-Psiquiatr 2003; 61:842-7. [PMID: 14595493 DOI: 10.1590/s0004-282x2003000500025] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pilocytic astrocytoma (PA) is a benign tumor that rarely spread along the neuraxis. At the moment there are no more than five cases of leptomeningeal dissemination (LD) from PA at diagnosis described in the literature. Different patterns of presentation or recurrence may be noted: local recurrence, malignant transformation, multicentric disease or metastatic disease. LD and multicentric disease can be distinct pathological entities. We report two cases and analyse literature, emphasizing leptomeningeal spread at presentation. Hydrocephalus, biopsy and parcial ressection are likely to be favorable factors to the occurrence of LD. Otherwise, LD may be part of natural history of PA, as evidenced by its ocurrence in non-treated cases.
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Affiliation(s)
- Eberval Gadelha Figueiredo
- Neurosurgery Division, School Of Medicine, Clinics Hospital, São Paulo University, São Paulo, SP, Brazil.
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46
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Kliemann SE, Waetge RTL, Suzuki OT, Passos-Bueno MR, Rosemberg S. Evidence of neuronal migration disorders in Knobloch syndrome: clinical and molecular analysis of two novel families. Am J Med Genet A 2003; 119A:15-9. [PMID: 12707952 DOI: 10.1002/ajmg.a.20070] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Knobloch syndrome is an autosomal recessive disease characterized by the early onset of severe myopia, vitreoretinal degeneration with retinal detachment, macular abnormalities, and midline encephalocele, mainly in the occipital region. Intra and interfamilial variability is present since the encephalocele is not found in all patients, and the degree of myopia is variable. Analysis of the associated malformations suggests alterations during early neuroectodermal morphogenesis. Only 24 cases have been reported. Recently, the gene responsible for the syndrome, mapped to 21q22.3, was identified. The present study reports on four new cases, revealing the existence of neuronal migratory defects associated with the disorder for the first time.
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Affiliation(s)
- Susana E Kliemann
- Department of Pediatrics, Neuropediatrics Division, Santa Casa of São Paulo School of Medicine, São Paulo, Brazil.
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47
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Suzuki OT, Sertié AL, Der Kaloustian VM, Kok F, Carpenter M, Murray J, Czeizel AE, Kliemann SE, Rosemberg S, Monteiro M, Olsen BR, Passos-Bueno MR. Molecular analysis of collagen XVIII reveals novel mutations, presence of a third isoform, and possible genetic heterogeneity in Knobloch syndrome. Am J Hum Genet 2002; 71:1320-9. [PMID: 12415512 PMCID: PMC378571 DOI: 10.1086/344695] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2002] [Accepted: 09/09/2002] [Indexed: 11/04/2022] Open
Abstract
Knobloch syndrome (KS) is a rare disease characterized by severe ocular alterations, including vitreoretinal degeneration associated with retinal detachment and occipital scalp defect. The responsible gene, COL18A1, has been mapped to 21q22.3, and, on the basis of the analysis of one family, we have demonstrated that a mutation affecting only one of the three COL18A1 isoforms causes this phenotype. We report here the results of the screening of both the entire coding region and the exon-intron boundaries of the COL18A1 gene (which includes 43 exons), in eight unrelated patients with KS. Besides 20 polymorphic changes, we identified 6 different pathogenic changes in both alleles of five unrelated patients with KS (three compound heterozygotes and two homozygotes). All are truncating mutations leading to deficiency of one or all collagen XVIII isoforms and endostatin. We have verified that, in exon 41, the deletion c3514-3515delCT, found in three unrelated alleles, is embedded in different haplotypes, suggesting that this mutation has occurred more than once. In addition, our results provide evidence of nonallelic genetic heterogeneity in KS. We also show that the longest human isoform (NC11-728) is expressed in several tissues (including the human eye) and that lack of either the short variant or all of the collagen XVIII isoforms causes similar phenotypes but that those patients who lack all forms present more-severe ocular alterations. Despite the small sample size, we found low endostatin plasma levels in those patients with mutations leading to deficiency of all isoforms; in addition, it seems that absence of all collagen XVIII isoforms causes predisposition to epilepsy.
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Affiliation(s)
- O T Suzuki
- Departamento de Biologia, Instituto de Biociências, São Paulo, Brasil
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48
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Fujimoto Y, Matsushita H, Velasco O, Rosemberg S, Plese JP, Marino R. Craniopharyngioma involving the infrasellar region: a case report and review of the literature. Pediatr Neurosurg 2002; 37:210-6. [PMID: 12372916 DOI: 10.1159/000065396] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Craniopharyngiomas are most commonly located in the intradural suprasellar region. However, ectopic craniopharyngiomas can originate in the infrasellar region. The authors present the case of an 8-year-old boy diagnosed with a large cystic craniopharyngioma involving the nasal cavities and maxillary, ethmoid and sphenoid sinuses, in addition to the sella turcica. The primary symptoms of this patient were nasal obstruction, unilateral decreased visual acuity and exophthalmos. He subsequently underwent combined radical resection of the tumor by means of an endonasal transsphenoidal approach followed by radiation therapy. During the surgery, the dura mater of the sellar floor was found to be intact. The neuroradiological and surgical findings suggested that this tumor originated in the extradural infrasellar region and invaded the sella turcica.
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Affiliation(s)
- Yasunori Fujimoto
- Divisions of Neurosurgery and Pathology, University of São Paulo Medical School, São Paulo, Brazil.
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49
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Albano LM, Zatz M, Kim CA, Bertola D, Sugayama SM, Marques-Dias MJ, Kok F, Ferraretto I, Rosemberg S, Cocozza S, Monticelli A. Friedreich's ataxia: clinical and molecular study of 25 Brazilian cases. Rev Hosp Clin Fac Med Sao Paulo 2001; 56:143-8. [PMID: 11781594 DOI: 10.1590/s0041-87812001000500003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Friedreich's ataxia is a neurodegenerative disorder whose clinical diagnostic criteria for typical cases basically include: a) early age of onset (< 20 or 25 years), b) autosomal recessive inheritance, c) progressive ataxia of limbs and gait, and d) absence of lower limb tendon reflexes. METHODS We studied the frequency and the size of expanded GAA and their influence on neurologic findings, age at onset, and disease progression in 25 Brazilian patients with clinical diagnosis of Friedreich's ataxia - 19 typical and 6 atypical - using a long-range PCR test. RESULTS Abnormalities in cerebellar signs, in electrocardiography, and pes cavus occurred more frequently in typical cases; however, plantar response and speech were more frequently normal in this group when the both typical and atypical cases were compared. Homozygous GAA expansion repeats were detected in 17 cases (68%) - all typical cases. In 8 patients (32%) (6 atypical and 2 typical), no expansion was observed, ruling out the diagnosis of Friedreich's ataxia. In cases with GAA expansions, foot deformity, cardiac abnormalities, and some neurologic findings occurred more frequently; however, abnormalities in cranial nerves and in tomographic findings were detected less frequently than in patients without GAA expansions. DISCUSSION Molecular analysis was imperative for the diagnosis of Friedreich's ataxia, not only for typical cases but also for atypical ones. There was no genotype-phenotype correlation. Diagnosis based only on clinical findings is limited; however, it aids in better screening for suspected cases that should be tested. Evaluation for vitamin E deficiency is recommended, especially in cases without GAA expansion.
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Affiliation(s)
- L M Albano
- Genetic Unit, Infant Neurological Unit of the Children's Institute of Hospital das Clinicas, University of Sao Paulo, Brazil
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Kösel S, Grasbon-Frodl EM, Arima K, Chimelli L, Hahn M, Hashizume Y, Hulette C, Ikeda K, Jacobsen PF, Jones M, Kobayashi M, Love S, Mizutani T, Rosemberg S, Sasaki A, Smith TW, Takahashi H, Vortmeyer AO, Graeber MB. Inter-laboratory comparison of DNA preservation in archival paraffin-embedded human brain tissue from participating centres on four continents. Neurogenetics 2001; 3:163-70. [PMID: 11523568 DOI: 10.1007/s100480100114] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
DNA extracted from formalin-fixed and paraffin-embedded brain tissue is known to contain as yet ill-characterized inhibitors of the PCR process. As part of a project that aims to clarify the role of mitochondrial DNA sequence variation in human neurodegenerative diseases using DNA from various ethnic backgrounds, we have investigated factors that influence the preservation of archival DNA and its suitability for PCR. In this study, neuropathological tissue samples were analysed that had been routinely processed in 18 international centres on four continents. Following DNA extraction, PCR amplification of mitochondrial and nuclear DNA sequences was performed with and without additional purification of the template DNA. In addition, the DNA used for PCR was analysed by HPLC. Phosphate-buffered formalin proved to be a superior fixative compared with unbuffered aldehyde: DNA extraction resulted in greater yields, the molecular weight of the isolated DNA was higher and PCR was more successful. PCR inhibitors were identified as (1) high concentrations of small (<300 bp) DNA fragments that competitively compete with template DNA and (2) contaminants of the DNA template solution including denatured protein that cannot be completely removed by phenolic extraction. HPLC analysis did not reveal significant qualitative differences between DNA isolated from fresh-frozen tissue samples and DNA recovered from formalin-fixed, paraffin-embedded brain tissue. The fact that DNA could be amplified from the majority of tissue specimens in this study suggests that rare diseases and diseases where ethnic background plays an important role can be sampled for genetic polymorphism analysis on a global scale using archival neuropathological collections.
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Affiliation(s)
- S Kösel
- Department of Neuropathology, Imperial College School of Medicine, London, UK
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