Ligamentum flavum analysis in patients with lumbar discus hernia and lumbar spinal stenosis

The normal ligamentum flavum (LF) is a well-defined elastic structure with specific innervation. Several studies investigated LF in patients with lumbar spinal stenosis (LSS) and used lumbar discus hernia (LDH) patients as control group, only on the presumed thesis that LF in this patients have normal morphology. In patients with LSS thickening of the LF is the main cause of stenosis, which is most often presented with neurogenic claudication, whose pathophysiological mechanism is not completely understood. We conducted observational cohort study of 60 operated patients divided into two groups. The first group of 30 patients underwent micro-discectomy (LSH group), and second group with 30 patients underwent decompression, after which analysis of harvested LF was performed. Patients from the LDH group and LSS group differed significantly in the frequencies of chief complaints, duration of symptoms, physical examination, and specific morphological/radiological parameters. The LF analysis showed that the groups differed significantly in the amount of collagen and elastic fibers, as well as in the histological appearance/architectonics of elastic fibers. Also, groups differ in the presence of LF nerve fibers. Our findings speak in favor of the recently postulated inflammatory theory in the origin of spinal neurogenic claudication's.

Dural metastasis of prostate carcinoma misdiagnosed as a bilateral subdural hematoma: A case report

Dural metastases originating from prostate cancer are exceedingly uncommon and may clinically imitate a subdural hematoma. Additionally, head computed tomography scan findings can be mistaken for meningioma or subdural hematoma. We present a 75-year-old male patient with dural metastasis as a first presenting sign of prostate cancer, misdiagnosed as a bilateral subdural hematoma on initial non-contrast brain CT scan. Also, a review of literature is presented. We found 12 cases of dural metastasis of prostate cancer mimicking subdural hematoma described in the literature, and unlike in our case, prostate cancer was already diagnosed.

All that glitters on PET is not cancer! 18F-deoxy-glucose avidity versus tumor biology: pituitary incidentaloma in a survivor of two previous unrelated malignancies

INTRODUCTION

18F-deoxy-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) is routinely used in the detection of malignant disease based on the property of malignant cells to fuel their growth and replication by increased glucose uptake. Malignant lesions are rare in the sellar region, while pituitary adenomas are the most common pathology. These are benign neoplasms with insidious onset and low proliferation activity, and therefore are only exceptionally detected by 18F-FDG PET/CT. Studies that compare the biology of pituitary adenomas and their radiological properties using PET/CT are still lacking.

CASE REPORT

We investigate and discuss tumour biology in light of increased 18F-FDG avidity in a symptom-free, 70-year-old male patient, previously treated for two different malignancies (lung and rectal). Increased tracer accumulation in the sellar region was incidentally detected on a follow-up 18F-FDG PET/CT scan. Additional MRI disclosed pituitary adenoma. Normal hormonal status was found, consistent with the diagnosis of non-functioning pituitary adenoma. Analysis of tumour tissue after pituitary surgery confirmed a silent gonadotroph adenoma with low proliferation index. Low expression of oncogene-induced senescence markers did not support senescence as the explanation for the tumour's low proliferative activity although it was in consonance with the hormonal activity.

CONCLUSIONS

Pituitary adenomas can manifest as hypermetabolic foci on 18F-FDG PET/CT imaging with increased tracer uptake even in indolent, clinically silent pituitary adenomas with low mitotic activity. Special attention should be paid to evaluation of 18F-FDG avid pituitary adenomas in patients with multiple malignancies, bearing in mind that avidity does not always mirror its biological behaviour.

Spontaneous Intracerebral Hematoma in Low-Grade Glioma After 14 Years of Follow-Up

We are reporting the case of a 53-year old woman presenting to our hospital with a hemorrhagic low-grade glioma (LGG). She was admitted to a nearby general hospital where she had presented with aphasia, right hemiplegia and change of mental status. Computer tomography (CT) images showed a left temporo-parietal hemorrhage with mass effect. She was transferred to our hospital neuro-intensive care unit where emergency craniotomy was performed. A tumor with hematoma was removed and further histopathology analysis revealed tumor progression. We reviewed the literature reporting cases of central nervous system tumors hemorrhage and found that these types of events are exquisitely rare in adults with LGG. However these events are possible, suggesting that it should be included in the differential diagnosis of any patient presenting with intracranial hemorrhage. This case raises questions regarding the benefit of early versus late intervention for patients known to have LGG.

Comparative analysis of antioxidative systems in malignant and benign brain tumours

OBJECTIVES

Comparison of redox conditions in malignant and benign tumours is essential for understanding the role of reactive oxygen species in the pathophysiology of aggressive cancer profiles. Here we compare antioxidative systems in highly malignant brain tumour - glioblastoma multiforme (GBM), and in meningioma, a benign brain tumour.

METHODS

Tumour tissues and blood of 67 GBM patients (mean age: 52.9 ± 11.5 years) and 67 meningioma patients (59.2 ± 10.2 years), and blood of 30 control subjects (50.8 ± 12.8 years) were analysed via biochemical assays.

RESULTS

Components of glutathione system, which is responsible for H2O2 removal, showed lower activity/level in GBM: glutathione peroxidase (GBM: 9.90 ± 0.22; meningioma: 11.78 ± 0.23 U/mg of proteins; P < 0.001), glutathione reductase (GBM: 3.83 ± 0.13; meningioma: 4.67 ± 0.11 U/mg of proteins; P < 0.001), and glutathione (GBM: 6.70 ± 0.12; meningioma: 7.58 ± 0.14 μmol/g of tissue; P < 0.001). In contrast, the rank order of glutathione reductase activity and glutathione level in erythrocytes was: GBM > meningioma > control. Superoxide dismutase and catalase activities were lower in the blood of cancer patients compared to controls.

DISCUSSION

Cells of malignant brain tumour show down-regulated antioxidative system which might result in increased levels of H2O2 compared to benign tumour tissue.