A rare case of lumbosacral meningioma: nondural attachment and possible enlargement by orally administered sex steroid

STUDY DESIGN

A case report is presented.

OBJECTIVES

To present a very rare case of orally ingested sex hormone pills inducing nondurally attached meningioma in the lumbosacral region.

SUMMARY OF BACKGROUND DATA

Meningiomas are known to enlarge in response to female sex hormones. At this writing, few cases of nondurally based intradural meningioma have been reported. Moreover, meningiomas in the lumbosacral region are very rare. Spinal meningiomas predominantly arise in the fourth to sixth decades of life and are more common in women.

METHODS

The patient was a 20-year-old woman. She had undergone oral sex steroid therapy for long-term oligomenorrhea. The patient complained of intolerable lumbago and numbness in her buttocks. Nonopioid analgesics did not relieve her pain, and she was unable to walk without the aid of a walker. Radiography disclosed a lumbosacral intradural tumor.

RESULTS

Complete removal of the tumor was performed. The tumor was not adherent to the dura, and its appearance was that of a typical neurilemmoma. However, the pathologic diagnosis was meningioma.

CONCLUSIONS

The tumor in the reported case may have enlarged in response to orally ingested sex steroid pills. Nondural attachment intradural meningiomas are quite uncommon. The gross appearance of the tumor during surgery was typical of neurilemmoma. All the cases reported so far, including the current case, have involved tumor located in the lumbosacral region. Care must be taken in the management of lumbosacral intradural tumors because tumors resembling neurilemmoma may in fact represent meningioma, some subtypes of which possess a high rate of recurrence.

Surgical treatment of the rheumatoid cervical spine in patients aged 70 years or older

OBJECTIVE

To investigate whether surgery is appropriate for elderly rheumatoid arthritis patients who are already approaching their statistical life expectancy.

PATIENTS AND METHODS

The subjects were 10 patients who underwent cervical spine surgery for rheumatoid arthritis at an age of over 70 yr. The pain grade and neurological deficit class according to Ranawat, peri-operative complications, causes of death and pre-operative cardiopulmonary function were assessed.

RESULTS

Good pain relief was achieved. Relief of pain enabled the patients, who could not sit up even in bed because of intolerable neck pain, to ride in a wheel chair without using a neck collar. Only one death was related to surgery. Pre-operative cardiopulmonary function was not significantly different compared with that of elderly patients undergoing other surgical procedures.

CONCLUSION

Surgery is a valuable option for the management of elderly patients with rheumatoid cervical spine since it can improve the quality of life.

[Radiosensitization of mouse intestinal epithelial cells with BudR]

For the radiosensitization of the repair rich epithelial cells of small intestine, BudR (B.U.) was continuously infused into mice. Its uptake into the DNA, as shown by the substitution rate (S.R.) of thymine to B.U., was dose-dependent in low dose, but above the 4 mg/d/head it did not increased. The radiosensitization effect was assayed by the clonogenecity of the cells, and (1) the repair capacity (recovery factor, RF.) of the cells and (2) the isoeffect dose (I.D) were obtained. From these data, their enhancement ratios (E.R) were estimated. E.R. by R.F. increased remarkably both in low dose and in low S.R., but showed the plateau at about 10 level after 4 mg/d/h of dose or 10% of S.R. Whereas E.R. by I.D. increased linearly in dose or it did quadratically in S.R. From these results, it was discussed that radiosensitization by debromozation of B.U. was seen in low dose, and the direct cytocidal effect of B.U. became dominant with the dose-increase. Also the clinical application of B.U. was discussed in cell kinetical aspect of B.U. labelling as well as the progress of infusion techniques.

[Cellular thermosensitivity]

(1) modes of expression of thermosensitivity and theoretical interpretation of thermal dose, (2) differential thermosensitivities between strains of cells and the possible correlation to heat shock proteins and their syntheses, (3) cell phase responses to hyperthermia, (4) low hyperthermia and the induction of thermotolerance, (5) comparative thermosensitivities at the temperatures between below and above 42.5 degrees C -43 degrees C, (6) Arrhenius plot and mean cellular lethal heating periods, (7) step-up heating and the thermotolerance induction, (8) step-down heating and the thermoenhancement, (9) fractionated high hyperthermia and the thermotolerance induction and (10) modification of thermosensitivity by chemical substance including anticancer drugs; are compactly reviewed mainly on cell level.

[Segmental (L4-S1) motor and sensory innervation of the lower extremity determined by electrical potentials]

Reliable knowledge of the segmental innervation of the muscles and skin of the lower extremity is required to evaluate the anatomical localization of the lumbosacral nerve root involvement. There exist a number of reports on the segmental innervation of the muscles and the area of skin supplied by the lumbosacral plexus. However, no universal acceptance on the lumbosacral nerve root innervation exists. In order to confirm the reliability of the information on myotomes and dermatomes that has been reported, muscle action potentials were recorded from 11 lower limb muscles of 10 subjects by electrical stimulation of the L4, L5 and S1 nerve roots. Sensory nerve potentials were also recorded from roots by stimulations of the sural nerve, superficial and deep peroneal nerve, and the 1st toe of 8 subjects. Under an image intensifier, the electrodes were inserted near the nerve root in the intervertebral foramen or the first sacral foramen. The medial and lateral head of gastrocnemius and the soleus were confirmed to be S1 innervation, but tibialis anterior had a dual innervation at L4 and L5. Extensor hallucis longus, extensor digitorum longus and brevis, and peroneus longus were supplied predominantly by L5. Abductor hallucis and the long head of biceps femoris were supplied by S1, and rectus femoris was supplied by the L4 root. The sural nerve and superficial peroneal nerve were supplied by S1 and L5 nerve root, respectively. The deep peroneal nerve was supplied by either L4 or L5. The 1st toe was supplied by L5.

Sensitivities of bleomycin-resistant variant cells enhanced by 40 degrees C hyperthermia in vitro

Cultured mammalian cells of higher (mouse L) and lower (Chinese hamster V-79) sensitivities to bleomycin (BLM) were repeatedly treated with BLM (0.1 mg/ml), through which BLM-resistant variant strains were induced. Sensitivities of these variant strains to BLM were enhanced by simultaneous treatment with 40 degrees C hyperthermia.

Demonstration of expanding cell populations in mouse pancreatic acini and islets

The acinar and islet cells of the adult mouse pancreas were examined by radioautography after continuous infusion of 3H-thymidine, for periods varying from 1 to 60 days, to determine whether they behaved like renewing or expanding cell populations. The labeling of both cell types increased with the duration of the continuous infusion and reached 2.22% and 12.0%, respectively, after 60 days. The rate of acinar and islet cell labeling was estimated from the regression line of the labeling index versus time and given as 0.039% and 0.20% cells per day, respectively. The rate of cell labeling was relatively low in these acinar and islet cells in comparison to the relatively high rate in duct cells. Occasionally, acinar cell labeling was not uniform, showing high labeling in the outer peripheral region of a lobe and at the periphery of the islets. Both acinar and islet cells increased in number in the adult, and at a rate indicating they are expanding cell populations. Their doubling times were estimated as 2,564 days (7.0 years) and 500 days (1.3 years), respectively. Duct epithelial cell populations were dividing at a rate indicating that they are renewing cell populations.

Device of anoxic chamber system and repair of potentially lethal damage of anoxic cells in vitro

In order to study radiation responses of anoxic plateau phase cells in vitro, an air-tight anoxic chamber was devised in which Chinese hamster V-79 or Swiss mouse NIH3T3 cells were deoxygenated by replacing the air with saturatedly humidified N2 gas. The cells as adhered on the culture plate, which was contained in the anoxic chamber, were x-irradiated. The deoxygenated condition in the anoxic chamber was maintained as long as necessary. Oxygen enhancement ratio obtained by the anoxic chamber was about 2.6. Repair of potentially lethal damage of the anoxic plateau phase cells was observed to the same extent of that of the oxic cells.

Dynamic features of duct epithelial cells in the mouse pancreas as shown by radioautography following continuous 3H-thymidine infusion

The possibility of turnover of the epithelial duct cells was examined in the adult mouse pancreas by radioautography following continuous administration of 3H-thymidine for periods varying from 1 h to 60 days. One hour after an injection of 3H-thymidine, the label observed in small and large ducts was low but increased with the duration of the continuous infusion of 3H-thymidine and reached a level of about 67% cells labeled after 60 days. The rate of duct cell labeling was estimated from the regression line of the labeling index vs. time in four types of ducts classified according to their inner diameter and the presence of the adventitia and was given as 0.60% cells per day in small (adventitia-free) ducts (phi 4-12 micron), 0.89%, 1.02%, and 1.23% cells per day in large (adventitia-including) ducts (phi 15-29, 30-49, and 50-160 micron respectively). In contrast, the labeling index of aciner cells after a 60-day infusion indicated an addition of only 0.02-0.07% per day, and that of islet cells 0.14-0.22% per day. It is known that most parenchymal cells belong to either expanding or renewing cell populations. The acinar cells of the pancreas have been shown to constitute an expanding population, a conclusion confirmed by the low addition of cells observed in the present work. However, the relatively high rate of cell addition in the duct epithelia indicates that they may turn over in a period of 2.7 months in the case of large ducts and 5.6 months in the case of small ducts.(ABSTRACT TRUNCATED AT 250 WORDS)

Recruitment of cells in the small intestine into rapid cell cycle by small doses of external gamma or internal beta-radiation

Epithelial cell recruitment was examined in mouse ileum after external gamma-irradiation (50 cGy) or internal beta-irradiation (0.148 MBq/g of [3H]thymidine), using the per cent-labelled-mitoses method and by analysing the distribution of mitotic cells in the crypts. In the presumptive stem cell zone at the lower cell positions of the crypt, the slowly cycling cells decreased their cell cycle 6 or 12 hours after a dose of 50 cGy. In the higher cell positions, a slight shortening of the cell cycle was also observed. After administration of a high dose of [3H]thymidine, dormant (G0) cells also entered the cell cycle in the lower cell positions. The results suggest that stem cells in the crypt may react to irradiation in two ways: first, by shortening the cell cycle in cycling cells; secondly, by an entry into the cell cycle by other dormant cells. There was destruction of some cycling stem cells before any recruitment. The data support the idea that the stem cell population in the crypt is heterogeneous.

The recruitability and cell-cycle state of intestinal stem cells

Evidence is presented which suggests that the crypts of the small intestine contain at least two discrete but interdependent classes of stem cells, some with discrete cell kinetic properties and some with discrete radiation responses or radiosensitivities. Very low doses of X rays or gamma rays, or neutrons, kill a few cells in the stem cell regions of the crypt in a sensitive dose-dependent manner. Similar doses generate several different cell kinetic responses within either the clonogenic fraction or the cells at the stem cell position within the crypt. The cell kinetic responses range from apparent recruitment of G0 clonogenic cells into cycle, to a marked shortening of the average cell cycle of the cells at the stem cell position. It is suggested that the cell kinetic changes may be the consequence of the cell destruction.

Mixed mesodermal tumor of the ovary with carcinoembryonic antigen and alkaline phosphatase production. Histochemical, autoradiographic, and electron microscopic studies of heterotransplanted tumors in athymic nude mice

A mixed mesodermal tumor of the ovary with carcinoembryonic antigen (CEA) and alkaline phosphatase (ALP) production was serially heterotransplanted into nude mice. The original tumor was diagnosed as homologous tumor, with sarcomatous component consisting of nonspecific spindle-shaped cells. These features were basically retained in the transplanted tumors, including CEA and ALP production. But, heterologous, chondrocytic-differentiated foci were found in the tumors at the third and sixth passages. Transitional-type cells from sarcomatous to carcinomatous cells were sometimes found in the transplanted tumors by light and electron microscopy. Ciliated sarcomatous cells, which may also represent the epithelial differentiation of sarcomatous cells, were found in the tumors at first passage. The current results support the combination tumor theory, which means that both the carcinomatous and sarcomatous components are of common stem cell origin.

Theoretical implications for cell migration through the crypt and the villus of labelling studies conducted at each position within the crypt

The migration and turnover of epithelial cells was examined in the crypt and villus of the mouse jejunum using 1-micron plastic and 6-microns paraffin sections both with or without [3H]thymidine radioautography. The mean diameter of columnar cells was constant at 13.8 microns throughout the crypt, whereas it gradually increased from 16.8 microns in the lower villus to 25.4 microns in the upper villus. The cell cycle time (Tc) and the duration of DNA synthesis (ts) obtained by plotting labelled mitoses against time after [3H]thymidine injection, were 13.4 and 7.5 hr respectively. The labelling index (LI) at the various cell positions in the crypt, of mean length 27.5 cells, averaged 28.6% with a peak of above 55% in positions 7 to 11. The migration velocity of cells in the villus epithelium was estimated from the leading labelled cells at 2.04 cell/hr. The fraction of epithelial cells present in crypt and villus was 0.44 and 0.56 respectively. The migration velocity in the crypt (expressed as cell positions entered per hour), calculated from a cumulative cell production rate (LI/ts) in each cell position, increased in the lower and middle crypt (that is, in the proliferative zone, cell positions 1-18), but remains constant at a level of 1.0 in the upper crypt in the non-proliferative zone (cell positions 19-28). Therefore the migration velocity increases from 1.05 cell/hr in the upper crypt to 2.04 at the base of villus. Accordingly the velocity (expressed as distance traversed per hour) also shifts from 13.8 microns in the upper crypt to 34.2 microns in the base of villus and further increases to 51.8 microns in the upper villus because of continuous enlargement of the cells. The transit times of epithelial cells through the non-proliferative upper crypt (above ten cell positions) and the villus (67.9 cell positions on the average) are 8.4 and 33.4 hr respectively. The turnover times of crypt, villus, and whole epithelium are estimated at 26.5, 33.4, and 59.6 hr respectively.

A new plateau in the dose-survival-time response of the golden hamster (Mesocricetus auratus) from whole body irradiation

The survival time of golden hamsters (Mesocricetus auratus) after whole-body 60Co-gamma-irradiation in the range of 600 to 200 000 rad was investigated. The two plateaus of the dose-survival curve which correspond to bone marrow and gastrointestinal death are similar to those of other species such as mice, rats and mongolian gerbils. A new plateau occurring 40-57 hours after doses of 30 000 to 60 000 rad, where there is a little reduction in survival time, has been found. It is in addition to the well recognized central nevous system (CNS) syndrome. This plateau is observed only in golden hamsters, presumably because of their relatively high resistence to CNS syndrome. Experiments involved partial body irradiation of the animals indicate that the target is in the cephalic one-third of abdomen. The new segment may well indicate a new type of acute somatic radiation injury different from the well known bone marrow, gastrointestinal and CNS syndromes.

Radiation-induced acute necrosis of the pancreatic islet and the diabetic syndrome in th golden hamster (Mesocricetus auratus)

Exposure of golden hamsters to 35 000 rad of X-rays induced acute and specific necrosis of the cells of thd isles of Longerham of the pancreas within 4 hours whereas no other tissue revealed any drastic changes which would lead to a critical illness until 36 hours. Animals began to show the characteristic signs of diabetes, that is, hyperglycaemia, hyperkaliemia, ketonemia, and acidosis at 12 hours and these continued until death, 56+/- 8 hours later. These were accompanied by the disappearance of beta-cell granules and a decrease of plasma insulin. Treatment of irradiated animals with injections of insulin resulted in a reduction in high blood glucose and the prolongation of survival time up to 5 days, which is comparable to this radiation-induced diabetic syndrome resulted from acute necrosis of the cell of the islets of Langerhans, a previously unreported lethal effect of radiation in golden hamsters.

Kinetic analysis of epithelial cell migration in the mouse descending colon

The kinetics of epithelial cell replacement in the descending colon of the mouse were studied using cell counts and other measurements in mice given a single injection of 3H-thymidine at 10:00 a.m. Cell migration occurs from the base of the crypts in the direction of the colonic lumen. The mean turnover time of epithelial cells as measured after the single injection of 3H-thymidine has been estimated at 4.85 days. Since this figure is in agreement with published data based on continuous infusion of the labeled precursor, it is concluded that the time selected for the analysis provides an index of proliferation which is representative of the mean proliferative activity of the epithelium. If each side of a crypt cut along its axis is referred to as a "crypt column," the mean number of cells per crypt column has been found to be 32.9; after a one-hour pulse labeling starting at 10:00 a.m., the mean number of labeled cells per column was 2.8; and the overall labeling index of the epithelium, 8.6%. The frequency of labeled cells in each cell position along the crypt column varies according to a Poisson distribution with a peak close to position 3. Presumably then, cell proliferation is taking place in a random manner and is, therefore, asynchronous, despite evidence to the contrary in the literature. The kinetic analysis supports the view that cell migration occurs along the crypt column in the direction of the colonic lumen at a velocity averaging 0.28 cell position per hour, or 4.48 microns per hour. The results support the view that vacuolated-columnar, mucous, and caveolated cells migrate jointly; whereas entero-endocrine cells migrate separately from these cell lines, except during the initial stages of the migration.

Migration and turnover of entero-endocrine and caveolated cells in the epithelium of the descending colon, as shown by radioautography after continuous infusion of 3H-thymidine into mice

Adult male mice were given a continuous infusion of about 0.5 muCi of 3H-thymidine per gram body weight per day for periods varying from 1 to 60 days. Semithin sections of descending colon were cut from/plastic-embedded blocks and stained by a method combining silver impregnation and iron hematoxylin, by which argentaffin entero-endocrine cells and caveolated cells could be identified. From radioautographs, the labeling index of these cells was determined. One to three days after the beginning of 3H-thymidine infusion, label is observed in some of the stained entero-endocrine cells in the bottom of the crypts; the apices of these cells reach the crypt lumen and are joined to neighboring cells by terminal bars (junctional complexes). After five to seven days, labeled entero-endocrine cells are seen on the sides of the crypts, where their base stretches along the basement membrane and their apex has lost its terminal bar connections to neighboring cells. Finally, by 13 and 24 days, labeled cells are observed within the epithelium at the mucosal surface. The turnover time, which is taken to be equal to the mean time required for migration from site of origin to site of loss on the mucosal surface, has been estimated at 23.3 days. This is much longer than the 4.6 days required by the two main cell types of the epithelium -- vacuolated-columnar and mucous cells -- to travel the same route. It is likely that, after entero-endocrine cells lose their terminal bar attachment to other epithelial cells, they migrate independently and very slowly. Labeled caveolated cells are first seen in the crypt bottom one day after the beginning of 3H-thymidine infusion. By three to five days, they are on the sides of the crypts; their base is stretched along the basement membrane, but their apex retains its attachment to neighboring cells by terminal bars. By seven days, labeled caveolated cells are on the mucosal surface. Their turnover time has been assessed at 8.2 days. This is, again, longer than for the two main types to which they are bound by terminal bars throughout migration. The discrepancy is explained by the caveolated cells arising deeper in the crypts than most vacuolated-columnar and mucous cells.