Non-functional recurrent pituitary adenoma with intracranial metastasis-Pituitary carcinoma: A case report and review of the literature

INTRODUCTION

Pituitary carcinomas are rare, with only a few case reports to date. We present a null cell type non-functioning pituitary carcinoma (NFPC) with intracranial metastases and a review of the literature.

CASE REPORT

A 56-year-old male with a history of an aggressive pituitary adenoma was admitted. Initial MRI highlighted a large intracranial mass with leptomeningeal involvement, simulating meningioma. Based on his previous pathology report of the sellar mass, a diagnosis of null cell type non-functioning pituitary carcinoma has been made.

CONCLUSIONS

An aggressive recurrent pituitary tumor with suprasellar and/or cavernous sinus invasion is the main characteristics of the NFPC. Single or multiple enhancing dural-based mass(es) mimicking meningioma is the most common MRI finding. The proof of malignancy is the same histopathological features of the recurrent aggressive pituitary tumor in the metastases. The histology alone is not distinctive in terms of malignancy. Most patients require a combined surgery, radiotherapy and chemotherapy.

Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Evaluation of auditory functions in patients with asthma

OBJECTIVE

The objective of this study is to evaluate the auditory functions in chronic asthma patients with the use of pure tone high frequency audiometry.

PATIENTS AND METHODS

Twenty-two healthy controls and 42 adult patients were included as a prospective, randomized, and controlled study. Pulmonary function tests and blood gas studies were completed on all subjects. Asthma patients have divided into two groups [Group A: Arterial oxygen tension (PaO2) > 75 mmHg, Group B: PaO2 ≤ 75 mmHg, Group C: Control group). Acoustic assessments of patients were performed in 250-20,000 Hz by using pure-tone audiometry (PTA) and tympanometry.

RESULTS

The mean value of air and bone conduction hearing threshold levels were in normal range for all groups. All patients had normal peripheral hearing all threshold levels across 250 Hz to 3000 Hz in the both ears. Significant differences were observed between the chronic asthma patients and control group for the extended high frequencies (10,000-20,000 Hz). Group B had statistically more significant increased hearing threshold levels than Group A in frequencies higher than 10,000 Hz. There were no statistical differences between the hearing threshold levels and FEV1, FVC, FEV1/FVC and tympanogram results in the groups.

CONCLUSIONS

This is the first study of evaluating the auditory functions in asthma patients. Sensorineural hearing loss in high frequencies (10,000 Hz-20,000 Hz) is common in chronic asthma and is probably present more often than were formerly thought.

Long-term follow-up of chronic obstructive pulmonary disease patients on long-term oxygen treatment

AIMS

Few studies exist on influence of long-term oxygen treatment (LTOT) on survival of chronic obstructive pulmonary disease (COPD) patients. This study was designed to determine whether LTOT improves survival or not in severely hypoxaemic COPD patients.

MATERIALS

COPD patients prescribed oxygen concentrator were consecutively included. Patients' baseline characteristics were noted. During follow-up, patients were divided into three groups according to LTOT utilisation: (i) non-utilisers, (ii) intermittent utilisers (< 15 h/day) and (iii) true utilisers (≥ 15 h/day). Patients' status (live or death) and, if died, the date of death were checked throughout the study. The factors which might influence mortality during 5-year period were analysed.

RESULTS

Two-hundred and twenty-eight patients completed the study. Of these patients, 55 were in Group 1, 112 were in Group 2 and 61 were in Group 3. Regarding the initial characteristics, there was not any significant difference between groups. Mean follow-up for whole group was 27.8 ± 18.5 months. Median survivals were similar between groups (19.5 ± 5.6, 32.5 ± 4.1 and 30.0 ± 5.7 months respectively) (p > 0.05). Compared with Group 1, survival was improved in Group 2 (p < 0.05) and there was a positive trend for Group 3 during first 2-year period. However, this improvement disappeared during further follow-up. Analysis of multiple factors which might influence mortality during 5-year period did not yield statistically significant parameter.

DISCUSSION AND CONCLUSION

We found that, regarding survival, any kind of LTOT proved to be beneficial over no LTOT only in the first 2 years of follow-up, and that there was not any difference between intermittent and true LTOT utilisation.

Gamma knife radiosurgery in non small cell lung cancer patients with brain metastases: treatment results and prognostic factors

PURPOSE

To evaluate the efficacy of gamma knife radiosurgery (GKRS) for the treatment of brain metastases from non small cell lung cancer (NSCLC) and find out the prognostic factors for overall survival.

METHODS

Between February 1997 and August 2003 100 patients underwent treatment for 184 brain metastases from NSCLC, either for recurrence (n=49) or with a new diagnosis (n=51). Median age was 55 years and 77 patients were male. Seventy-eight of the patients received whole brain radiotherapy (WBRT) prior to or after GKRS and 26 patients had surgical removal of the metastasis. Imaging and clinical status were monitored every 3 months following treatment. Kaplan-Meier survival curves, Cox proportional hazards regression for risk factor analysis were used.

RESULTS

The median follow up after the procedure was 8 months and after the diagnosis 11 months. The median overall survival for all patients was 9 months from the date of GKRS and 14 months from the diagnosis of brain metastasis. Local tumor control was achieved in 95% of the lesions. In multivariate analysis, adenocarcinoma histology, Karnofsky performance status (KPS) score > 80, 1-3 metastases and tumor diameter <2 cm were related to longer survival. Addition of WBRT did not have any effect on overall survival.

CONCLUSION

Gamma knife surgery appears to be effective in treating patients with brain metastases from NSCLC, either alone or with WBRT in selected groups of patients.

Efficacy of Gamma-Knife Surgery for Treating Meningiomas that Involve the Superior Sagittal Sinus

BACKGROUND

Meningiomas involving the superior sagittal sinus (SSS) are among the most challenging tumors to treat. Authors of some recent series have advocated total removal with SSS reconstruction. However gamma-knife surgery is a reasonable choice for these tumors.

PATIENTS

This study focused on 43 cases of meningioma invading the SSS that were treated with gamma-knife therapy. Twenty-eight patients had undergone previous resection. The follow-up period after radiosurgery ranged from 24 to 86 months (median, 46 months). The median marginal dose was 15 Gy.

RESULTS

During follow-up, 22 (51%) tumors decreased in size, 16 (37%) remained unchanged, and 5 (12%) expanded. The overall rate of tumor control with radiosurgery was 89%.

CONCLUSION

When a small meningioma involves the SSS and the sinus is patent, the first-line treatment should be radiosurgery. If the tumor is large and the sinus is patent, we recommend gross total resection with no removal of SSS. If postoperative or follow-up MR imaging demonstrates residual tumor or recurrence, gamma-knife surgery should be performed. If a large meningioma has completely obliterated the SSS, our policy is to remove the tumor and all sinus tissue without reconstructing the SSS.

Biventricular involvement in a Turkish boy with palmoplantar hyperkeratosis and curly hair, an unusual presentation of Naxos-Carvajal syndrome

Naxos disease is an autosomal recessively inherited familial syndrome characterized by woolly hair, palmoplantar keratoderma and a cell adhesion cardiomyopathy, especially arrhythmogenic right ventricular dysplasia (ARVD). Carvajal syndrome is a variant of Naxos disease in which curly or woolly hair, biventricular--predominantly left ventricular involvement were seen. Mutations in genes encoding the cell adhesion proteins like plakoglobin and desmoplakin were related with these syndromes. We report a 17-year-old boy and his family findings with curly hair, palmoplantar hyperkeratosis, ARVD and left ventricular involvement. The family was of Arabic origin, and a third-degree consanguinity was reported between the parents. They are from east part of Turkey and there were no relatives from Cyclades Island (Greece). Patient's younger brother had ARVD without cutaneous manifestations of the syndrome and his grand father had mild ARVD, curly hair and palmoplantar hyperkeratosis.

Relation between proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome

OBJECTIVE

To investigate the relation between serum high sensitivity (hs) C reactive protein (CRP), proinflammatory cytokine concentrations, proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome (NSTEACS).

DESIGN

Prospective follow-up study for the first six months and then for the first year after admission to hospital.

SETTING

Tertiary referral centre.

PATIENTS

80 patients (60 men, 20 women, mean age 60 (SD 10) years) with NSTEACS and moderate to high TIMI (Thrombolysis In Myocardial Infarction) risk scores.

INTERVENTIONS

Blood samples from patients with NSTEACS were obtained at the time of admission. Serum concentrations of hs-CRP, (hs) pro-inflammatory (interleukin (IL) -1beta, IL-6, tumour necrosis factor alpha) and (hs) anti-inflammatory (IL-10) cytokines were analysed and proinflammatory to anti-inflammatory cytokine ratios were calculated by dividing proinflammatory cytokine concentrations by anti-inflammatory cytokine IL-10.

MAIN OUTCOME MEASURE

The primary end point of the study was new coronary events (NCE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalisation within 12 months of follow up.

RESULTS

During the one-year follow-up period, 23 patients (29%) met the NCE criteria. Concentrations of hs-CRP, IL-1beta and IL-6 and ratios of IL-1beta:IL-10 and IL-6:IL-10 were significantly higher in patients with NCE than in patients without NCE. In the logistic regression analysis, IL-6:IL-10 ratio was the most important predictor for NCE (p = 0.006) with an odds ratio of 2.24 (95% CI 1.26 to 3.97).

CONCLUSIONS

Cytokine concentrations and proinflammatory to anti-inflammatory cytokine ratios may be useful markers for predicting vascular risk in patients with NSTEACS.

Outcome determinants of pterional surgery for tuberculum sellae meningiomas

BACKGROUND

Current literature on tuberculum sellae meningiomas is very heterogenous due to wide variation in nomenclature, diagnostic and operative techniques. The aim of this study is specifically to analyze the results of pterional craniotomy for tuberculum sellae meningiomas. A homogenous cohort of 42 consecutively operated tuberculum sellae meningioma cases are reviewed with special emphasis on the effects of pterional microsurgery on visual outcome.

METHODS

This is a retrospective clinical analysis. 42 consecutive patients operated upon during the period of 15 years in a single institution using standard imaging protocols and pterional microsurgery are presented and effect of various variables on visual outcome analysed.

FINDINGS

81% of the patients presented with visual symptoms. The mean duration of symptoms was 12 months. Tumour volumes ranged from 7.5 to 210 mm(3). A right sided pterional microsurgery was used in all patients. Complete resection rate was 81%. Vision improved in 58%, worsened in 14%. Non-visual morbidity was 7.1% and mortality was 2.4%. The follow up period of patients ranged from 3 to 192 months (median: 30 months). The mean was 37.5 months (SD = +/-36.7 months) and a recurrence rate of 2.4% was observed.

CONCLUSIONS

A standard pterional craniotomy using microsurgical technique provides the necessary exposure enabling total removal while keeping the complications to a minimum. Upon analysis of our findings we found that patient age of more than 60, duration of visual symptoms longer than 1 year, severe visual symptomatology, predominantly vertical growth, presence of significant peri-tumoural oedema, absence of an intact arachnoid plane and subtotal removal were correlated with a dismal visual outcome.

Intracranial inhibition of platelet-derived growth factor-mediated glioblastoma cell growth by an orally active kinase inhibitor of the 2-phenylaminopyrimidine class

Glioblastoma multiforme is the most common primary human brain tumor, and it is, for all practical purposes, incurable in adult patients. The high mortality rates reflect the fact that glioblastomas are resistant to adjuvant therapies (radiation and chemicals), the mode of action of which is cytotoxic. We show here that an p.o.-active small molecule kinase inhibitor of the 2-phenylaminopyrimidine class may have therapeutic potential for glioblastomas. STI571 inhibits the growth of U343 and U87 human glioblastoma cells that have been injected into the brains of nude mice, but it does not inhibit intracranial growth of ras-transformed cells. Studies on a broad panel of genetically validated human and animal cell lines show that STI571 acts by disruption of the ligand:receptor autocrine loops for platelet-derived growth factor that are a pervasive feature of malignant astrocytoma. The cellular response of glioblastoma cells to STI571 does not appear to involve an apoptotic mechanism.