FDG-PET to predict different patterns of progression in multicentric glioblastoma: a case report

True multicentric glioblastoma multiforme (GBM) is rare and consists of separate distinct tumors in different cerebral lobes or hemispheres without any apparent route of dissemination. Few data are available describing its imaging using positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D: -glucose (FDG). In this paper, we report on the case of a man with bifocal tumor in the right frontal and temporal lobes who underwent FDG-PET imaging. Visual and semiquantitative analysis showed two different metabolic patterns with much more intense uptake in the smaller temporal lesion. Subtotal surgical removal of the main frontal lesion allowed satisfactory control in the operative site, whereas the temporal lesion was rapidly progressive with occurrence of necrosis, which led to a second neurosurgery. The diagnosis of glioblastoma was confirmed by neuropathological examination in both cases but with much higher immunohistochemical expression of O(6)-methylguanine-DNA-methyltransferase (MGMT) in the temporal lesion. This report illustrates the potential interest of FDG-PET in multicentric GBMs to identify different metabolic patterns, in accordance with clinical, morphological, and molecular aggressiveness.     

MR扩散张量成像对鼻咽癌放疗后早期放射性脑损伤的诊断价值

背景与目的:MR扩散张量成像(diffusiontensorimaging,DTI)是磁共振成像的一个新技术,能在分子水平上无创性地研究组织中水分子的扩散现象,本文旨在用DTI定量分析鼻咽癌放疗后常规MR表现正常者双侧颞叶脑白质区域的水分子扩散特性,探讨DTI在放射性脑损伤诊断中的应用价值。方法:13例鼻咽癌放疗后常规MR表现正常者和21例健康正常人均作DTI,在双侧颞叶脑白质区域测量各向同性显著扩散系数(isotropicapparentdiffusioncoefficient,ADCiso)值和各向异性指数值。结果:(1)鼻咽癌放疗组ADCiso犤(631.30±27.83)×10-6mm2/s犦与正常对照组ADCiso犤(651.76±39.10)×10-6mm2/s)犦之间无显著性差异(P>0.05);(2)鼻咽癌放疗组各向异性指数值均下降,分别为:FA(fractionalanisotropy)值=0.405,RA(relativeanisotropy)值=0.355,1-VR(1minusvolumeratio)值=0.192,与正常对照组对应的各向异性指数值(FA值=0.463,RA值=0.418,1-VR值=0.257)比较,有显著性差异(P<0.01)。结论:MR检查中用各向异性指数值能更好地描述水分子的扩散特性,在评价鼻咽癌放疗后双侧颞叶的白质改变方面比ADCiso更敏感。     

Primary Leptomeningeal Sarcomatosis; A Pathology Proven Case with Challenging MRI and Clinical Findings

A 20-year-old male patient admitted with intractable seizures and progressive dementia is presented. Magnetic resonance imaging (MRI) examinations revealed diffuse leptomeningeal thickening, enhancement especially in the basal cisterns and multiple cystic formations in the brain stem, temporal lobes and basal ganglia. The pathologic examination from the right temporal lobe was consistent with leptomeningeal sarcoma. Marked regression of the symptoms and MRI lesions were detected following radiotherapy.     

Infiltrating intramuscular lipoma of the temporal muscle. A case report with molecular cytogenetic analysis

Intramuscular lipomas are uncommon benign mesenchymal tumors which infiltrate skeletal muscle and are exceedingly rare in the head and neck region. Because of the infiltrating nature of the lesion and a high propensity for recurrence, they are sometimes difficult to distinguish from well-differentiated liposarcomas (WDLS). We report, the first case of an infiltrating lipoma of the temporal muscle in a 62-year-old white man who presented with a slow growing mass in the left temporal region. The histopathological examination showed diffuse infiltration of the striated muscle fibers by mature adipocytes. There were no lipoblasts or cells with atypical nuclei as described in WDLS. We performed interphase fluorescence in situ hybridization (FISH) analyses using painting probes for chromosome 12 and a specific probe for the MDM2 gene and comparative genomic hybridization. The results did not identify MDM2 or 12q amplification and therefore confirmed the benign nature of the lesion.     

Primary CNS lymphoma associated with streptococcal abscess: an autopsy case

This report describes a case of streptococcal abscess in the nodules of a primary central nervous system (CNS) lymphoma. Magnetic resonance imaging (MRI) of the brain revealed multiple lesions with ringlike enhancement over the bilateral frontal, right temporal, and left parietal lobes. On admission, acute brain edema occurred following angiography, which resulted in respiratory arrest. Autopsy findings showed that the ringlike enhanced lesions on MRI were streptococcal abscesses localized in the lymphoma nodules. The lymphoma was classified as non-Hodgkin, diffuse large cells of B-cell lineage. No other lymphoma mass was found extracranially. An immunohistochemical study showed that the lymphoma cells were positive for leukocyte common antigen, Epstein-Barr virus, bax, and bcl-XL, and negative for L-26 and bcl-2. This case demonstrated that an opportunistic streptococcal abscess developed in primary CNS lymphoma in a patient without acquired immunodeficiency syndrome (AIDS), though a few similar cases have been reported in patients with AIDS.     

Cranial magnetic resonance imaging of Wolfram (DIDMOAD) syndrome

Wolfram syndrome is a rare neurodegenerative disorder characterized by diabetes insipidus, diabetes mellitus, optic atrophy and deafness (DIDMOAD). A wide spectrum of abnormalities of the central nervous system, urinary tract and endocrine glands is also observed. We report cranial MRI findings in a 32-year-old female patient with Wolfram syndrome. In addition to the classical features, including absence of the normal high signal of the neurohypophysis, atrophy of visual pathways, the brainstem, cerebellum and cerebral cortex, we observed bilateral hyperintensity on proton density- and T2- weighted images related to the optic radiations in the periventricular white matter of the temporal and parieto-occipital lobes, which may reflect gliosis pathologically.     

Nasopharyngeal carcinoma with brain metastasis: A case report

Summary We report a case of nasopharyngeal carcinoma with brain metastasis of a 69-year-old man. The patient presented with blindness and a huge mass over right upper neck. The magnetic resonance imaging (MRI) showed right nasopharyngeal tumor and metastatic lesion in bilateral occiptal regions. The bony x-ray showed diffuse osteoblastic metastases. The brain lesion was pathology-proven through the computed-tomographic guidance sterotatic biopsy.     

淋巴瘤侵犯泌尿及妇性生殖系统的影响表现

Fourteen cases of lymphoma involving urogenital systems (10 kidney, 1 bladder and 3 female genital system) were studied as to their image manifestations. In all 10 kidney cases of diffuse non-Hodgkin's lymphomas, multiple parenchymal nodules were found in 4, single mass in 3, perirenal involvement (Halo sign) with multiple nodules in the kidney in 2 and diffuse infiltration in the other one. The main ultrasonographic findings were hypoecho solid lesions without sharp margins. On pre-contrast CT scans, most of the lesions had similar attenuation as the normal renal parenchyma. After contrast, the normal parenchyma was enhanced much more than the lesion. The lesion may be missed if scan was performed without contrast enhancement. In the 3 cases with involvement of the female genital organs, the involved uterus and cervix were obviously enlarged and vaginal wall became thickened as hypoecho in B-ultrasound. Multi-planned scanning ultrasound is very helpful in showing the relation between pelvic mass and uterus.     

Fractionated, three-dimensional, planning-assisted proton-radiation therapy for orbital rhabdomyosarcoma: a novel technique

PURPOSE: Most children with orbital rhabdomyosarcoma will survive their disease. However, conventional photon-radiation treatment, as part of multimodality therapy, results in varying degrees of long-term functional and cosmetic side effects. This report introduces external beam proton radiation therapy (PRT) as a conformal, three-dimensional planned radiation technique for this disease, analyzes normal tissue dosimetry, and describes the technique's application in the first 2 patients. MATERIAL AND METHODS: Between January 1995 and February 1996, 2 patients underwent PRT following biopsy and chemotherapy for orbital rhabdomyosarcoma. Fifty and 55 Cobalt Gray Equivalent (CGE) were delivered to the gross tumor volume and 40 CGE to clinical target volumes in both patients. A relative biologic effectiveness (RBE) of 1.1 was utilized to correlate proton dose calculations with CGE. To achieve dose conformity, a "patch technique" was utilized, where target regions were divided into segments, each treated by a separate proton field. Dose-volume histograms were obtained for target and nontarget regions, including lens, bony orbit, pituitary gland, optic chiasm, optic nerves, lacrimal gland, and ipsilateral frontal and temporal lobes. RESULTS: At 3.4 and 2.5 years after PRT, both patients are clinically and radiographically free of disease. Visual acuity remains excellent, without signs of cataract formation; pituitary function is normal; cosmetically, only mild enophthalmos is noticeable. Doses to 90%, 50%, and 5% of lens volume were kept at less than 1%, less than 2%, and less than 8%, respectively. Fifty percent of lacrimal gland volume received less than 36% of the prescribed dose and 50% of the volume of the optic chiasm, pituitary gland, and hypothalamus were restricted to less than 2%. Proton conformity to orbital contents resulted in between 9% and 36% of the prescribed dose reaching the ipsilateral temporal and frontal lobes immediately adjacent to bony orbit (5% volume). CONCLUSION: PRT can offer excellent sparing of lens and selected intraorbital and ocular normal structures, while maintaining conformal target-dose coverage. The steep dose gradient beyond the orbit minimizes irradiation of normal brain parenchyma, with almost complete sparing of the pituitary gland. Reduction of integral irradiation exposure of the periorbital region will, hopefully, reduce the risk of second malignancy later in life. Reduced radiation dose to specific organs in close proximity to, but not part of the target region promises improved functional outcome and better cosmesis for childhood cancer survivors.     

Bilateral optic pathway glioma with intracranial calcification: Magnetic resonance imaging and magnetic resonance spectroscopy findings

Optic nerve glioma is the most common primary neoplasm of the optic nerve in childhood. It can extend intracranially along the optic pathway (optic pathway glioma). The lesion tends to present with decreased visual acuity in the affected eye, but can cause additional symptoms when it is large. Local involvement within the orbit can be characterized using CT, but MRI is superior in showing the intracranial extent of the lesion. Intracranial calcification in optic pathway glioma is rare. We present a rare case of optic pathway glioma with calcification in the intracranial component. Also, we describe MR spectroscopy (MRS) findings in this case.     

Pilocytic astrocytoma arising from an area of nudular heterotopia located in the white matter of the temporal lobe: case report

A 16-year-old girl suffering from intractable temporal lobe epilepsy presented with a pilocytic astrocytoma, which occurred in an area of nodular heterotopia located in the white matter of the temporal lobe. The pilocytic astrocytoma appeared to be covered by an area of gliosis, which contained numerous Rosenthal fibers, while in the lesion the pilocytic astrocytoma occupied a small area. The gliosis eventually became a tumor-like lesion. The while matter around the mass was composed of gliosis with nodular heterotopia. Temporal developmental malformation, which was a basic lesion of the patient, might therefore be a precursor lesion of pilocytic astrocytomas.     

Gliomatosis Cerebri and Pituitary Adenoma: Case Report and Literature Review

Summary The diagnosis of Gliomatosis cerebri (GC) is known to be difficult and is still a matter of debate. We describe an in␣vivo case of GC associated with a pituitary tumor. A 47-year-old woman presented with short-term memory loss. A MRI revealed the presence of a pituitary enhancing tumor and a diffuse lesion involving the brain. A left pterional craniotomy with partial temporal lobectomy and removal of the pituitary lesion were performed in order to obtain diagnosis. The histological analyses showed a pituitary non-functioning tumor and a GC consisting of neoplastic oligodendrocytes and astrocytes. Both lesions showed nuclear immunoreactivity for progesterone receptors (PGr) and estrogen receptors (EGr). This result could suggest there is a common receptor substrate in these tumors. In this case hormones could constitute a common step in tumorigenesis of both lesions.     

以原发性脾淋巴瘤为表现的弥漫性大B细胞淋巴瘤1例并文献复习

目的:探讨原发性脾淋巴瘤(PSL)的诊断以及原发性脾弥漫性大B细胞淋巴瘤的治疗。方法:报告1例以PSL为表现的弥漫性大B细胞淋巴瘤并结合文献进行复习。结果:患者表现为左上腹疼痛,无发热、盗汗,无浅表淋巴结肿大,CT证实脾脏内有占位性病变,脾脏病理示弥漫性大B细胞淋巴瘤,外周血和骨髓检查正常,脾切除术后PET/CT未见明显与淋巴瘤相关的18F-脱氧葡萄糖摄取异常增高表现,后给予联合化疗,随访8月余仍处于完全缓解期。结论:PSL是一少见肿瘤,采取脾切除后继以CHOP±利妥昔单抗治疗原发性脾弥漫性大B细胞淋巴瘤能够达到长期生存的目的。     

Primary anaplastic pleomorphic xanthoastrocytoma with widespread neuroaxis dissemination at diagnosis––a pediatric case report and review of the literature

We report a 5 year-old boy with primary anaplastic pleomorphic xanthoastrocytoma (PXA) with whole neuroaxis dissemination at diagnosis who experienced the sudden onset of generalized convulsion. Head- and spinal magnetic resonance imaging (MRI) showed widespread gadolinium (Gd)-enhanced lesions extending to the bilateral frontal- and medial temporal lobes and the spinal cord. Subsequent MRI study demonstrated that the lesion size increased without any neurological deterioration. Under a histopathologic diagnosis of anaplastic PXA he underwent adjuvant chemotherapy consisting of 12 cycles of carboplatin and vincristine. The patient is alive without any neurological deficits; follow-up MRI showed that the lesions remained stable during 18 months of chemotherapy. We report a very rare pediatric case of primary anaplastic PXA with dissemination involving the entire neuroaxis at the time of diagnosis.     

A case of primary malignant hemangiopericytoma of the lung with marked response to combination chemotherapy with cisplatin, ifosfamide and gemcitabine

A 51-year-old man was admitted because of complaints of cough and bloody sputa. A chest CT scan revealed a giant mass lesion in the right middle and lower lobes of the lung and mediastinal lymphadenopathy. Bronchoscopic findings showed a tumor which almost completely obstructed the intermediate bronchus. Histopathological examination of a biopsy specimen demonstrated malignant hemangiopericytoma. Two courses of chemotherapy that combined cisplatin, ifosfamide and gemcitabine were performed every 3 weeks. Both primary lesion and mediastinal lymph node metastases showed marked reduction and toxicity was manageable.     

Diffuse malignant leptomeningeal gliomatosis in a child: a case report and review of the literature.

Diffuse leptomeningeal gliomatosis is a rare condition characterized by glioma in the leptomeninges without a dominant mass lesion. The difficulty in diagnosis of this condition, its rarity. and its extensive nature have hampered its successful treatment. Most cases of primary diffuse leptomeningeal gliomatosis have occurred in adults. Reported here is a case of this condition in a 9-year-old girl; to the authors' knowledge, she is the youngest patient with diffuse leptomeningeal gliomatosis and the longest survivor of the malignant variety.     

鼻咽癌CT模拟定位保护重要器官

CT模拟定位系统能通过逐层准确地勾画出鼻咽肿瘤,包括原发灶和转移灶,周围正常组织和重要器官,清楚地显示肿瘤侵犯范围和敏感器官的三维关系,为照射野的设计提供直观的图像信息.勾画出肿瘤周围的重要器官和组织,如眼、视神经、视交叉、脑神经、颞颌关节、腮腺、垂体、脑干、脊髓等,对正常组织的保护更确切,而这些结构在常规模拟机下是不可视的,设野时可根据肿瘤侵犯范围和周围正常组织的关系决定应对那些周围敏感器官的保护,减少危险器官的照射体积和剂量.它使常规模拟难以实现的复杂的射野设计变得很容易,使照射野设计更准确、合理,避免正常组织的不必要的照射,从而减少放射损伤.     

Incidence of gliomas by anatomic location

The anatomic location of a glioma influences prognosis and treatment options. The aim of our study was to describe the distribution of gliomas in different anatomic areas of the brain. A representative population-based sample of 331 adults with glioma was used for preliminary analyses. The anatomic locations for 89 patients from a single center were analyzed in more detail from radiologic imaging and recorded on a three-dimensional 1 x 1 x 1-cm grid. The age-standardized incidence rate of gliomas was 4.7 per 100,000 person-years. The most frequent subtypes were glioblastoma (47%) and grade II-III astrocytoma (23%), followed by oligodendroglioma and mixed glioma. The gliomas were located in the frontal lobe in 40% of the cases, temporal in 29%, parietal in 14%, and occipital lobe in 3%, with 14% in the deeper structures. The difference in distribution between lobes remained after adjustment for their tissue volume: the tumor:volume ratio was 4.5 for frontal, 4.8 for temporal, and 2.3 for parietal relative to the occipital lobe. The area with the densest occurrence was the anterior subcortical brain. Statistically significant spatial clustering was found in the three-dimensional analysis. No differences in location were found among glioblastoma, diffuse astrocytoma, and oligodendroglioma. Our results demonstrate considerable heterogeneity in the anatomic distribution of gliomas within the brain.     

An atypical presentation of recurrent temporal lobe meningioma with external auditory canal mass

Extracranial spread of recurrent meningiomas involving the middle ear is rare. We present the case of a 59-year-old woman with headache and swelling of scalp over the right temporal region. MRI revealed a lesion in the right temporal lobe suggestive of meningioma. She underwent complete surgical excision of the lesion followed by post-operative radiotherapy. After 1 year, she presented with right-sided otalgia and a middle-ear mass extruding into the external auditory canal. She was re-operated and histopathology was anaplastic meningioma. We are discussing this unusual pattern of recurrence in our patient with a review of literature.     

脑部恶性纤维组织细胞瘤1例报道

Malignant fibrous histiocytoma (MFH) firstly described as "malignant fibrous xanthoma" by O'Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life. Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity. MFH only rare arises from structures of the head and neck. When it does, it most often originates in facial structures, particularly the maxilla. This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes. Radical excision was a surgical challenge because of the extensiveness of the lesion.