Biomedical subjects

R A Prayson

Publications and source records attributed to R A Prayson.

At least 37 records · Page 2Linked to original sources

PubMed2000

Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading.

UNLABELLED: Many of the problems associated with the current grading approaches for fibrillary astrocytomas center around the lack of consistency in grading. This study compares the diagnoses of five neuropathologists with five experienced surgical pathologists with regard to assigning astrocytoma grade. Thirty neoplastic and non-neoplastic lesions were sent to each of five neuropathologists and five surgical pathologists for placement into one of three grades as outlined by modified Ringertz schema. Grading criteria (Burger et al., 1985. Cancer 56:1106-1111) were distributed to all participants, who have been practicing for at least 5 years. An additional category for non-neoplastic or normal tissue was also provided. The diagnoses, based on the majority opinion of the neuropathologist group, included six low grade astrocytomas, 11 anaplastic astrocytomas, seven glioblastoma multiforme, and six normal/reactive lesions. Agreement by all neuropathologists was reached in 12 cases (40%). A discrepant diagnosis was obtained in one of five neuropathologists in 14 additional cases (46.7%). In the remaining four cases, two neuropathologists deviated from the majority opinion; in each of these cases, the diagnostic problem involved differentiating tumor from reactive gliosis. All five surgical pathologists agreed in six cases (20%). One discrepant diagnosis among the surgical pathologist group was seen in seven cases (23.3%). In the remaining 17 cases, two or more discrepant diagnoses were obtained (56.7%); discrepancies in these cases included differences in assignment of tumor grade and in distinguishing low grade astrocytoma from gliosis. IN CONCLUSION: (1) it is likely that experience with grading accounts for the better level of agreement among the neuropathologist group (kappa statistic 0.63) versus the surgical pathologist group (kappa statistic 0.36); (2) in most cases, the neuropathologists all agreed or had one discrepant diagnosis (86.7%) versus the surgical pathologist group (43.3%); (3) the discrepancies in diagnosis among both groups is likely related, in good part, to the limitations of the grading schema in fully enumerating the spectrum of such grading parameters as cytologic atypia and vascular proliferation.

Astrocytoma↗

PubMed2000

Local control and overall survival in atypical meningioma: a retrospective study.

PURPOSE: To evaluate local control and overall survival after primary surgery for patients with atypical meningiomas. METHODS AND MATERIALS: From the Department of Pathology database, we identified 491 cases of meningioma treated at the Cleveland Clinic Foundation from 1979 through 1995. Thirty-three were diagnosed with atypical meningioma. Eleven of the excluded patients had incomplete records, were lost to follow-up, or received treatment elsewhere. Of the 22 evaluable patients, 15 underwent gross total resection (GTR), 4 had a subtotal resection (STR), and 3 had a resection of unknown extent. Eight patients received radiation therapy (2 after initial resection and 6 after at least one recurrence). The median radiation dose was 5,400 cGy (range 3,500-5,940). The median age at presentation was 55.5 years, the male:female ratio was 14:8, and 19/22 patients had a Karnofsky performance score (KPS) > or =80. The independent variables analyzed for overall survival and local control were gender, KPS (> or =80 vs. < 80), extent of surgery (GTR vs. STR or unknown extent of surgery), and postoperative radiation therapy. RESULTS: Median survival was 10.6 years, with a median follow-up of 5.5 years (range 1.5-14.8). Eight of the 22 patients had local recurrence, including 2/15 with GTR, 3/4 with STR, and all 3 patients who underwent resection of unknown extent. At 10 years, patients with GTR had a higher local control rate than those who had either a STR or a resection of unknown extent (87% vs. 17%; p = 0.02). The 5- and 10-year overall survival rates for the entire group were 91% and 76%, respectively. Patients who had GTR had 5- and 10-year overall survival of 87% and 87%, respectively. Patients with STR or resection of unknown extent had 5- and 10-year overall survival rates of 100% and 75%, respectively. CONCLUSION: In patients with atypical meningiomas, gross total resection is associated with a lower recurrence rate than in subtotal resection.

Analysis of Variance↗

PubMed2000

In vivo expression of the interleukin 4 receptor alpha by astrocytes in epilepsy cerebral cortex.

We reported previously that non-neoplastic astrocytes (derived from brain tissues of patients with epilepsy) expressed interleukin 4 receptor alpha (IL-4Ralpha) and responded to interleukin 4 (IL-4) in culture. To determine whether reactivity of cultured astrocytes was relevant to primary tissue, we investigated IL-4Ralpha expression in specimens of non-neoplastic cerebral cortex removed for surgical treatment of intractable epilepsy compared to specimens of glial tumours, which have been reported to contain IL-4Ralpha. Freshly frozen tissues from eight cases (four epilepsy, four malignant astrocytoma) were evaluated for IL-4Ralpha expression by reverse-transcriptase polymerase chain reaction (RT-PCR), Southern blotting, and double-labelled immunohistochemistry with antibodies to IL-4Ralpha and glial fibrillary acidic protein (GFAP). IL-4Ralpha mRNA was detectable in both non-neoplastic and neoplastic tissues, whereas interleukin 2 receptor gamma chain (IL-2Rgammac) mRNA was not found. By immunohistochemistry, IL-4Ralpha protein co-localized to cells displaying GFAP and astrocytic morphology in epilepsy tissues. As anticipated, IL-4Ralpha was detectable in astrocytoma, but, surprisingly, was also observed in GFAP-positive, non-neoplastic "reactive" astrocytes adjacent to tumour. Results are consistent with the concept that non-neoplastic epilepsy astrocytes express IL-4Ralpha in situ, thus confirming in vitro studies and implying IL-4 sensitivity in vivo.

Actins↗

PubMed2000

Interleukin-13 sensitivity and receptor phenotypes of human glial cell lines: non-neoplastic glia and low-grade astrocytoma differ from malignant glioma.

Many of the actions and receptor components of interleukin-13 (IL-13), a pleiotrophic cytokine with immunotherapeutic potential, are shared with IL-4. Because human low-grade astrocytoma cells express IL-4 receptors and their growth is arrested by IL-4, we speculated that IL-13 sensitivity and receptor expression might also be present. The purpose of the current study was to investigate IL-13 receptor components and sensitivity in a series of glial cell lines derived from adult human non-neoplastic cerebral cortex, low-grade astrocytoma, anaplastic astrocytoma, and glioblastoma multiforme. Unlike peripheral blood lymphocytes (PBL), glial cells did not express IL-2 receptor gamma chain. IL-13 receptor alpha-1 (IL-13Ralpha1), however, was present in 11/13 glial lines and PBL. Deficient cell lines were all glioblastoma-derived. All anaplastic astrocytoma and glioblastoma but not other glial lines or PBL expressed IL-13 receptor alpha-2 (IL-13Ralpha2). In non-neoplastic glia, low-grade, and anaplastic astrocytoma, IL-13 decreased DNA synthesis, an effect reversible with antibody to IL-4Ralpha. Results indicate that low-grade astrocytoma cells resemble non-neoplastic glia in terms of IL-13 sensitivity and IL-4Ralpha/IL-13Ralpha1 receptor profile but alterations occur with malignant progression. Glioblastoma cells were uniformly insensitive to IL-13 and, unlike other glia, failed to phosphorylate STAT6 after IL-13 challenge. Data suggest that IL-13 and analysis of IL-13 receptors may have clinical application in glial tumors.

Astrocytoma↗

PubMed2000

Middle ear meningiomas.

Meningiomas arising in or presenting as middle ear lesions are relatively uncommon. This study retrospectively reviews the clinicopathologic features of six meningiomas arising in or extending into the middle ear. The patients comprise five women and one man ranging in age from 45 to 67 years (median, 55 years) at the time of surgery. Five tumors arose in the posterior fossa or temporal bone region and one tumor arose from the auditory canal itself. Three tumors arose on the right side and three on the left. Duration of symptoms before surgery involving the middle ear was known in five patients and ranged from 2 to 13 years (median, 10 years). Symptoms at presentation included gait or balance problems (n = 3), chronic otitis media (n = 2), diplopia (n = 2), hearing loss (n = 2), pain (n = 1), aural polyp (n = 1), and tinnitus (n = 1). Histologically, all six tumors resembled a syncytial (meningotheliomatous) meningioma. Psamomma bodies were noted in two tumors and two tumors demonstrated mild nuclear pleomorphism. None of the tumors demonstrated histologic features of atypical meningioma. Follow-up information was available in five patients. Four patients had prior surgery for removal of posterior fossa temporal bone meningiomas and developed recurrences involving the auditory canal 60 to 84 months after surgery. At the time of most recent follow-up examination, three patients were alive with evidence of tumor (65, 112, and 214 months), one patient was alive with no evidence of tumor (99 months), one patient died in the postoperative period of sepsis and pneumonia following resection of a middle ear recurrence (64 months), and one patient was lost to follow-up analysis. Meningiomas arising in or extending to the middle ear canal are unusual. They more commonly arise in woman and in most cases involve extension of intracranial/cranial tumors into the canal.

Aged↗

PubMed2000

Expression of Bax, Bcl-2, and P53 in progressive multifocal leukoencephalopathy.

It has been shown in vitro that JC viral protein can form a complex with wild-type p53 protein, which is a key regulator of both cell proliferation and cell death. Cellular factors, Bax and Bcl-2, are two essential downstream elements involved in p53-dependent apoptosis. To determine whether association of JC virus with p53 protein affects the expression of Bax and Bcl-2 in viral-infected cells in progressive multifocal leukoencephalopathy (PML), we studied the expression of Bax, Bcl-2, and p53 in 14 cases from 13 PML patients by using paraffin immunohistochemistry. Seven of 13 patients were known to be HIV positive. Overexpression of p53 was found in viral-infected oligodendrocytes and some astrocytes in all 14 cases. Intense immunostaining of Bax was strongly expressed in viral-infected oligodendrocytes and astrocytes. Bax immunostaining was also found in macrophages in the demyelinating lesions. Bcl-2 was not detected in viral-infected glial cells. The expression pattern of Bax positive/Bcl-2 negative in viral-infected glial cells suggests that the oligodendrocyte may be undergoing apoptosis which may in turn contribute to the demyelinating process in PML. The coexpression of p53 and Bax in the infected glial cells suggests that p53 detected by immunohistochemistry may still maintain its wild-type function.

Adult↗

PubMed2000

Clinicopathological findings in patients who have undergone epilepsy surgery in the first year of life.

Epilepsy presenting early in childhood may be associated with a neurologically devastating clinical course and have significant implications for the child's development. There are limited published data regarding the clinicopathological features of patients who have undergone epilepsy surgery in the first year of life and the role such surgery may have in reducing seizure frequency. This study retrospectively reviews the clinicopathologic features of eight patients from a tertiary care setting who underwent surgery for epilepsy in the first year of life. Eight infants, including seven males and one female, underwent surgery for epilepsy at 3-11 months of age (median 7.5 months). Age at the time of seizure onset ranged from birth to 2 months. Epileptogenic foci were localized by electroencephalographic and radiographic studies to the right side in five patients and left side in three patients. Histopathological findings in excised tissues included cortical dysplasia (n = 7), hemimegalencephaly (n = 3), and Sturge-Weber syndrome (n = 1). Dysplasia was marked by abnormalities in cortical lamination and neuronal orientation (n = 7), neuronal cytomegaly (n = 6), increased molecular layer neurons (n = 5) and balloon cells (n = 2). One patient was known to have epidermal nevus syndrome. Two patients required additional surgery for continued seizures. At last known follow up, all but one patient, who died in the postoperative period, were alive with no or decreased seizures at postoperative intervals of 3-60 months (median 13 months). Surgery can potentially ameliorate epilepsy in patients less than 1 year of age. Most of the patients in this series had cortical dysplasia as the underlying pathology of their epilepsy.

Brain↗

PubMed2000

The role of histopathologic examination of intracranial blood clots removed for hemorrhage of unknown etiology: a clinical pathologic analysis of 31 cases.

Intracranial hemorrhage is a well recognized cause of morbidity and mortality. Often, the etiology of the hemorrhage is known before surgical intervention, ie, evacuation of the hematoma. In a subset of patients, however, no known cause for the hemorrhage has been found in either history (eg, trauma) or radiographic findings (eg, tumor) before surgery. We retrospectively reviewed 54 blood clot evacuation specimens received in the surgical pathology department over a 16-year period (1983-1999). Cases were excluded in which the hemorrhage was attributed to or associated with prior trauma or for which there was a prior known cause of the hemorrhage. Thirty-one cases fulfilled the study requirements and comprised the study group. Thirty-one patients (aged 7 to 79 years; mean 54 years), including 16 females and 15 males, formed the study group. In 14 cases (45%), only blood clot was identified in the tissues examined. Of the remaining 17 cases, specific pathologic diagnoses were made in nine instances including cerebral amyloid angiopathy in three cases, arteriovenous malformations in three cases, and tumors in three cases. Tumor types included metastatic non-small cell carcinoma in two cases and low-grade astrocytoma in one case. Examination of blood clot evacuation specimens can lead to a discovery of the etiology of the hemorrhage in a subset of cases, particularly if neural tissue is part of the specimen. The quantity of neural tissue submitted for histologic evaluation seems to correlate with a higher likelihood of making a diagnosis. The routine use of Congo red stain in all adult cases in which brain tissue is present proved to be of diagnostic utility in screening for amyloidosis.

Adolescent↗

PubMed2000

Clinicopathologic study of forty-four histologically pure supratentorial oligodendrogliomas.

Few studies in recent years have specifically focused on pure oligodendroglial neoplasms. We retrospectively reviewed the clinicopathologic features of 44 patients with supratentorial oligodendroglioma diagnosed over a 19-year period (1974 to 1993). The study group consisted of 44 patients (age range, 8 to 69 years; median, 42 years), including 31 males. Thirty-one initially resected tumors (70%) were low grade and 13 (30%) were high grade (anaplastic). Using the St Anne-Mayo criteria for astrocytic tumors, 19 tumors (43%) were grade 2, 17 (39%) were grade 3, and 8 were (18%) grade 4. Histologic features of the tumors at initial resection included prominent nucleoli (N = 18, 41%), vascular proliferation (N = 9, 20%), necrosis (N = 6, 14%), and microcystic degeneration (N = 23, 52%). Nuclear atypia was graded as mild in 22 tumors (50%), moderate in 18 (41%), and marked in four (9%). The highest mitosis counts ranged from 0 to 10 mitotic figures (MF)/10 high-power fields (HPF) (mean, 2.4). Twelve patients (27%) had four or more MF/10 HPF. Initial surgery included gross total resection in 10 patients, subtotal resection in 16 patients, and biopsy in 14 patients. Thirty-one patients received adjuvant radiotherapy and 15 received chemotherapy. MIB-1 labeling indices ranged from 0 to 42.3 (median, 1.2 [low grade tumor median, 0.5; anaplastic tumor median, 6.2]). p53 immunostaining was observed in 18 of 43 stained tumors (41%). Overall, 5- and 10-year survival rates were 71% and 63%, respectively. The entire group had a median follow-up of 5.2 years. Age greater than 45 years (P = .02), mitosis counts of > or =4 MF/10 HPF (P = .0004), and MIB-1 labeling indices <2 (P = .03) were independent predictors of survival (Kaplan-Meier analysis). MIB-1 labeling indices <2 (P = .0009) was an independent predictor of disease-free survival. Low cell density (P = .04) and low histologic grade (P = .03) show trends with regard to being associated with longer survival. In conclusion, older patients (>45 years) or patients with tumors with an increased rate of cell proliferation generally have a worse prognosis. Although tumors of high histologic grade generally have a worse survival, the correlation was not statistically significant.

Adolescent↗

PubMed2000

Apoptotic activity and bcl-2 immunoreactivity in meningiomas. Association with grade and outcome.

We retrospectively evaluated 90 meningiomas for bcl-2 expression, apoptosis counts (per 10 high-power fields [HPF]), MIB-1 labeling indices (LI), and mitosis counts (per 10 HPF). Characteristics were as follows: 37 low-grade (benign) meningiomas: mean apoptosis count, 1.2; MIB-1 LI, 1.0; mitosis count, 0.1; and bcl-2 positivity, 40%; 29 atypical meningiomas: apoptosis count, 3.3; MIB-1 LI, 5.5; mitosis count, 2.2; and bcl-2 positivity, 62%; 24 malignant meningiomas: apoptosis count, 6.5; MIB-1 LI, 12.0; mitosis count, 6.0; and bcl-2 positivity, 67%. By univariate analysis, MIB-1 LI, apoptosis and mitosis counts, and tumor grade were associated significantly with death due to tumor; by multivariate analysis, only mitosis count was independently associated with death due to tumor. We compared similar data for 27 patients with nonrecurrent tumors and 32 patients with recurrent meningiomas. Histologic sections from the initially resected tumor and from the most recent recurrence were reviewed. Only the apoptosis count was significantly higher by univariate analysis in the initial resection specimens from tumors that ultimately recurred vs nonrecurrent tumors. Expression of bcl-2, MIB-1 LI, and mitosis count did not correlate with recurrence. By multivariate analysis, only extent of surgical resection was associated significantly with tumor recurrence. Although bcl-2 immunostaining was not associated statistically with outcome, bcl-2 positivity was more common in atypical and malignant meningiomas than in low-grade tumors.

Adolescent↗

PubMed2000

Solitary fibrous tumor of the thoracic spine. Case report and review of the literature.

Solitary fibrous tumor (SFT) is a neoplasm first described as a tumor of mesenchymal origin involving soft tissues. The authors provide a review of the literature with detailed pathological analysis and radiological description of SFTs involving the central nervous system. The authors report a rare case of a SFT of the thoracic spine in an adult man presenting with myelopathy. Magnetic resonance imaging revealed a well-circumscribed, intradural, extramedullary mass at the T2-3 level. Histological examination demonstrated a proliferation of predominantly spindle-shaped cells with a collagen-matrix background. Immunohistochemical staining was positive for vimentin and CD34 and negative for S-100 and epithelial membrane antigen with an MIB-1 labeling index of 2.6%. Review of the literature revealed 10 cases in which this tumor, frequently found in the pleura, was involved in the central nervous system. Although rare and their clinical significance as yet unknown, SFTs may be considered in the differential diagnosis of intradural spinal cord lesions. The natural history is also unknown, but these tumors appear to be biologically benign.

Adult↗

PubMed2000

Peripheral nerve amyloidosis in sural nerve biopsies: a clinicopathologic analysis of 13 cases.

OBJECTIVE: Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in sural nerve biopsies and to evaluate the clinical and pathologic features of these lesions. METHODS: All available histologic and ultrastructural materials on biopsy tissue from 13 cases of peripheral nerve amyloidosis were examined. Muscle biopsies performed at the same time as the nerve biopsy were reviewed when available. Clinical data were collected on all patients. RESULTS: The prevalence of amyloidosis in sural nerve biopsies at our institution was 13 (1.2%) of 1098 cases over a 15.8-year period. These patients ranged in age from 41 to 82 years (median, 61 years) at initial presentation and included 10 men and 3 women. Presenting neuropathy symptoms were sensory in 6 of the 13 patients, motor in 2 cases, and mixed in 5 cases. Cardiac, renal, or gastrointestinal involvement was present in 7 of 13 cases. Two patients had myeloma and 7 had systemic autonomic symptoms. Two patients had probable familial amyloid polyneuropathy, and 1 patient demonstrated an alanine 60 point mutation. Amyloid, identified as amorphous eosinophilic extracellular deposits demonstrating apple green birefringence on Congo red stain or recognized by its characteristic fibrillar ultrastructure by electron microscopy, was identified in the endoneurium in 12 nerves, perineurium in 2 nerves, and epineurium in 9 nerves. Chronic inflammation was identified in 5 nerves. Axonal loss was recorded as mild (<25%) in 1 nerve, moderate (25% to 75%) in 8 nerves, and severe (>75%) in 4 nerves. Axonal degeneration predominated over demyelination in 8 of 10 cases that could be evaluated. Concomitant muscle biopsies contained amyloid deposits in 8 of 9 cases. CONCLUSIONS: Amyloidosis is a rare (1.2% in our series) cause of peripheral neuropathy with a distinct microscopic and ultrastructural appearance. Just over half the patients in our study had visceral organ involvement and systemic autonomic symptoms. The peripheral neuropathy was associated with axonal degeneration and a moderate to severe axonal loss in the majority of cases. Amyloid deposition was present in 8 out of 9 muscle biopsies performed at the same time.

Adult↗

PubMed2000

Dysembryoplastic neuroepithelial tumor: an immunohistochemical study with myelin oligodendrocyte glycoprotein.

CONTEXT: The dysembryoplastic neuroepithelial tumor (DNT) is an uncommon lesion characterized by a heterogeneous population of neurons, astrocytes, and oligodendroglia-like cells (OLCs). The basic nature of the DNT and its constituent cells, particularly the OLCs, remains unresolved; some authors favor a neuronal origin, and others propose a glial or mixed origin for these cells. DESIGN: We examined 11 DNTs with antibodies to myelin oligodendrocyte glycoprotein, a marker of mature oligodendrocytes. RESULTS: All DNTs studied (7 from males, 4 from females; age range of patients, 2-37 years) were composed of varying proportions of neurons, astrocytes, and OLCs. Membrane or cytoplasmic immunoreactivity for myelin oligodendrocyte glycoprotein was found in many OLCs in 9 of 11 cases. The number of myelin oligodendrocyte glycoprotein-positive OLCs was variable: >75% of the OLCs were positive in 5 cases, 25% to 75% of the OLCs were positive in 2 cases, and <25% of the OLCs were positive in 2 cases. CONCLUSION: These findings suggest that many of the OLCs represent mature oligodendrocytes and support the notion that DNTs are heterogenous lesions composed of multiple, mature cell types.

Adolescent↗

PubMed2000

Surgical pathologic findings of extratemporal-based intractable epilepsy: a study of 133 consecutive resections.

BACKGROUND: Surgical management of intractable epilepsy continues to be important in select cases to achieve seizure control. DESIGN: This study retrospectively reviews the pathologic findings in 133 consecutive cases of extratemporal lobe epilepsy experienced during a 17-year period. RESULTS: The study group consists of 133 patients (78 males) who underwent extratemporal lobe resection for epilepsy at a mean age of 21.1 years (range, 3 months to 57 years). In 50 patients (37.6%), cortical dysplasia (neuronal migration abnormalities) was identified. The most common patterns of dysplasia observed included diffuse architectural disorganization in 46 cases, neuronal cytomegaly in 30 cases, increased numbers of molecular layer neurons in 30 cases, and balloon cells in 18 cases. Tumors were identified in 37 cases (27.8%) and included 13 astrocytomas, 7 gangliogliomas, 6 dysembryoplastic neuroepithelial tumors, 6 glioneuronal hamartomas, 4 oligodendrogliomas, and 1 oligoastrocytoma (mixed glioma). Twenty-four resections (18%) showed evidence of remote ischemic damage or infarct. Neuronal heterotopia was identified in 59 resection specimens (44.4%). Other less common findings included vascular malformations in 4 patients (3.0%), Sturge-Weber malformations in 3 patients (2.3%), and Rasmussen encephalitis in 2 patients (1.5%). Two patients were known to have tuberous sclerosis. In 23 resection specimens (17.3%), no significant pathologic finding was identified. Coexistent cortical dysplasia and tumor were seen in 10 cases and coexistent dysplasia and infarct or remote ischemic damage in 11 cases. CONCLUSION: This series demonstrates that most patients with extratemporal lobe epilepsy have significant histopathologic findings, which most frequently include cortical dysplasia, tumor, or evidence of remote ischemic damage or infarct. Coexistent pathologic findings were present in a significant minority of cases (16.5%).

Adolescent↗

PubMed2000

Parotid gland malignant melanomas.

BACKGROUND: Malignant melanomas are relatively unusual tumors in the parotid gland. The majority of previously reported cases appear to represent metastatic lesions, often from cutaneous head and neck primaries. METHODS: Retrospective clinicopathologic review of 12 cases of malignant melanoma involving the parotid gland encountered between 1980 and October 1999 at a tertiary referral center. RESULTS: Patients consisted of 9 men and 3 women ranging in age from 30 to 84 years (median, 66 years). Eleven of 12 patients presented with a neck mass or nodule. In 9 of 12 patients, a cutaneous or conjunctival primary was noted in the head region. In 2 patients, a cutaneous melanoma and the parotid gland melanoma were diagnosed at the same time. In 1 patient, melanoma was initially diagnosed in the parotid gland, and a definite primary was not uncovered. All patients underwent excision of the parotid melanoma, which was accompanied by a lymph node biopsy or dissection in 10 out of 11 patients. Four patients received adjuvant radiotherapy, and 3 patients received adjuvant chemotherapy. Four of 11 patients had ipsilateral cervical lymph node metastasis at the time of parotid tumor resection, and 5 patients had involvement of intraparotid lymph nodes by metastatic melanoma. Tumors ranged in size from 0.3 to 2.5 cm in greatest dimension. Multiple parotid nodules were noted in 4 patients. All tumors were characterized by a diffuse proliferation of cells with abundant eosinophilic cytoplasm and prominent nucleoli. Four tumors demonstrated focal spindle cell regions. Intravascular and/or lymphatic involvement by tumor within the parotid gland was noted in 3 lesions. At last known follow-up, 6 patients had died with tumor at a median follow-up period of 11 months after parotid gland surgery. Four patients were alive with evidence of tumor at follow-up intervals of 4, 17, 21, and 113 months after parotid gland surgery. Two patients were alive with no evidence of residual tumor at 20 and 148 months of follow-up. CONCLUSIONS: The majority of melanomas involving the parotid gland appeared to be associated with lymph node metastasis in and around the gland from a cutaneous primary in the head region. Prognosis is generally poor, although rare patients may survive a long period of time following surgery.

Adult↗

PubMed2000

Papillary glioneuronal tumor.

Tumors of mixed glioneuronal type are well recognized in the central nervous system. The most common examples of these lesions include gangliogliomas and dysembryoplastic neuroepithelial tumors. Recently, unusual examples of these lesions have been described, including the papillary glioneuronal tumor. This report describes a histologically similar-appearing lesion arising in the left parieto-occipital lobe of an 18-year-old man who presented with headaches and difficulties with vision. Imaging studies noted a large cystic neoplasm marked by a peripheral rim of enhancement. The patient underwent gross total resection of the tumor, which histologically was marked by a mixture of glial (glial fibrillary acidic protein-positive) and neural (synaptophysin-positive) components. Architecturally, the tumor was notable for a focal pseudopapillary pattern. Papillae were lined by predominantly glial cells, with intervening areas occupied by neurally differentiated cells. Mitotic activity, vascular proliferation, and necrosis were not noted. A MIB-1 labeling index of 1.1% was seen. p53 immunoreactivity was not observed. This report adds further evidence supporting the existence of this unusual mixed glioneuronal tumor of the central nervous system.

Adolescent↗

PubMed2000

Immunohistochemistry in the diagnosis of neoplasms of the central nervous system.

The diagnosis and evaluation of neoplasms of the central nervous system frequently involves the use of immunohistochemical stains. This article reviews some of the more commonly used markers including glial fibrillary acidic protein, synaptophysin, neurofilament protein, S-100 protein, epithelial membrane antigen, and cytokeratin markers. The focus of the discussion is on the use of these markers including their utility in resolving differential diagnostic issues. We also review the use of p53 and a variety of cell proliferation markers including proliferating cell nuclear antigen, Ki-67, MIB-1 and their potential role as adjuncts in the grading of tumors and their potential role in predicting tumor behavior.

Antibodies↗

PubMed2000

Glioneuronal tumor with neuropil-like islands.

Mixed glioneuronal neoplasms are relatively uncommon tumors in the central nervous system. Recently, an unusual glioneuronal tumor arising in adults marked histologically by neuropil-like islands was described. We present a similar case arising in a 23-year-old woman who presented with headaches and seizures and on imaging studies was noted to have a frontal-temporal lobe mass. The patient underwent partial resection of the tumor, which histologically resembled anaplastic astrocytoma, and received a course of radiation therapy and chemotherapy. Increasing seizure frequency and expanding size on neuroimaging prompted a re-excision of the tumor. The second resection was marked by islands of tissue resembling gray matter with slightly atypical neuronal and glial cells situated in the white matter. These islands stained positively with synaptophysin and did not stain with glial fibrillary acid protein. Mild vascular proliferation and moderate nuclear pleomorphism also characterized the tumor. Areas of necrosis were not noted. A MIB-1 labeling index of 18.1% was noted. P53 immunoreactivity was observed in approximately 40% of tumor cell nuclei. This lesion is felt to represent a clinically aggressive glioneuronal neoplasm with an unusual and distinctive histologic phenotype. HUM PATHOL 31:1435-1438.

Adult↗