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Biomedical subjects

S Utsuki

Publications and source records attributed to S Utsuki.

At least 19 recordsLinked to original sources
PubMed2006

Primary germinoma arising from the midbrain.

A 29-year-old man presented with diplopia, dysarthria, anisocoria, oculomotor nerve paralysis, abducens nerve paralysis, right facial palsy, and spastic hemiparetic gait. Magnetic resonance imaging (MRI) showed a homogenously enhanced mass in the midbrain. MRI-guided stereotactic biopsy was performed, and the histologic diagnosis was pure germinoma. The tumor disappeared after chemotherapy and radiotherapy. Germinoma should be included in the differential diagnosis of midbrain lesions in young adults. MRI-guided stereotactic biopsy provided a helpful diagnostic clue in a patient with a midbrain lesion.

Adult↗
PubMed2006

Utilization of personal digital assistants (PDA) for intraoperative naming tasks in awake surgery.

The naming task, one of the most important tasks for screening essential language function, is widely used in awake surgery. We employed personal digital assistants (PDA) for the display of objects in three patients performing the naming task during awake surgery for gliomas adjacent to the language area in the left hemisphere. The compact, light-weight, self-illuminated instrument can easily be held close to the patient's face. None had difficulty seeing the screen despite the presence of the surgical drape around the face. The examiner could easily change the displayed objects with a click. However, the PDA screen is too small for use in auditory comprehension tasks such as the Token Test.

Brain Mapping↗
PubMed2003

Importance of re-examination for medulloblastoma and atypical teratoid/rhabdoid tumor.

Medulloblastoma may can be difficult to distinguish from atypical teratoid/rhabdoid tumor (AT/RT), since they resemble each other histologically. We re-examined whether AT/RT was included among cases who had been diagnosed as medulloblastoma. All of fifteen medulloblastomas (10 males and 5 females) diagnosed at the Kitasato University Hospital were collected and stained immunohistochemically. Two cases originally diagnosed as medulloblastoma were reclassified as AT/RT based on histological re-examination including immunohistochemical studies. While these two cases of AT/RT were found during infancy, only one medulloblastoma was found in infancy.Histologically, small rhabdoid cells and large, pale, bland cells were common but typical rhabdoid cells were not seen in the two AT/RTs. Gland-like structures were also seen. The tumor cells in AT/RT, but not those in medulloblastoma, were immunoreactive for vimentin, epithelial membrane antigen and smooth muscle actin. In conclusion, if a diagnosis of medulloblastoma is made histologically, it should be confirmed immunohistologically, since it is difficult to distinguish AT/RT from medulloblastoma. When appropriate treatment was specifically targeted at AT/RT it may improve the outcome.

Adolescent↗
PubMed2002

Long-term outcome of intracranial germinoma with hCG elevation in cerebrospinal fluid but not in serum.

OBJECTIVE: Pure germinomas have a good prognosis compared to those with syncytiotrophoblastic giant cells (STGCs), which show elevated human chorionic gonadotropin or human chorionic gonadotropin-beta (hCG/hCG-beta) levels and relapse frequently. However, the long-term outcome of patients with germinoma and detectable hCG/hCG-beta in cerebrospinal fluid (CSF) but not in serum is unclear. MATERIALS AND METHODS: The outcome of patients with pure germinomas (no increase in hCG/hCG-beta in serum or CSF, 13 cases; group A), germinomas with STGC (increased hCG/hCG-beta in serum, 13 cases; group B) and germinomas with increased hCG/hCG-beta only in CSF (6 cases; group C) was analyzed. RESULTS: All three groups received similar radiotherapy. Groups A and C each showed a 10-year survival rate of 100%, while this was only 69.2% in group B. The 10-year relapse-free survival rates were 92.3%, 69.2% and 83.3% (groups A, B and C, respectively). Groups A and C each had one case of tumor relapse, but there was no recurrence simply by the application of radiotherapy. On the other hand, in group B, tumor relapse was seen in 4/13 (30.8%) cases. Three of them showed relapse within the region of the initial radiation exposure and died despite all available treatment. CONCLUSION: Patients with an increased hCG/hCG-beta level in CSF may be considered to be similar to pure germinomas and should be treated and followed-up carefully.

Adolescent↗
PubMed2002

Multiple arteriovenous malformations with hemorrhage.

BACKGROUND: A rare case of a left temporal arteriovenous malformation (AVM) with bleeding 10 days after removal of another hemorrhagic AVM in the frontal lobe is reported. METHOD: A 47-year-old man had an attack of headache and vomiting and was admitted to our hospital. On admission, a CT scan showed subcortical hemorrhage in the left frontal lobe. Left carotid angiography revealed four AVMs and a vertebro-basilar angiogram demonstrated a vascular malformation. FINDINGS: First, a hemorrhagic AVM was removed with a hematoma. Following the operation, left carotid angiograms continued to show, AVMs, particularly a temporal AVM with increased blood flow, and after 10 days this hemorrhaged. This was surgically resected and the remaining small AVMs were treated by stereotactic radiosurgery. INTERPRETATION: The patient had a high risk of hemorrhage. Adding hemodynamic stress to this situation, hemorrhage would have been expected to occur at an early time after the initial intervention for hemorrhagic AVM. Considering the risk of hemorrhage, other AVMs should undergo surgery as soon as possible after resection of hemorrhagic AVM.

Cerebral Angiography↗
PubMed2001

Prognostic value of Ki-67 (MIB-1) and p53 in ependymomas.

To determine whether Ki-67 (MIB-1) and p53 have prognostic value in ependymomas, clinicopathologic study was undertaken in 29 patients with this tumor. The clinical course correlated well with the histological grade according to the World Health Organization (WHO) grading system, and it was the worst in patients with anaplastic ependymoma. The percent expression of MIB-1 and p53 correlated with the histological grade of malignancy. With regard to the subtypes of benign ependymoma, the clinical course was the worst in clear-cell ependymoma, which had a significantly higher expression of MIB-1 and p53 than the other subtypes. Tanycytic ependymoma showed the most benign clinical course and the lowest expression of MIB-1 and p53. Although the WHO grading generally tended to correlate with the clinical course of ependymomas, these two subtypes--clear-cell ependymoma and tanycytic ependymoma--exhibited biological properties different from those of other grade II ependymomas.

Adolescent↗
PubMed2001

Bilateral crossed cerebello-cerebral diaschisis and mutism after surgery for cerebellar medulloblastoma.

A 7-year-old boy developed mutism after surgery for cerebellar medulloblastoma. Postoperative magnetic resonance imaging (MRI) showed atrophy of the cerebellar vermis and both cerebellar hemispheres, predominantly on the right side. Single photon emission computed tomography (SPECT) with technetium-99m-ethyl cysteinate dimer (Tc-99m ECD) revealed decreased cerebral blood flow (CBF) in the bilateral thalami, bilateral medial frontal lobes, and left temporal lobe in addition to the cerebellar vermis and both cerebellar hemispheres when mutism was manifest, indicating the existence of bilateral crossed cerebello-cerebral diaschisis (BCCCD). Circulatory disturbance in both cerebellar hemispheres secondary to tumor resection probably caused BCCCD in both cerebral hemispheres, predominantly in the left, via the dentatothalamocortical pathway (DTCP). With recovery of his mutism, CBF increased in the right thalamus, bilateral medial frontal lobes and left temporal lobe. Thus BCCCD was improved, with only a slight decrease in CBF still persisting in the left thalamus. The mechanism of mutism may have involved damage to the cerebellar vermis (the site of incision at operation), the left dentate nucleus (heavily infiltrated by the tumor) and the right dentate nucleus of the cerebellum (affected by circulatory disturbance secondary to acute postoperative edema). The SPECT findings suggested that mutism was associated with BCCCD-induced cerebral circulatory and metabolic hypofunction in the supplementary motor area mediated via the DTCP.

Cerebellar Neoplasms↗
PubMed2001

Spinal tanycytic ependymomas.

Three cases of spinal tanycytic ependymoma are reported, a man aged 45 years and two women aged 36 and 55 years. Each patient developed gradual paraparesis over a few months prior to admission. Magnetic resonance imaging showed an enhancing, well-circumscribed tumor in the spinal cord in each case. Histologically, the tumors consisted of monotonous proliferation of long spindle cells with markedly eosinophilic cell processes; focally forming perivascular pseudorosettes. The tumor cells were strongly immunopositive for glial fibrillary acidic protein, S-100 protein and vimentin. Ultrastructurally, in addition to massive intermediate filaments, many tumor cells showed abundant microtubules. Well-developed desmosomes and microvilli/cilia-lined microlumina were occasionally observed. The tumors were grossly totally removed and the patients remain recurrence free at 9, 9, and 2 years postoperatively. Reviewing reported cases including our three cases, tanycytic ependymoma may occur frequently in spinal cord, especially in the cervical region of the spinal cord. Since histologically it resembles pilocytic astrocytoma and schwannoma, tanycytic ependymoma should be included in the differential diagnosis of benign spindle cell tumors of the central nervous system.

Adult↗
PubMed2001

[A symptomatic Rathke's cleft cyst with pituitary apoplexy: a case report].

We encountered a rare case of symptomatic Rathke's cleft cyst associated with pituitary apoplexy. To our knowledge, six cases have been reported in the literature. The mechanism of this symptom is still obscure because of the rare pathological findings concerning Rathke's cleft cysts. Judging from the operative and the histopathologic findings, we speculate that pituitary apoplexy could occur due to hemorrhage from certain vessels such as compressed portal veins or newly organized vessels of the granulation tissue of the cyst wall.

Aged↗
PubMed2000

Solitary fibrous tumor arising from the falx cerebri--case report.

A 50-year-old female was admitted with headache and visual disturbance. Neuroimaging demonstrated a well-demarcated large tumor attached to the falx cerebri. The tumor was totally removed by surgery. Histological examination showed that the tumor consisted of spindle cells with no pattern in the collagenous background. Staghorn-like blood vessels were common. Immunohistochemical study showed the tumor cells were strongly positive for CD34 and vimentin, but negative for epithelial membrane antigen. The diagnosis was solitary fibrous tumor arising from the falx cerebri. Solitary fibrous tumor is rare within the cranial cavity, and can be distinguished from meningioma and hemangiopericytoma by the histological, ultrastructural, and immunohistochemical findings.

Brain Neoplasms↗
PubMed1999

Cerebral germinoma with syncytiotrophoblastic giant cells: feasibility of predicting prognosis using the serum hCG level.

As the biological behaviour of germinoma with syncytiotrophoblastic giant cells (STGC) is not well established, the present study was undertaken to ascertain the prognostic significance of serum hCG level in affected patients. Of a total of 23 cases studied, 12 patients were regarded as pure germinomas and 11 were germinomas with STGC. All but one of the former demonstrated an excellent outcome. The exception developed subarachnoid metastases, but the tumour disappeared on radiation therapy and the patient is enjoying a normal social life 13 years after the initial treatment. With the germinoma complicated by STGC, 3 cases showed local recurrence which were followed by a poor outcome. Their pretreatment hCG levels were 15.0, 26.0 and 29.6 mIU/ml respectively. The study showed a tendency, in germinomas with STGC, for a positive association between serum hCG, and the likelihood of a poor outcome. Germinomas with STGC and serum hCG levels higher than 15 mIU/ml thus have a high recurrence rate, and more aggressive treatment is indicated for the affected patients.

Adolescent↗
PubMed1999

Cerebellar clear cell ependymoma mimicking hemangioblastoma: its clinical and pathological features.

BACKGROUND: As the clinical and pathological significance of cerebellar clear cell ependymoma (CCE) has not been recognized in the past, eight cases of cerebellar CCEs were studied. METHODS: Subjects were six men and two women, and their ages ranged from 23 to 64 years old. Their neuroradiological, operative, and pathological features were reviewed. RESULTS: The tumors frequently showed high vascularity on angiography and marked enhancement on computerized tomography. Grossly, six tumors exhibited a "cyst with mural nodule" and two were mostly solid containing small cysts. At operation, the tumor nodules were dark red in color and the cysts contained xanthochromic fluid. Microscopically, all tumors displayed mostly clear round cells and abundant blood vessels. Although they commonly lacked the characteristic features of ependymomas, immunostaining and electron microscopy confirmed their ependymal origin. CONCLUSIONS: The results indicate that cerebellar CCEs closely mimic hemangioblastoma both clinically and pathologically, which suggests CCE should be considered in the differential diagnosis of vascular tumors of the cerebellum. Some diagnostic clues to differentiate CCE from hemangioblastoma are discussed.

Adult↗
PubMed1998

Long-term functional outcome of suprasellar germinomas: usefulness and limitations of radiotherapy.

We investigated the long-term functional outcome of patients with suprasellar germinoma after radiotherapy to determine the usefulness and limitations of radiotherapy for these tumors. From among 54 cases of intracranial germ cell tumor at Kitasato University Hospital, 12 patients with suprasellar germinoma who were treated with radiotherapy but not chemotherapy retrospectively investigated for mental, hormonal and visual functions. The follow-up period ranged from 63 to 262 months (mean, 161.1 months). The mortality rate was zero and there was no recurrence of tumors. However, three patients treated with local irradiation alone showed metastasis to the ventricles or spinal cord. With regard to mental function, 50% of the patients showed remarkably low mental function after radiotherapy. With regard to pituitary hormonal function, deficiency of ADH, GH, ACTH, and TSH was documented in 75%, 41.7%, 16.7% and 8.3% of the patients, respectively, before radiotherapy. Prolactin was elevated in 50% of the patients. After radiotherapy, 91.7% needed hormone replacement. With regard to visual function, most patients showed an improvement or no change after radiotherapy. In conclusion, radiotherapy for suprasellar germinomas gave long-time survival. However, such radiotherapy may cause mental and pituitary hormonal dysfunction. Our results show that while radiotherapy is useful for treating suprasellar germinomas, its dose have some limitations.

Adolescent↗
PubMed1996

Dural-pial arteriovenous malformation with unusual venous drainage.

A 41-year-old female presented with an uncommon mixed dural-pial arteriovenous malformation (AVM) with unusual venous drainage. Angiography at the initial operation for massive intracerebral hematoma in the parietal lobe showed no vascular malformations. Follow-up angiography 3 years later revealed a mixed dural-pial AVM at the previous surgical site. Unexpectedly, the venous drainage from the AVM was not into the patent superior sagittal sinus, but was retrograde into the contralateral cortical veins in the occipital lobe. No skull fracture or sinus thrombosis was demonstrated. The AVM was resected successfully without neurological deterioration. The pial portion of the lesion may have been a congenital anomaly, and the dural portion acquired. The development of a dural AVM at an earlier surgical site is uncommon, and may indicate the possible pathogenesis of acquired dural AVMs unrelated to sinus occlusion or accidental trauma. Furthermore, there are various possible patterns of venous drainage in vascular malformations.

Adult↗
PubMed1995

Origin of ciliated craniopharyngioma: pathological relationship between Rathke cleft cyst and ciliated craniopharyngioma.

Histological study was undertaken on ciliated craniopharyngioma and Rathke cleft cyst, to know the origin of ciliated craniopharyngioma. Subjects were 7 cases with symptomatic Rathke cleft cysts and a ciliated craniopharyngioma. Light and electron microscopic observations were made on surgically resected specimens of the 8 cases. The ciliated craniopharyngioma was composed mainly of papillary type of craniopharyngioma and of dispersed ciliated columnar epithelium including goblet cells. Four cases with Rathke cleft cyst showed squamous metaplasia of which the basal cells were histologically similar to that of papillary type of craniopharyngioma. Other 3 cases of Rathke cleft cyst, basal cells were revealed to have tonofilaments and desmosomes. It seems possible that ciliated craniopharyngioma has derived from the basal cells of Rathke cleft epithelium.

Adult↗
PubMedDate not supplied

Olfactory neuroepithelioma arising from the olfactory placode.

The patient was a 54-year-old man, who had lost his sense of smell 6 years previously and had started to become forgetful about 6 months prior to presenting at hospital. MRI admission showed a large multicystic tumor with Gd-DTPA enhancement extending from the anterior cranial fossa through the sphenoid sinus and into the nasal cavity. Histopathological examination revealed extensive proliferation of small round cells that were divided by connective tissue septae. The tumor cells occasionally formed tubular structures, although no basement membranes were present. On immunostaining, round tumor cells were positive for neuron-specific enolase, synaptophysin, and chromogranin A, while cells forming tubules were positive for AE 1 and CAM 5.2. Almost all of the tumor cells were positive for Ber-EP4, and some of the epithelioid cells surrounding the tubular structures were also positive for luteinizing hormone-releasing hormone (LH-RH). Electron microscopy demonstrated sporadic intercellular junctions, many microtubules in the tumor cell processes, and clear- and dense-cored vesicles in the cytoplasm. Based on the results, this case appears to be the first documented neuroepithelioma with Ber-EP4- and LH-RH-positive cells arising from the olfactory placode.

Biomarkers, Tumor↗