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At least 325 records · Page 18Linked to original sources
PubMed2000

Metastatic thymic carcinoma in a digit: a case report.

Acrometastases are a rare but important clinical entity. We present the case of a 54-year-old man with a metastasis to a digit from a primary thymic carcinoma. The prognostic implications of such a diagnosis are discussed.

Biopsy↗
PubMed2006

[Diagnostic difficulties in encephalitis and glioma].

BACKGROUND: Glial neoplasms can infiltrate the central nervous system extensively with relative preservation of the underlying neuronal architecture. The differential diagnosis between cerebral glioma and infective lesions can be very difficult to distinguish by MRI only. CASE REPORT: We report a 7 year old boy with recurrent vomiting, fever, weakness, abdominal pain and diarrhea. Besides an expressive speech disturbance the neurological examination showed no pathological findings. The sonography revealed discrete hepatomegaly and small pericardial effusion. MRI showed a diffuse mesencephalic and pontine swelling without contrast medium enhancement possibly pointing to an infective lesion. Microbiological, serological and metabolic investigations of blood and CSF were normal. After initial improvement associated with antibiotic, antiviral and dexamethasone treatment the process relapsed progessively. The 1H-MR-spectroscopy showed elevated cholin and decreased N-acetyl-aspartate levels suspicious for a proliferating process. Brain biopsy revealed anaplastic astrocytoma (WHO III). Despite of radiation and chemotherapy the tumordisease deteriorated and the patient died because of progressive brainstem infiltration one year later. CONCLUSION: This case report shows that cerebral glioma can mimick infective brain disease and that MR-spectroscopy is an important non-invasive tool in this differential diagnosis.

Aspartic Acid↗
PubMedDate not supplied

[High dosage methotrexate in combination with "8 in 1" in therapy of pediatric grade III/IV brain tumors].

20 patients with malignant brain tumors in childhood were treated according to a regimen which included initial surgery, preradiation chemotherapy and subsequent irradiation. The chemotherapy consisted of alternating cycles of high-dose methotrexate (12 g/m2) and "8 drugs in 1 day" (Bleyer, 1983). Each cycle was to be given up to six times, as tolerated. The diagnoses were medulloblastoma in 10 cases, astrocytoma in 5 cases, ependymoma and PNET in 2 patients each, and malignant mesenchymoma in 1 case. 15 patients were previously untreated, 5 patients experienced relapse after a different first line therapy and a longer time interval. 8 patients are in continuous complete remission for 13 to 54 months. The toxicity upon the bone marrow, the kidney and the inner ear was tolerable. Long lasting emesis contributed a marked problem to the patients but did not cause abbreviation of the therapy. The neurotoxicity was notably mild. Three episodes of generalized seizures were seen without subsequent sequelae, four cases of peripheral neuropathy were attributable to vincristine. A leukoencephalopathy was neither detected on clinical grounds nor on neuroradiological imaging. Therapy related deaths were not seen. We conclude that the combination of HD-MTX and "8 in 1" markedly contributes to the intensification of the chemotherapy for malignant brain tumors in childhood. In the setting as preradiation chemotherapy the toxicity is tolerable.

Adolescent↗
PubMedDate not supplied

[Treatment of an extraneural metastasized medulloblastoma].

We report a patient with a history of a previously treated medulloblastoma, now presenting with generalized osseous metastases. Currently there is a complete remission under continuous therapy with VP-16. Since the frequency of systemic metastases in patients with medulloblastoma is approximately 5%, we recommend a more extensive initial evaluation in these patients.

Adult↗
PubMedDate not supplied

[Sonographic detection of brain tumors in infancy].

Using the open fontanelle as an acoustic window brain tumours were diagnosed by gray scale ultrasonography in 3 infants aged 1 day to 5 months. The tumours were characterized by their echo dense structure and their good delimination from the surrounding brain. In 2 children the tumour was localized infratentorially (medulloblastoma and unclassified neuroectodermal tumour) and had caused an occlusive hydrocephalus. Both children died aged 3 and 5 months in central nervous dysregulation. One child suffered from plexus papilloma which had caused a hypersecretory hydrocephalus. After resection of the tumour the hydrocephalus decreased without any further treatment. Comparison with axial computed tomography and autopsy findings showed, that gray scale ultrasonography is equally efficient in diagnosing brain tumours and associated hydrocephalus.

Brain Neoplasms↗
PubMedDate not supplied

Advances in treatment techniques and time/dose schedules in external radiation therapy of brain tumours in childhood.

Recent advances in radiotherapy techniques seek to improve the therapeutic ratio in childhood brain tumours by adding potentially more effective treatment in ways that will increase tumour control and limit radiation toxicity. Stereotactic irradiation techniques in conjunction with rigid head fixation systems comprising single high-dose delivery ("radiosurgery"), fractionated convergence therapy and three dimensional conformal therapy focus the dose to tumour while sparing surrounding normal tissue. Although these techniques are well established in adults data for childhood central nervous system malignancies are scarce. Preliminary data reveal low acute toxicity and promising results in recurrent tumours as well as in primary treatment. Whether stereotactic radiation therapy with either of the latter techniques will add substantially to disease control and preserve neurologic function remains to be established and should be part of future investigations. The introduction of quality control procedures assures precise radiotherapy of the tumour site, whole brain and craniospinal axis and is a prerequisite to improve survival and to reduce potential adverse effects. Hyperfractionated radiotherapy has the potential of increasing dose to tumour more safely theoretically sparing children some of the late effects while in particular in craniospinal irradiation. Pilot studies revealed excellent tumour control in medulloblastoma with acceptable acute toxicity. The strategy is part of the subsequent HIT '98 trial both for low and high risk patients. In conclusion, there is considerable enthusiasm among all those caring for children with brain tumours to study modifications of radiation delivery that may result in improved treatment. Rapid accrual to an increasing number of cooperative prospective trials is expected to provide the body of data supporting the selection of novel radiation therapy modalities in the future.

Adult↗
PubMed1988

[MR tomography in tumors of the posterior cranial fossa in childhood].

MR tomography was performed on 23 children with tumors in the posterior fossa. In 14 cases, the MR tissue parameters were determined. Astrocytomas can be easily differentiated from medulloblastomas and ependymomas on the basis of their localization and signal intensities. Grading of astrocytomas and distinction between medulloblastomas and ependymomas was not possible. Because of high tissue contrast, multiplanar imaging and minimal artifacts, MR proved to be the method of choice for planning surgery and for the follow-up of tumours in the posterior fossa.

Adolescent↗
PubMed1985

[Computed tomographic control of the course of primary brain tumors following radiotherapy].

Two hundred and seventy-eight CT scans are presented which were carried out on 105 patients following radiotherapy for primary cerebral tumours. Of these, 90 had surgery and 15 did not. Amongst 63 patients who showed abnormal enhancement before irradiation, enhancement was reduced in 32, increased in ten and remained the same in 17 following treatment. Of the 42 patients who did not show enhancement before irradiation, this was observed in 24 patients after treatment, but not in the remaining 18. Changes in the pattern of contrast enhancement was very variable in both groups. Other signs of tumour (compression of ventricles, mid-line displacement, ventricular dilatation) showed no differences in the groups. Changes in the central nervous system due to irradiation were observed in 25% of cases.

Adolescent↗
PubMed1984

[Posterior fossa masses. Comparison of magnetic resonance tomography and computed tomography].

The results of magnetic resonance imaging, using a 0.5 Tesla superconductive magnet in 6 patients with clinical (6), angiographic (6) and histologic (4) diagnosis of posterior fossa tumors were reviewed and compared with x-ray computed tomography. Optimal visualization of normal and abnormal anatomic relationships and the possibility and value of calculated T1- and T2-pictures with the aid of spin-echo-technique are discussed.

Adult↗
PubMed1989

Reliability of simple cytological methods in brain tumour biopsy diagnosis.

Stereotactic procedures in brain tumour diagnosis and therapy are used increasingly because small lesions are more frequently detected and methods of interstitial irradiation are gaining wide acceptance among neurosurgeons. The diagnosis of underlying pathological processes has to be performed from very small tissue samples. The method of smear and/or squash preparations therefore has long been used by neurosurgeons. Neuropathologists, formerly reluctant, are becoming more and more enthusiastic over this simple and elegant method. Since the diagnostic reliability in such small samples is questioned, we have undertaken to analyse 200 open tumour biopsies in a comparative investigation: the diagnosis from smear preparation on the one hand has been performed without knowledge of the lesion, and on the other hand the remaining material was submitted to the whole pattern of diagnostic methods including frozen sections, paraffin sections with special staining, immunohistochemistry, electron microscopy and tissue culture. Diagnostic reliability was estimated in a four step procedure: Is there tumour or not--is there neuroepithelial newgrowth or metastasis--what kind of tumour is it--has the degree of malignancy--according to the criteria of the WHO--been estimated correctly? The overall diagnostic reliability in our material is about 75%. This is less than the diagnostic reliability of other methods, mostly due to the lack of histologic "architecture" criteria in evaluating the cytological biopsies.

Adolescent↗
PubMed1994

Surveillance scanning of children with medulloblastoma.

BACKGROUND: The standard follow-up care for children with medulloblastoma includes regular clinical evaluations and surveillance scanning of the central nervous system with computed tomography or magnetic resonance imaging. The evaluations and scanning assess the response of the tumor to treatment, detect any recurrence of disease, and monitor any complications of treatment. We compared the effectiveness of a periodic history taking and physical examination with that of surveillance scanning in detecting recurrent tumors. METHODS: We reviewed the medical records, including 794 scanning reports or scans, of 86 children with posterior fossa medulloblastoma who were followed regularly between 1980 and 1991. Recurrent tumors were classified as symptomatic if neuroimaging studies had been prompted by clinical symptoms or signs and as radiographic if the tumor had been detected by imaging in an asymptomatic patient. RESULTS: Twenty-three of the 86 children (27 percent) had a recurrence of tumor. Four recurrences (17 percent) were detected on scanning only, and 19 (83 percent) were associated with symptoms arising a median of four months after the previous scan. The median and range of survival after a recurrence of the tumor were 5 months and < 1 to 38 months, respectively, for a symptomatic recurrence and 20 months and 10 to 32 months, respectively, for a radiographic recurrence (P = 0.03). No patient survived after a recurrence. The longer survival of patients with recurrent tumors detected by scanning most likely reflects the small number of patients and lead-time and length biases associated with screening. CONCLUSIONS: Among children with medulloblastoma, surveillance scanning is of little clinical value. Scanning detected a minority of recurrences, and no patient who had a recurrence survived.

Adolescent↗
PubMed1997

Expression of Bax and bcl-2 proteins, regulators of programmed cell death, in human brain tumors.

Expression of Bcl-2, a programmed cell death (PCD)-suppressing molecule, and Bax, the Bcl-2 related PCD-accelerating protein was investigated in varied human brain tumors. Thirty-six cases of human brain tumors comprising 4 astrocytomas, 3 anaplastic astrocytomas, 4 glioblastomas multiforme, 5 medulloblastomas, 1 ependymoma, 2 choroid plexus papilloma, 1 ganglioglioma, 1 central neurocytoma, 4 meningotheliomatous meningiomas, 3 transitional meningiomas, 4 fibroblastic meningiomas, 3 acoustic neurinomas and 1 craniopharyngioma were analyzed for the localization of Bax and Bcl-2 proteins. No relationship between the degree of the histological malignancy and the presence of Bax or Bcl-2 proteins was found in varied human brain tumors. However, it is suggested that reduced expression of Bax protein is necessary for the malignant transformation and progression of the brain tumors, since no histologically malignant brain tumors with positive Bax protein were present. Our findings indicate that the expression pattern of Bax and Bcl-2 may reflect histogenetic difference of each type of brain tumors.

Adolescent↗