Central nervous system neoplasms in pregnancy.
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Central Nervous System Neoplasms↗
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Proliferating cell nuclear antigen expression in central nervous system neoplasms.
Proliferating cell nuclear antigen (PCNA) is a cell-cycle-regulated protein, which can be demonstrated in routinely fixed specimens. Studies on various tissues, cell cultures and neoplasms have shown that PCNA labelling index (LI) correlates with flow cytometry, tritiated thymidine LI, bromodeoxyuridine (BrdU) incorporation and Ki67 LI. PCNA LI may have prognostic value in various neoplasms. The present study concerns PCNA immunostaining in a series of neuroglial tumours. We demonstrate that there is a relation between PCNA LI and histological grade, and between PCNA LI and reported thymidine LI, BrdU LI and Ki67 LI. Pleomorphic xanthoastrocytomas and low-grade astrocytomas had the lowest LI, whereas metastases of small cell lung cancer and medulloblastomas had the highest LI. Glioblastomas sometimes showed a certain degree of intratumoral heterogeneity of distribution of immunostained cells. Intratumoral heterogeneity underscores the critical importance of representative sampling of central nervous system neoplasms for kinetic studies. As expected, PCNA LI are somewhat higher than tritiated thymidine LI, BrdU LI and Ki67 LI because PCNA is a marker of G1, S, G2 and M-phases of the cell cycle and not of S-phase only. In addition, because of its long half-life, PCNA may be detected immunohistochemically in cells that have recently left the cell cycle. The immunohistochemical evaluation of PCNA LI is easy to perform on routinely processed material, allowing retrospective studies. PCNA LI may be a useful tool in grading gliomas. However, its prognostic value must be validated by comparing PCNA LI with the follow-up of the neoplasms, and possibly with the responsiveness to anti-proliferative therapy.
Antigens, Neoplasm↗
Epidemiology of central nervous system neoplasms. A regional survey in Central Finland.
An epidemiologic survey of central nervous system (CNS) neoplasms in Central Finland revealed a total of 367 neoplasms, 298 of which were diagnosed during 1975-82, the remaining being diagnosed earlier. Histological verification was available in 83% of intracranial and 90% of intraspinal neoplasms. 14% of the intracranial neoplasms diagnosed during 1975-82 were found incidentally at autopsy. Metastases corresponded to 18% of all CNS neoplasms. Age- and sex-adjusted annual incidence rates for primary and metastatic intracranial neoplasms were 12.3 and 3.4/100,000, and for intraspinal neoplasms 1.3 and 0.7/100,000, respectively. The total incidence of all CNS neoplasms was 17.7/100,000/year. Of the different types of intracranial neoplasms, meningiomas were more frequent among women than among men with a ratio of 8:1; metastases were more common among men with a ratio of 2.5:1. For primary intracranial neoplasms, point prevalences (January 1, 1983) were 65.9/100,000 and intraspinal neoplasms 9.1/100,000. The corresponding period prevalences for 1982 were 73.7 and 9.5/100,000.
Adolescent↗
Aging and primary central nervous system neoplasms.
The number of primary brain tumors in the aging population has increased over the past few decades. Although overall survival rates for many patients with primary central nervous system neoplasms have not changed drastically, patients with particular tumor types are benefitting from new treatments. Many factors must be considered when treating primary brain tumors in the elderly, including overall medical condition, tumor biology, and social issues.
Aged↗
Descriptive epidemiology of central nervous system neoplasms in Los Angeles County.
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Adult↗
[Central nervous system neoplasms in clinical data from the Neurology Clinic KCU in Sarajevo 1990-1999].
The Neoplasms are the second leading cause of the mortality of the adult according to WHO. The last decade is the decade of the increase of all the epidemiologic parameters of the neoplasms in general, so also the neoplasms of the central nervous system. The goal of the work was to realize the frequency of the appearance of the neoplasms of the CNS on the clinical material of the Neurologic clinic CC University of Sarajevo with the special accent on the influence of the war as the specific stressor and the factor sui generis at the epidemiologic parameters of the neoplasms of the CNS. The study is retrospective: it is comprehended the period from the 1st January 1990 till 31st December 1999 year. The patients have been analyzed according to years, according the kind of the neoplastic processes and according to the time periods. At the analyzed period was treated 10,329 patients per year, according to the kind of the neoplastic processes and according to the time periods we evidenced the mild decrease from 1991-1999 year (3.03%-2.44%). According to the sex we register 167 males (60%) and 116 females (40%). The most frequent occurrence is in the age period from 55 to 69 years (55% patients). Of the primary neoplastic processes we had in 178 patients (64), with metastases 105 patients (36%). We analyzed the time periods: the prewar period (1st January 1990-5th April 1992), the war period (6th April 1992 till 14th February 1955), and the postwar period (15th December 1995 till 31st December 1999 year). The primary neoplasms in the postwar period we had in 70 patients (40%), in the course og est 35 patients (20%) and after war 69 patients (40%). The metastatic processes are in the evident increase during the war and after the war: before the war 19 patients (18%), during the war 32 patients (31%) and after the war 54 patients (51%). In the collected material during the war and after the war was evidenced the increase of the primary neoplastic processes at the lungs and other organs which have methastized at the nervous system. On the basis of our examination we can conclude that the total clinical material was present the mild percentage decrease of the neoplasms in the relation to all other admitted patients. The primary neoplastic process have been equally present in the patient material before and after the war with certain decrease during the war (probably because of the war and the reduced diagnostics). It is noticed the significant increase of the metastatic processes of the nervous system during the war and after the war. We are of opinion that the increase of the metastatic processes during the war and after the war is more many fold conditioned: the conditions of life of people during the war, shellings, fright from death and wounding, mourning for the killed and the wounded members of the most narrow family, the weak and inadequate nutrition, the increased smoking of the cigarettes, decrease of the total immune forces of an organism and others.
Aged↗
[Hospitalization of patients with central nervous system neoplasms in 1979-1981 and 1986-1988].
The hospitalizations and hospital deaths due to nervous system tumours were analysed on the basis of statistical cards filled in hospitals in a random sample of 10% of patients hospitalized in all Polish hospitals in the years 1979-1981 and 1986-1988. An evident rise was observed in the frequency of these hospitalizations and a less evident rise in the number of hospital deaths with a decrease of the hospital deaths caused by nervous system tumours. In the analysed time periods the greatest number of hospitalizations was in the age group 40-59 years, and deaths in the age group over 60 years. Hospitalization and hospital deaths indices were higher for urban population and males.
Adult↗
Newly defined central nervous system neoplasms.
In recent years, numerous new entities or variants of recognized central nervous system tumors have been described in the literature, and the morphologic spectrum of these neoplasms is delineated incompletely. The accurate diagnosis and classification of these lesions is important to ensure that patients receive adequate therapy and prognostic information. The clinicopathologic features and differential diagnosis of 4 new entities, including the chordoid glioma of the third ventricle, cerebellar liponeurocytoma, atypical teratoid/rhabdoid tumor, and papillary glioneuronal tumor, are discussed in this review.
Adult↗
Cytology of primary central nervous system neoplasms in cerebrospinal fluid specimens.
Although two-thirds of tumors occurring in the central nervous system (CNS) are primary neoplasms, only 10% of positive cerebrospinal fluid (CSF) specimens are from primary CNS tumors. In this study, we reviewed the cytologic findings of 21 positive CSF specimens from primary CNS tumors. A computer search identified 21 cases of positive CSF specimens from patients with primary CNS tumors from the archives. Follow-up included review of medical charts and histologic correlation. The specimens were from 20 patients (9 females and 11 males). Their ages ranged from 6-83 yr, old with a mean of 30 yr. The cases included 9 medulloblastomas, 7 gliomas (3 glioblastoma multiformes, 2 anaplastic astrocytomas, and 2 ependymomas), 2 germinomas, 2 non-Hodgkin's large B-cell lymphomas, and 1 ganglioneurocytoma. Two cases were classified as suspicious and the remaining as positive for malignancy. Immunocytochemistry was employed in 3 cases to support the cytologic diagnosis. These cases included one large-cell lymphoma (leukocyte-common antigen-positive), one germinoma (placental alkaline phosphatase-positive), and the ganglioneurocytoma (neuron-specific enolase- and synaptophysin-positive). There were no false-positive cases. Our results suggest that positive CSF cytology in patients with a primary CNS tumor is a reliable indicator of malignancy and reflects leptomeningeal involvement. The use of immunocytochemistry is helpful in confirming the cytologic impression in some cases.
Adolescent↗
An epidemiological study of central nervous system neoplasms in Oklahoma.
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Adolescent↗
Central nervous system neoplasms: indications for electron microscopy.
Diagnostic dilemmas of biopsy specimens in the central nervous system (CNS) tumors are often the result of multiple factors, including fixation artifact, biopsy size, lack of immunohistochemical techniques to distinguish cell types, and unawareness of rare entities. Correct diagnosis and confirmation of diagnosis of primary CNS neoplasms is imperative and may require electron microscopic examination. In some instances, use of electron microscopy may be the only approach for accurate recognition of an entity. Although diagnostic electron microscopy is expensive and cost cutting is encouraged in today's practice of medicine, cost must be weighed against the consequences of even 1 patient developing CNS treatment-related necrosis or a radiation-induced neoplasm secondary to misdiagnosis of a benign entity. This study reviews the ultrastructural differences of three groups of diagnostically difficult CNS lesions: clear cell neoplasms (ependymoma, oligodendroglioma, central neurocytoma), rare entities containing astrocytes invested by a basal lamina (pleomorphic xanthoastrocytoma, the desmoplastic neuroepithelial tumors of infancy), and benign entities characterized by transitional cell forms (subependymoma, subependymal giant cell astrocytoma).
Astrocytoma↗
Leptomeningeal fibrosis and the delayed diagnosis of a central nervous system neoplasm (primitive neuroectodermal tumor).
We report a unique case of histologically confirmed meningeal fibrosis in a child who had progressive ischemic neurologic symptoms before the delayed diagnosis of an intracranial primitive neuroectodermal tumor (PNET) was made > 1 year after initial presentation. This pathology has previously been described after neurosurgical procedures, subarachnoid hemorrhage, cranial irradiation, and with no known etiology, but has never been reported in association with a central nervous system neoplasm. In a 6-year-old boy with headaches of several months' duration MRI demonstrated hydrocephalus, a right cerebellopontine angle cyst, and dural enhancement. Biopsies of the thickened meninges taken when the cyst was surgically fenestrated demonstrated only fibrosis with no evidence of infection, hemorrhage, or neoplasm. In the next 6 months, the child had two acute stroke-like episodes with alternating hemiparesis that gradually improved. There were ischemic changes in the diencephalon on MRI. Repeat dural biopsies were unchanged. One year after the initial operation, a left hemiparesis recurred and MRI demonstrated multiple intracranial masses in the cerebral cortex, cerebellum, suprasellar area, and cauda equina. After surgical resection, the cortical mass was found to be a PNET. All the lesions regressed after treatment with radiation and chemotherapy. We hypothesize that the meningeal fibrosis represented a "desmoplastic" reaction to an occult PNET, similar to the fibrous proliferation with cerebellar desmoplastic medulloblastoma except for the extent of the meningeal involvement and the long undetected parenchymal tumor. The mechanism of the ischemic brain injury was most likely vascular involvement by the fibrotic process, either directly or by predisposition to vasoconstriction.
Brain Neoplasms↗
The cytopathology of cerebrospinal fluid. II. Metastatic cancer, meningeal carcinomatosis and primary central nervous system neoplasms.
The evaluation of cerebrospinal fluid (CSF) requires adaption of basic cytopathologic principles to the specific neoplasms that involve the central nervous system (CNS). In this review, general criteria for detecting malignant cells in CSF are presented. The incidence and cytologic characteristics of specific metastatic tumors that involve CSF are reviewed, and the incidence, pathogenesis and natural history of meningeal carcinomatosis are discussed. The role of cytopathology in the detection and management of primary CNS tumors is presented. Emphasis is placed on the cytologic characteristics of individual types of primary brain tumors and the application of fine needle aspiration biopsy to intracranial lesions.
Adenocarcinoma↗
Proliferating cell nuclear antigen immunoreactivity in human central nervous system neoplasms.
Formalin-fixed, paraffin-embedded surgical specimens from 140 primary human central nervous system tumors, including 51 meningiomas, 26 astrocytomas, 26 anaplastic astrocytomas, 9 glioblastomas, 1 gliosarcoma, 8 oligodendrogliomas, 5 ependymomas, 2 subependymomas, 9 medulloblastomas, and 3 paragangliomas, were immunostained using a streptavidin/peroxidase method and the PC10 monoclonal antibody, which recognizes an epitope on the proliferating cell nuclear antigen (PCNA). The following PCNA labeling index (LI) mean values were found for the above neoplasms: meningiomas, 3.80 +/- 7.35%; astrocytomas, 0.65 +/- 1.03%; anaplastic astrocytomas, 8.46 +/- 7.95%; glioblastomas, 10.26 +/- 11.21; gliosarcoma, 46.34%; oligodendrogliomas, 2.31 +/- 3.59%; ependymomas, 1.12 +/- 2.10%; medulloblastomas, 23.91 +/- 11.95%; and paragangliomas, 2.07 +/- 1.86%. Collectively, our findings indicate that while benign central nervous system tumors generally have low PCNA LI values, consistent over-expression of PCNA epitopes was noted in some examples, especially in a number of meningiomas. Among the malignant neuroectodermal tumors, medulloblastomas were found to have the highest PCNA LI values, corresponding to their histological grade of malignancy, and malignant glial tumors generally displayed significantly higher PCNA LI values, than their benign counterparts. Although in our study mean PCNA LI values seemed to reflect histological grading, large discrepancies were noted in all tumor groups. Our data, therefore, suggest than PCNA immunoreactivity can not be considered reliable for predicting the prognosis of the disease in individual cases.
Antigens, Neoplasm↗
Epidemiology of primary nervous system neoplasms.
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Adult↗
Pre-morbid height and weight as risk factors for development of central nervous system neoplasms.
Information on pre-morbid height and weight from a national screening of tuberculosis between 1963 and 1975 was linked with the registrations in the population-based Norwegian Cancer Registry. For each case with a primary central nervous system (CNS) neoplasm, 10 matched controls were taken from the non-cases. Analyses were done by a Cox regression model for the total group of CNS neoplasms and the various histological groups. In the case of the total group, height emerged as a significant risk factor for both sexes. Within each sex, a similar trend was found for each histological group although statistical significance was retained only for glioblastoma among males and for other types of glioma (astrocytoma, oligodendroglioma, mixed glioma and ependymoma) for females. A significant negative association was revealed between Quetelet's index (weight/height squared) and 'other gliomas' in females. No association with body mass, as expressed by Quetelet's index, was found for patients with meningioma.
Adolescent↗
[The treatment of central nervous system neoplasms].
From August 1993 to March 1998 30 children (13 females and 17 males) at the age of 1-14 with central nervous system tumours were treated in Paediatric Hematology and Oncology Hospital in Wrocław. In 11 patients we diagnosed medulloblastoma, in 4 ependymoma, 6 astrocytoma, 2 oligodendroglioma and in 7 other types of tumours. The histological diagnosis of 2 cases with tumours localized in the brain trunk was not available. All patients were directed to the chemotherapy after the surgery. Complete resection was achieved in 13 out of 30 patients. The chemotherapy was proceeded according to SIOP regimen. Children older than 3 years received additional radiotherapy. The effectiveness of treatment was controlled by constant neurological examinations with computed tomography and ultrasonography. The rate of failures was 10 patients with local recurrences and 1 patient with drug toxicity. 17 children remain still in observation--among them 5 are treated with chemotherapy and 2 present the progression of disease.
Adolescent↗
Worldwide incidence of primary nervous system neoplasms. Geographical, racial and sex differences, 1960-1977.
International and interregional comparisons of average annual age-adjusted incidence rates for primary tumours of the nervous system showed marked variations. The highest rates were observed in those areas having high socioeconomic levels. In communities with multiple racial groups the highest rates were in Caucasians. Migrant populations retained rates close to those found in the country of origin. The majority of populations showed modest increases only while about one-third showed a decrease in the incidence rates during a period of approximately 15 years. Overall, there was a male excess. It is suggested that differences in medical practices (including availability of specialist expertise), diagnostic facilities and individual registry practices account for some of the variations observed. However, the possible aetiological roles of genetic, racial, hormonal and environmental factors need to be evaluated to explain the consistently higher incidence rates in Caucasians and in males of all races.
Ethnicity↗