A. Maleci

Prostaglandin E2 as an immunomodulating factor released in vitro by human glioma cells

SummaryCultured human glioma cells were found to produce soluble factors that can modulate the in vitro proliferative response of purified T lymphocytes stimulated by phytohemagglutinin (PHA). Neoplastic tissue was removed during surgery for brain glial tumors and cultured in vitro. The glial nature of the neoplastic cells was verified by means of anti-glial fibrillary acidic protein immunohistochemical staining. Serum-free supernatants from these cultures proved capable of suppressing in vitro proliferation of PHA-stimulated T lymphocytes. Suppression was reduced when indomethacin or aspirin was added to the culture medium. Thin-layer chromatography revealed the presence of prostaglandins and other arachidonic acid derivatives in the supernatants. The radioimmunoassay used to quantify the prostaglandin E2 (PGE2) in the supernatants showed detectable amounts of PGE2, which disappeared after the cultures had been treated with anti-inflammatory drugs. These data support the hypothesis that tumoral glial cells can play a role in the host immune response in the central nervous system, namely by producing soluble factors.

Medulloblastoma in children and in adults: a comparative study.

SummaryWe report on the clinical and pathological characters and factors influencing prognosis in a consecutive series of 20 cases of medulloblastoma presenting in childhood and of 20 cases of the tumour presenting in adulthood. The significant differences which emerged were compared with the findings of the largest published series. Medulloblastoma is more often lateral in site and desmoplastic in histology in adults than in children. On our evidence the age at tumour onset not affect survival.

Malignant monstrocellular brain tumours. A study of 42 surgically treated cases.

SummaryA series of 42 cases of monstrocellular brain tumour (MBT) who received surgery over a 34 year period is reviewed with the aim of gaining more understanding of the biology of this oncotype. A case of benign pleomorphic xanthoastrocytoma was identified among the cases and is discussed in another paper. In this series, as in most others taken from the literature, MBTs were more frequent in young subjects (55% were under 50 years of age and 17% were children) and presented as a superficially located (63%), often sharply circumscribed (42%) mass. The mean survival time for 24 patients treated by surgery and radiotherapy (RT) was 57 weeks compared to 32 weeks for 12 treated by surgery alone (p < 0.02). Patients younger and older than 50 years showed the same survival and the slightly better course of children did not reach statistical significance. Besides postoperative RT, the only other factor that showed a significantly positive influence on survival was the presence of a definite lymphocytic infiltration (LI) in the tumour (p < 0.05). This result confirms our previous study on the prognostic influence of LI in glioblastoma (GB). Actually, we noted that the prolonged survival of both MBT and GB patients exhibiting a definite LI (67% and 11.5%, respectively, in the two series) was strikingly similar. We conclude that MBT is a peculiar oncotype with a probably better prognosis than GB in the majority of cases. Lymphocytes seem to play a major prognostic role and giant-monstrous cells are indirectly implicated, reasonably enhancing the hosts immune response by magnifying the antigenic stimulus.

Medulloblastoma in late adults: report of two cases and critical review of the literature

SummaryThe authors describe two cases of medulloblastoma occurring in two men aged 71 and 67 years respectively. Medulloblastoma in late adults (older than 65 years) is an exceptional occurrence, and in this age group is generally of the classic type. Our first case was exceptional for the long survival of the patient compared with those so far reported for the same age group.

Isolated haemangioblastoma of spinal cord : report of 18 cases and a review of the literature

SummaryEighteen cases of isolated spinal haemangioblastoma are presented. 13 patients were male and 5 female; average age was 34 years. The site of the tumour was bulbo-cervical in 1 case, cervical in 6, cervico-thoracic in 2, thoracic in 7, thoraco-lumbar in 2. Surgical excision of the tumour was total in all cases and peri-operative mortality was 5%. At average follow-up of 11 years, 8 patients had died (4 from neurological causes and 4 from non-neurological disease), and 9 survived; symptoms and signs improved in 11 cases, and were not improved in 6.The biological and pathological characteristics of this tumour are reported in the light of the present 18 cases and those reported in the literature.

Ultrasound-guided brain biopsy : a personal experience with emphasis on its indication

Between January 1989 and June 1991, 40 ultrasound-guided biopsies of supratentorial brain lesions exceeding 15 mm in diameter were performed. The apparatus used was Bergers neurobiopsy set, intraoperative 5 = MHz transducer, and a B-mode scanner. In 38 cases (95%) the procedure provided a histological diagnosis at the first attempt; in two patients, early in the present series, biopsy was repeated by computed tomography-guided technique due to insufficient samples. Operative mortality was zero and there were no septic complications. Clinical symptoms were stationary after the procedure in 34 cases; two cases temporarily worsened due to postbiopsy edema and subcortical hemorrhage, respectively; and four other cases showed an improvement as a result of evacuation of neoplastic cysts. Histologically, there were 24 primary malignant tumors, eight low-grade glial tumors, five metastatic tumors, two abscesses, and one lymphoma. The ultrasound method for brain lesion biopsy was found to be a simple, quick, and low-cost method that gave reliable results. It is indicated for supratentorial lesions over 15 mm in diameter that do not demand absolute anatomical accuracy.

Cell-mediated cytotoxicity in glioma-bearing patients: Differential responses of peripheral blood mononuclear cells to stimulation with interleukin-2 and microbial antigen

Peripheral blood mononuclear cells (PBMC) of malignant glioma-bearing patients were stimulated in vitro with Interleukin-2 (ILr2) or a glucomannan-protein antigen of Candida albicans (GMP) then assayed for proliferation, production of IFN-gamma, and generation of cytotoxic effectors against either K562 tumor cell line or freshly-cultured allogenic glioma cells. PBMC of healthy, age and sex-matched subjects were the controls. PBMC of glioma-bearing patients did not differ, as a whole, from PBMC of healthy donors in IL-2 or GMP-induced proliferation. However, they showed a lesser ability to produce IFN as well as a substantial inability to generate cytotoxic effectors following GMP stimulation. PBMC of glioma patients were fully responsive to ILr2 in cytotoxicity generation, as were the PBMC from normal subjects. The results suggest that glioma patients may have a defective antigen-mediated activation of natural cytotoxic effectors. This hyporesponsiveness is not accompanied by depressed lymphoproliferation and does not apparently involve a reduced response to IL-2.

Post-radiation glioma in a child

A case of primary brain neoplasm is reported that developed 11 years after prophylactic brain irradiation and intrathecal methotrexate (MTX) given for acute lymphocytic leukemia (ALL) at the age of 3 years. Cases of supposed postirradiation gliomas in children seem to have increased in recent years, particularly following apparently successful treatment for ALL or medulloblastoma. This increse might reflect the increased number of long-surviving cancer children and thus suggest that brain irradiation may be a potential risk factor in this population. After reviewing some general data on neurooncogenesis, two points are stressed: (1) the childs brain is particularly susceptible to the mutagenic effects of ionizing radiation owing to physiologically active postnatal glial cell proliferation, which takes place in the cerebral hemispheres, especially during myelinogenesis; (2) MTX could promote glial neoplasm by enhancing reparative glial cell proliferation. Prospective studies seem necessary to show whether or not prophylactic brain radiaton in ALL plays an oncogenetic role. Nevertheless, besides recurrent leukemia, leukoencephalopathy, and radionecrosis, the remote possibility of radiation-induced glial neoplasma should always be considered in cases of children treated for leukemia who present with neurological complications.

Crossed aphasia. An update

The aim of this article is to present an update of a rare but interesting problem: “crossed aphasia”. This term indicates the presence of aphasia after unilateral cerebral lesion of the hemisphere ipsilateral to the patients dominant hand. We report two cases, review the most relevant literature, and analyze clinical, neuroanatomical, and neurophysiological aspects, taking in consideration the various interpretations proposed to explain this unusual language disorder.

Chemioterapia intra-arteriosa con carboplatino nel trattamento del glioblastoma multiforme Uno studio di fase I

12 pazienti portatori di glioblastoma multiforme sono stati sottoposti a chemioterapia con carboplatino mediante somministrazione intra-arteriosa (carotide interna e/o vertebrale) in cicli ripetuti. Gli effetti collaterali sono stati valutati con metodiche cliniche, neurofisiologiche, ematochimiche. I risultati indicano come questa procedura sia sufficientemente ben tollerata, in assenza di tossicità diretta sul SNC, e con una mielotossicità globalmente di grado lieve.