Dean F. Uphoff

Patterns of Epithelial Metaplasia in Malignant Gliomas II. Squamous Differentiation of Epithelial-like Formations in Gliosarcomas and Glioblastomas

Six cases are reported (four gliosarcomas and two glioblastomas) in which the epithelial-like areas of glial anaplasia showed focal squamous cell differentiation, characterized by the development of epithelial whorls, keratin pearls and immunopositivity for cytokeratin. The expression of glial flbrillary acidic protein and the development of squamous metaplasia usually were mutually exclusive. Autopsy findings in two patients and clinical work-up in five failed to disclose a primary extraneural malignancy. It is suggested that squamous differentiation may represent an extreme form of epithelial metaplasia in a malignant glioma. This possibility should be kept in mind in the diagnostic evaluation of such cases, especially in view of the current emphasis on the immunomorphologic demonstration of intermediate filament tumor markers.

Applications of lipid-coated microbubble ultrasonic contrast to tumor therapy

Lipid-coated microbubbles (LCM) make an excellent diagnostic ultrasonic contrast agent in experimental tumor systems. LCM have been shown to aggregate in brain tumors and subcutaneous tumors after intravenous administration, and to provide persistent image enhancement for many minutes. In this work, experimental subcutaneous Walker Carcinosarcoma is insonated after the bubbles are given intravenously. Selective necrosis, lymphocyte proliferation and hemorrhage within the tumor can be demonstrated. Preliminary data are given to demonstrate this phenomenon. The mechanism of the effect is discussed in the context of both heating and cavitation.

Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease

A 48-year-old man presented with progressive spastic paraparesis and diffuse white matter involvement on neuroimaging that suggested a primary demyelinating disease. Brain biopsy 3 years after onset of symptoms demonstrated idiopathic granulomatous angiitis. In patients with MRI features of diffuse white matter disease of uncertain etiology, open brain biopsy of leptomeninges and parenchyma should be considered to exclude idiopathic granulomatous angiitis of the CNS.

Meningioma: The role of a foreign body and irradiation in tumor formation

A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented.

Rhizopus brain abscess: report of a case and review of the literature

The case of a 34-year-old intravenous drug abuser who survived brain abscess due to Rhizopus arrhizus is presented. The diagnosis was made by brain biopsy. Fungal brain abscess is a rare complication of IV drug abuse. Phycomycetes cause venous thrombosis and infarction of brain tissue. Medical versus surgical options are discussed.

Diagnostic role of target lesion on diffusion-weighted imaging: a case of cerebral aspergillosis and review of the literature.

Background/Purpose Target lesions on diffusion-weighted imaging are uncommon and their significance not well appreciated. To assess the diagnostic value of this neuroimaging finding, a case of cerebral aspergillosis is presented and the literature reviewed. Methods The diffusion-weighted magnetic resonance imaging features of target lesions in a case of cerebral aspergillosis with neuropathologic correlate is presented and 8 other cases manifesting this neuroimaging finding are reviewed for etiology, patient immune status, lesion number, enhancement, and location. Results The etiologies included cerebral aspergillosis, Balo concentric sclerosis, and acute necrotizing encephalopathy. The cerebral aspergillosis cases were immunocompromised with multiple lesions in 4 of 5 patients. The acute necrotizing encephalopathy and Balo concentric sclerosis patients were immunocompetent with bilateral thalamic lesions in the former and multiple random or solitary lesions in the later. Enhancement was seen in 5 patients. Conclusion Target lesions on diffusion-weighted imaging are compelling for a diagnosis of cerebral aspergillosis in immunocompromised patients and for acute necrotizing encephalopathy in immunocompetent patients when lesions are bilateral thalamic and Balo concentric sclerosis when white matter is involved.

Rheumatoid Meningitis Presenting With Multiple Strokelike Episodes

Discussion | Greco et al6 described the presence of inclusions in 11 cases of men with FXTAS aged 67 to 87 years. In our patient, the number of inclusions were in the low range when compared with those cases. In summary, FXTAS is thought to be a disorder of aging in carriers of FMR1 premutation; however, this case documents that FXTAS can occur earlier in adult life, particularly if another disease process is occurring, such as substance abuse, that may exacerbate the pathological process of FXTAS.5

Ring sign on diffusion-weighted imaging.

A 44-YEAR-OLD WOMAN with a progressive neurologic illness characterized by headache and seizurewasadmitted to thehospitalwith new dysarthria, left facial droop, and left hand weakness. Cerebrospinal fluid examination findings were unremarkable except for 5 oligoclonal bands. Magnetic resonance imaging demonstrated ring lesions on diffusion-weighted imaging (DWI) with corresponding changes on apparent diffusion coefficient mapping with associated gadolinium enhancement and increased signal on fluid-attenuated inversion recovery imaging (Figure 1). The patient’s condition deteriorated and she died after a 3-week hospitalization. Autopsy showed pulmonary embolism as the cause of death. Neuropathologic examination of the brain demonstrated a cavitated lesion in the right centrum semiovale. Microscopy showed multiple lesions of active and recent demyelination in the periventricular white matter and left middle cerebellar peduncle with alternatingbandsofmyelinatedanddemyelinated axons, characteristic of Baló concentric sclerosis, along with macrophages containing myelin breakdown products (Figure 2).