Junkoh Yamashita

Treatment results of intracranial germinoma as a function of the irradiated volume

Between 1962 and 1986, 70 patients were treated with radiation for confirmed or suspected intracranial germinoma at our hospital. The diagnosis was based on histology in 30 cases, cerebrospinal fluid (CSF) cytology in 12 cases, and on clinical and radiological findings in the remaining 28 cases. The target of radiation was the primary tumor site in 34 cases (Group A), the entire neuraxis in 22 cases (Group B), the whole brain in 4 cases (Group C), and the ventricle plus spine in 6 cases (Group D). Four patients were not included in the above groups for various reasons. The average radiation dose was 50-55 Gy to the tumor, 30 Gy to the whole brain, and 24 Gy to the spinal axis. The 5- and 10-year survival rates of the 68 primary cases in which radiotherapy was completed were 86% and 79%, respectively. The survival and relapse-free survival rates for the above 4 groups did not differ significantly, although slightly better results were seen in Groups B and C. Five cases in Groups A and D developed intracranial recurrence, 4 adjacent to the primary site but 1 distant from it, whereas no intracranial recurrence was found in the whole-brain-treated groups (B and C). One patient in Group B developed spinal metastasis, which was possibly due to inadequate radiation fields, and another in Group B developed abdominal metastasis via the shunt tube. Craniospinal irradiation should be administered to the patients with demonstrated meningeal seeding or with a positive CSF cytology. For cytology-negative cases with no evident metastasis, irradiation of the tumor plus a wide margin is usually sufficient, but craniospinal irradiation should be considered when the disease extends along the ventricular walls or is present in both pineal and suprasellar regions.

Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables.

Background. In supratentorial low‐grade astrocytoma, radiation therapy effects and prognostic factors, especially with respect to computed tomography (CT) findings, are not yet well established. A retrospective analysis of 119 patients with this disease (histologically confirmed ordinary astrocytoma) therefore was conducted.

Long-term follow-up of large or invasive pituitary adenomas

A long-term follow-up study of pituitary adenomas showed that 60 out of 83 patients with mild or moderate suprasellar extension, but only three out of 19 patients with huge or invasive adenomas, were alive at a mean post-operative period of 12.8 and 12 years, respectively. Cerebral ischemic attacks and complications of radiotherapy affected their fate and quality of survival. Patients in the post-computed tomography scan era had a good prognosis, and this may be due partly to the brevity of the postoperative period.

Brainstem glioma: An analysis of 85 cases

SummaryThe study analyses 85 cases of brainstem glioma in the past 35 years, 69 of which include patients under 16 years of age. The incidence of brainstem glioma was 2.4% of all intracranial tumours, and 9.4% of intracranial tumours in children. There were two peaks in age distribution, in the first and in the fourth decades.In children, the tumours were located mainly in the pons, so VIth and VIIth cranial nerve palsies, and pyramidal and cerebellar signs were frequently seen. In adult cases, the tumours ranged in location from the midbrain to the medulla, so neurological symptoms caused by lesions of the whole brainstem axis were seen. The left side was dominant in both age groups.The choice of treatment was steroid administration and radiation. Chemotherapy was not effective. Even after these treatments, the median survival period from onset was no longer than 10.5 months.We conclude that the treatment of brainstem gliomas in children should be distinguished from adult cases, which in the latter may be considered to be merely one of the gliomas which may occur at any other sites. Since brainstem gliomas in children may be congenital, we must redirect our treatment of these lesions to treatment of congenital tumours.

Primary spinal intramedullary malignant melanoma: case report

A rare case of primary spinal intramedullary malignant melanoma at the T6 level in a 31-year-old man is presented. The tumor was partially removed, and neuroaxis irradiation up to 50 Gy was then administered. Subsequently, systemic interferon beta (specific activity, 2.0 X 10(8) IU/mg protein) therapy (total dose, 2.2 X 10(7) units) was begun. At the completion of these therapies, immunohistochemical analysis with monoclonal antibodies against melanoma-associated antigens confirmed the presence of melanoma cells in the cerebrospinal fluid (CSF). Chemotherapy with intrathecal administration of dacarbazine (dimethyltriazenoimidazole carboxamide, DTIC) was then initiated, to avoid the dissemination of tumor cells by the CSF. Periodic cytological examination of CSF for melanoma cells revealed a marked reduction in the number of tumor cells. Pharmacokinetic study showed that the disappearance of DTIC from the CSF was biphasic, with an initial half-life of 30 minutes and a terminal half-life of 5 hours. Follow-up examination by MRI 1 year after the operation did not disclose any significant increase in size of the residual tumor. Neither recurrence nor metastasis was observed. The pertinent literature on spinal cord melanoma is reviewed, and the usefulness of MRI and intrathecal chemotherapy with DTIC is discussed.

Neurinoma of the oculomotor nerve

A case of intracranial neurinoma with discrete oculomotor nerve palsy and ipsilateral exophthalmos was reported. Review of the literature revealed that oculomotor palsy as the initial symptom may be pathognomonic in the neurinoma originating from the oculomotor nerve.

Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings

The CT findings of 19 children under 16 years of age with primary brain tumors in the cerebral hemisphere were investigated with special reference to the existence of cerebral hemiatrophy ipsilateral to the side of the tumor. Ipsilateral cerebral hemiatrophy was observed in four of 19 cases (21%). These included two cases with germinoma in the basal ganglia and two with low-grade astrocytoma in the frontal and occipital cortex. This peculiar CT finding was not specific to the location or histology of the tumor. The four cases were characterized by slow progression, which contrasted with the rapid progression of tumors shown in seven cases with a mass effect on CT.

Intracranial cavernous angioma angiographically mimicking venous angioma in an infant

We present a case of a 15-month-old infant with intracranial cavernous angioma in the right frontal lobe in which the cerebral angiogram revealed transmedullary collecting veins characteristic of venous angioma around the lesion. This vascular malformation was histologically confirmed to be a cavernous angioma.

Single agent therapy of interferon for brain tumours: Correlation between natural killer activity and clinical course

SummaryThe anti-tumour effect of mouse interferon (IFN) on an intracranially transplanted 203-glioma in C 57 BL mice and the natural killer (NK) activity of spleen cells were studied. As a clinical trial, five patients with glioblastomas were treated with human fibroblast IFN and the anti-tumour effect of IFN and the NK activity of peripheral blood lymphocytes were also studied. The NK activity increased after the beginning of IFN therapy but there was no remarkable antitumour effect of IFN in both mouse and human studies. There was no marked correlation between the increased NK activity and the anti-tumour effect of IFN in this study.

An immunohistochemical study of intracranial germ cell tumours.

SummaryHistologically verified intracranial tumours, mainly germ cell tumours of the pineal and suprasellar regions, were studied immunohistochemically using anti-serum of alpha fetoprotein (AFP), human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA), human placental lactogen (HPL), pregnancy specific β-1 glycoprotein (SP-1), glial fibrillary acidic protein (GFAP), S-100 and neuron specific enolase (NSE). In germinomas, HCG positive cells were occasionally demonstrated in cells presenting as syncytiotrophoblastic giant cells (STGC), and GFAP and S-100 positive cells were found in the surrounding gliotic lesions. Teratomas were positive for CEA in their epithelial components. Endodermal sinus tumours were positive for AFP, choriocarcinomas for HCG and SP-1, and embryonal carcinomas for AFP, HCG and SP-1. HCG and SP-1 positive cells were demonstrated in STGC. As for the relationship between serum AFP level and tissue localization, many cases presenting a serum AFP level exceeding 220 ng/ml were positive for AFP in tumour tissue.