Toshiro Shimura

Chondroblastoma of the temporal bone

A rare case of chondroblastoma arising from the temporal bone that occurred in a 60-year-old woman is reported. The tumor appeared well demarcated and osteolytic on the radiographs. CT scan clearly depicted marginal and central calcification in the tumor. MR imaging demonstrated two components in the tumor: a solid component with predominantly low signal intensities on both T1- and T2-weighted sequences, and a multilocular cystic component with T1- and T2-elongation and fluid-fluid levels on the T2-weighted images. Postcontrast MR imaging revealed marked enhancement in the solid component and the septa of the cystic component.

Cavernous hemangioma of the skull in a neonate

Abstract Cavernous hemangiomas rarely occur in the calvarium and most commonly present in middle-age. Although a congenital vascular disorder can theoretically cause a diploic lesion in any age group, a calvarial cavernous hemangioma has not been reported in newborn. A 4-month-old male infant presented with a large left parietal mass that had been present since birth. Total resection was performed. Pathological examination revealed a cavernous hemangioma developing within the diploic space adjacent to prior hemorrhages. Surgery was performed in this case because of the size and persistence of the lesion. Removal of tumors of a benign nature from the calvarium can be done safely. Cavernous hemangioma of the skull in a neonate should be considered as one of the differential diagnoses in the case of suspected ossified cephalohematoma.

Drug-induced Apoptosis by Anti-microtubule Agent, Estramustine Phosphate on Human Malignant Glioma Cell Line, U87MG; in vitro Study

The drug effect of estramustine phosphate (EMP), an anti-microtubule agent on human glioma cells has been studied with the focus being mainly its cytotoxity or its targeting of organelles. However, the pharmacological knowledge of estramustine with respect to its cytotoxity and mechanism is limited. To acquire such knowledge, the present study investigates the ability of EMP to induce apoptosis in a human malignant glioma cell line. Transmission electron microscope (TEM) images were examined to monitor periodic changes. Agarose gel electrophoresis was also examined. Cellular DNA fragmentation ELISA was performed to investigate the DNA fragmentation rates and an MTT assay was studied to evaluate the ID50. A TEM study revealed condensing and fragmentation of the chromatin. Laddering of the bands was observed in all EMP exposure groups in agarose gel electrophoresis. DNA fragmentation in all EMP groups began at 0.5 h following an exposure with EMP and increased in a dose- and time-dependent manner as revealed by DNA ELISA fragmentation. ID50 at 24 h was 5.0 µM according to the MTT assay, a value close to 4.8 µM of ID50 was revealed by the DNA fragmentation assay. None of the above mentioned changes was observed in the control group. These results indicated that EMP caused a drug-induced apoptosis in the human malignant glioma cell line, U87MG.

Intracranial malignant meningioma with abdominal metastases associated with hypoglycemic shock : a case report

A thirty-year-old male with an intracranial malignant meningioma, first diagnosed 9 years ago, with three recurrences was admitted with a hypoglycemic shock. The blood glucose level was 17 mg/dl, requiring treatment with high doses of intravenous and oral dextrose for improvement. A large metastatic tumor in the liver was noted. All hormones and peptides influencing blood glucose levels were in their normal levels. Chemo-embolization and injection of anti-cancer drugs was employed in the management of the metastatic tumor. Positron emission tomography was performed to measure the glucose metabolism of the abdominal tumor and it indicated that glucose consumption within the tumor was much elevated than the surrounding abdominal organs. Hypoglycemia secondary to primary hepatoma or islet-cell cancer has been frequently described, but a complication of metastatic meningioma is an exceedingly rare event. Elevated glucose consumption within the tumor might be addressed as one of the reasons for hypoglycemia, not due to the elevated serum levels of insulin or IGF, but due to the closely related blood glucose level.

Metabolic studies of the edematous cerebral cortex of the pyrithiamine-treated thiamine-deficient rat

The pyrithiamine-treated rats produced by our method histopathologically exhibited the edematous lesion not only around the third ventricle and at the tegmentum of pons, as expected, but also in the cerebral cortex. These animals were, therefore, used in a biochemical study of the cerebral cortex, in particular, glucose metabolism. The results indicate an accumulation of lactate and severe impairment of the lipid metabolism in the edematous lesion of the cerebral cortex among the pyrithiamine-treated rats. The fact that oxygen consumption was hardly diminished, however, strongly suggested that amino acids were selectively supplied to the tricarboxylic acid cycle from the free amino acid pool.

A case of solitary fibrous tumor of the meninges.

We report a rare case of solitary fibrous tumor (SFT) of the meninges of the posterior fossa presenting as an intracerebellar hemorrhage. A 29-year-old woman was admitted with sudden-onset severe headache, nausea, and vomiting. A computed tomographic (CT) scan of the brain revealed an intracerebellar hemorrhage 3.5 cm in diameter. Gadolinium-enhanced magnetic resonance imaging (MRI) showed a heterogeneous enhancement mass. A posterior craniotomy found a firm, highly vascular tumor attached to the meninges. Histologically, the tumor showed mostly sclerotic tissues with spindle cells. In few areas, the tumor had a more compact arrangement of spindle-shaped cells with vascular spaces and highly cellular components. Immunohistochemical study revealed strong CD-34 immunopositivity in many tumor cells. The tumor was diagnosed as SFT of the meninges. We report the clinical and histological features of this newly described tumor with a heterogeneous component.

Central neurocytoma expressing characteristics of ependymal differentiation: electron microscopic findings of two cases.

 We describe two cases of central neurocytoma in the lateral ventricle. Ultrastructural examination showed occasional cilia mixed in with sparse dense core vesicles and thin tumor cell processes containing parallel microtubules. These central neurocytomas revealed evidence of ependymal differentiation. We propose that central neurocytoma originates from multiple differentiation from the germinal matrix cell layer.

Detection of Epstein-Barr virus DNA and expression of CD30 antigen in primary anaplastic diffuse large B-cell lymphoma of the brain.

We describe a case of primary anaplastic diffuse large-cell lymphoma arising in the central nervous system (CNS). Primary CD30-positive anaplastic diffuse large B-cell lymphoma of the brain is very rarely reported. Given that this tumor is immunohistochemically heterogeneous, polymerase chain reaction (PCR) and Epstein-Barr virus (EBV) analysis of tumor DNA are essential techniques for early and accurate histological diagnosis in these CD30-positive cerebral lymphoma cases. We report an early CD30- and EBV-positive anaplastic diffuse large B-cell lymphoma in the CNS that was diagnosed not only from the immunohistochemical study and MRI findings, but also from the genotype confirmations. This tumor was documented to have EBV episomes of monoclonal origin by PCR analysis of immunoglobulin gene rearrangement.

An adult case of cerebral primitive neuroectodermal tumour.

A 33 year-old woman was referred to our department in April 1980 with a 7-year history of involutary movement of the right hand. The computer tomography (CT) scan revealed a 1 1 cm calci®cation and a 3 cm 3 cm low to isodensity mass in her right parietal lobe with midline shift (Fig. 1a). In 1985, the patient underwent a right parietal craniotomy and partial removal of the tissue. Biopsy of the abnormally hard cortex was performed and the histological diagnosis was hamartomatous gliomesenchymal tissue with calci®cation. Because of its very slow progression, neither radiation nor chemotherapy was given. The patient was re-admitted with deterioration of consciousness and moter weakness of the right hand in May 1997. The CT scan showed huge right fronto-parietal mass lesion with hydrocephalus and calci®cation. A T1-weighted magnetic resonance image with gadolinium showed marked enhancement (Fig 1b). A right frontoparietal craniotomy was performed. The tumour was yellowish grey, elastic hard with a cystic part and well demarcated from surrounding brain parencuyma. Histological examination of the tumour showed numerous uniform small round cells with hyperchromatic round nuclei (Fig. 1c). Anaplastic features and mitotic ®gures were frequent and the proliferative cell index using monoclonal antibody MIB-l was 25.2%. Immunohistochemical staining for glial ®brillary acidic protein (GFAP), neuro-®lament, S-100 protein, keratin, vimentin, synaptophysin was negative while neuron speci®c enolase and chromogranin-A was weakly positive in scattered cells. UCHL-1 and L26, the surface marker of lymphocytes, and MIC-2, a speci®c marker of peripheral PNET, were negative. Ultrastructural observation demonstrated clusters of small undi ̈erentiated cells with scanty cytoplasmic rims containing sparse organelles. An immature neuronal axon-like structure with microtubules of 200 to 220 A in diameter was observed (Fig. 1d). By immunohistochemical and ultrastructural studies, the tumour was diagnosed as a PNET with slight neuronal di ̈erentiation.

Intracranial fibromyxoma in a four-year-old child

A case of an intracerebral fibromyxoma in a 4-year-old female with a developing left hemiplegia is described. Primary intracranial benign fibrous tumors are rare. A review of the relevant patients in the literature revealed 12 other cases. The management of this patient and an analysis of reported cases are presented.