Yuzo Yamakawa

Ciliated and goblet cells in craniopharyngioma

SummaryA case of a suprasellar epithelial cyst in a 48-year-old man is reported. The cyst was lined with two different types of stratified epithelium: one was two to three or more layers of squamous cells with overlying ciliated columnar cells and goblet cells at the surface and the other was typical stratified squamous epithelial cells. The tumor was neither a pure Rathkes cleft cyst nor a typical craniopharyngioma but was considered essentially to be a craniopharyngioma with ciliated columnar cells and goblet cells. Thus it might be considered a mixed form of these two tumors. This case indicates the close relationship between craniopharyngiomas and Rathkes cleft cysts.

Epithelial cells in symptomatic rathke's cleft cysts: A light- and electron-microscopic study

Epithelial cells composing symptomatic Rathkes cleft cysts were examined electron microscopically in two cases, and the fine structures were compared with those of the mucosa in the normal sphenoid sinus, of the normal choroid plexuses, and of a craniopharyngioma with goblet and ciliated cells. The Rathkes cleft cysts were composed of a single or pseudostratified epithelial layer abutting on the connective tissue. The epithelial cells were of four different kinds of cells, such as goblet, ciliated, flat, and basal cells. The flat cells containing bundles of tonofilaments and desmosomes were the squamous cells. They were present in a single-epithelial layer in both cases. The basal cells were present as small, wedge-shaped cells, even if the number was very small. The epithelial cells in Rathkes cleft cysts were more similar to those of the mucosa in the sphenoid sinus and those of a craniopharyngioma with goblet and ciliated cells than those of the choroid plexus. This study indicates the close relationship between Rathkes cleft cysts and mucosa in the sphenoid sinus or craniopharyngioma with ciliated and goblet cells.

Primary leiomyosarcoma of the cervical spine causing spontaneous compression fracture: Report of an autospy case

An extremely rare case of the primary leiomyosarcoma of the cervical spine presenting as a compression fracture is reported. A 69‐year‐old man complained of dysesthesia of both hands. A plain radiograph, computed tomography and magnetic resonance imaging of the cervical spine showed a compression fracture of the vertebral body at C7 without the formation of an obvious mass. From radiological findings, the fracture was considered to be caused by an infiltrative vertebral bone tumor. Biopsy of the tumor revealed a leiomyosarcoma, a metastatic tumor being ruled out by a systemic investigation. The patient died of pleural metastasis 6 months later, and an autopsy confirmed the primary site of the tumor as the cervical spine.

3H-thymidine autoradiography of CSF cells in primary reticulum cell sarcoma of the brain.

SummaryCSF cells in a case of primary reticulum cell sarcoma of the brain with diffuse subarachnoid spreading were examined by 3H-thymidine autoradiography. Immediately after lumbar puncture, the CSF withdrawn was incubated at 37°C for 1 hr with an admixture of 3H-thymidine at a rate of 1 μCi/ml CSF. The cells were collected by centrifugation and the microautoradiographic procedure was performed. The labeling index (L.I.) of the total CSF cells was 10.5%, and when non-neoplastic cells, i.e. polymorphonuclear leukocytes, small lymphocytes, monocytes etc., were excluded, the real L.I. of the tumor cells in the CSF was supposed to be more than 14.4%. Referring to the results of various brain tumors reported in the literature, this belongs at least to the highest labeling group. The high L. I. of the tumor cells in this case was well consistent with the extremely rapid clinical course. It should be stressed that the examination of CSF cells by 3H-thymidine autoradiography in cases of brain tumors could be one of the valuable methods indicating the DNA synthesis of the tumor cells, which is an important parameter of malignancy.ZusammenfassungLiquorzellen in einem Fall von primärem Reticulumzellsarkom des Gehirns mit diffuser subarachnoidealer Ausbreitung wurden mit 3H-Thymidin-Autoradiographie untersucht. Sofort nach der Lumbalpunktion wurde der entnommene Liquor bei 37°C für 1 Std mit 3H-Thymidin inkubiert. Die Zellen wurden durch Zentrifugation gesammelt, und ein mikroautoradiographisches Verfahren wurde ausgeführt. Der Markierungsindex der gesamten Liquorzellen wurde mit 10.5% errechnet. Wenn nichtneoplastische Zellen, d. h. Granulocyten, Monocyten, Lymphocyten usw., ausgeschlossen wurden, dann betrug der echte Markierungsindex der Tumorzellen im Liquor mehr als 14.4%. Der Index entspricht somit den höchsten von den in der Literatur berichteten Markierungen bösartiger Gehirntumoren des Menschen. Der hohe Markierungsindex dieses Tumors entsprach dem außerordentlich rasch progredienten klinischen Bild. Es wird hier betont, daß die Untersuchung der Liquorzellen bei Gehirntumoren mit 3H-Thymidin-Autoradiographie für eine Beurteilung der Fähigkeit der DNS-Synthese der Tumorzellen verwendet werden kann, und damit einen Hinweis auf die Malignität gibt.

Clinical features of the localized girdle sensation of mid-trunk (false localizing sign) appeared in cervical compressive myelopathy patients

Cervical compressive myelopathy patients sometimes show localized girdle sensation in the mid trunk (so-called false localizing sign). This symptom often confuses physicians, but the clinical features and mechanism of this symptom are still unclear. We investigated the clinical features and possible mechanism. In each of five cases of cervical compressive myelopathy disease with and without mid-truncal girdle sensation, the clinical features, degree and shape of cord compression were analysed. The girdle sensation was expressed as a vague or burning sensation, and was localized with a width of 3 or 4 dermatomes from the T3 to T11 level. There was no correlation between the appearance of the girdle sensation and etiology and level of cervical cord compression. Pyramidal tract signs and disturbance of superficial sensation were observed in all cases. Furthermore, on axial MRI, the midline ventral surface of the cervical cord was remarkably compressed in cases with girdle sensation, as if the compressive lesion entered the anterior medial fissure of the cervical cord. From these findings, this false localizing sign may be caused by severe compression of midline ventral structure of the cervical cord. Ischemia of the thoracic watershed zone of the anterior spinal artery from the compression of the anterior spinal artery at the cervical level might also be considered to be a possible cause.

3H-thymidine autoradiography of the CSF cells in cases of non-neoplastic disease.

SummaryHuman CSF cells in cases of non-neoplastic disease of the central nervous system (CNS) were examined in vitro by 3H-thymidine autoradiography. Immediately after withdrawal by lumbar or ventricular puncture, the CSF was incubated in a sedimentation chamber at 37°C for 1 hr with an admixture of 3H-thymidine at a concentration of 1–2 μCi/ml CSF. In a few cases the CSF withdrawn was incubated in a glass tube in the same condition as in a sedimentation chamber, and the CSF cells were collected by centrifugation. The CSF cells collected were fixed in methanol and the microautoradiographic procedure was performed.Labeled CSF cells were found in 21 cases out of 22. The average labeling index of the total nucleated cells was 0.22% with the highest labeling of 0.74%. Almost all the labeled cells were thought to be medium to large sized lymphocytes and monocytoids. Peripheral blood was examined by a similar method and the results were compared with those of the CSF.It may be noteworthy that there exist DNA synthesizing cells in the CSF even in a non-neoplastic state of the CNS, although the number is not large.ZusammenfassungMenschliche Liquorzellen in den Fällen von nichtneoplastischen Krankheiten des zentralen Nervensystems wurden in vitro mit 3H-Thymidin-Autoradiographie untersucht. Sofort nach der Lumbal- oder Ventrikelpunktion wurde der entnommene Liquor in einer Sedimentierkammer bei 37°C für 1 Std mit 3H-Thymidin inkubiert. Bei einigen Fällen wurde der entnommene Liquor in einem Spitzglas in dem gleichen Zustand wie in der Sedimentierkammer inkubiert, und die Liquorzellen wurden durch Zentrifugation konzentriert. Diese Zellkonzentrate wurden in Methanol fixiert und ein mikroautoradiographisches Verfahren angewandt.In 21 von 22 untersuchten Fällen wurden die markierten Liquorzellen gefunden. Der durchschnittliche Markierungsindex der gesamten kernhaltigen Liquorzellen war 0,22%, und der höchste Markierungsindex war 0,74%. Die markierten Zellen wurden fast ausschließlich als mittelmäßige oder große Lymphocyten und Monocytoiden angesprochen. Blutzellen wurden mit der gleichen Methode untersucht, und die Resultate wurden mit denen der Liquorzellen verglichen.Es ist bemerkenswert, daß es auch bei nichtneoplastischen Prozessen des Zentralnervensystems Liquorzellen mit der Fähigkeit der DNS-Synthese gibt, obwohl ihre Zahl nicht groß ist.

A study of CSF cells by 3H-thymidine autoradiography and cytology regarding the subarachnoid dissemination of brain tumor.

SummaryIn order to evaluate subarachnoid dissemination of brain tumor, the cerebrospinal fluid (CSF) cells of 104 patients with brain tumor were examined by 3H-thymidine autoradiography and cytology. As a control CSF cells from 34 patients with non-neoplastic disease were examined by the same method. Immediately after withdrawal by lumbar or ventricular puncture, the CSF was incubated with an admixture of 3H-thymidine at a concentration of 1–2 μCi/ml CSF at 37°C for 1 h. The CSF cells were collected by sedimentation or centrifugation and the microautoradiographic procedure was performed. The labeling index (LI) of CSF cells was counted excluding small lymphocytes and polymorphonuclear leukocytes. Labeled CSF cells were found in 33 of 34 cases of non-neoplastic cases. The mean LI of CSF cells in non-neoplastic cases was 0.4% and the highest was 1.7%. Cytological study revealed neoplastic CSF cells in 15 of 104 cases of brain tumor. A LI exceeding 1.7%, which was the highest in non-neoplastic cases, was encountered in 24 of 104 neoplastic cases. The highest LI in neoplastic cases was 14.4% in a case of primary reticulum cell sarcoma of the brain. High labelings were seen in cases of primary brain sarcoma, metastatic carcinoma, meningeal leukemia and pinealoma. In cases of glioma, even though malignant, the LI was relatively low in most cases. High LIs were parallel with the result of cytology in most cases. It was suggested that either 3H-thymidine autoradiography or cytology of CSF cells alone was not always conclusive for the diagnosis of subarachnoid dissemination of brain tumor, but by using both methods the diagnosis would be obtained with more accuracy.ZusammenfassungUm eine subarachnoideale Ausbreitung des Tumors auszuwerten, wurden die Liquorzellen von 104 Patienten mit Hirntumoren mittels 3H-Thymidin-Autoradiographie und Cytologie untersucht. Zur Kontrolle wurden die Liquorzellen von 34 Patienten mit nicht-neoplastischen Krankheiten des zentralen Nervensystems nach der gleichen Methode untersucht. Sofort nach der Lumbal- oder Ventrikelpunktion wurde der entnommene Liquor in vitro bei 37°C für 1 Std. mit 3H-Thymidin (1–2 μCi/ml Liquor) inkubiert. Die Zellen wurden durch Sedimentation oder Zentrifugation gesammelt und dann ein mikroautoradiographisches Verfahren angewandt. Der Markierungsindex der Liquorzellen wurde nach Ausschluß der kleinen Lymphocyten und Granulocyten berechnet. Markierte Liquorzellen wurden in 33 von 34 nicht-neoplastischen Fällen gefunden. In nicht-neoplastischen Fällen war der durchschnittliche Markierungsindex der Liquorzellen 0,4% und der höchste 1,7%.Die cytologische Untersuchung zeigte neoplastische Liquorzellen in 15 von 104 neoplastischen Fällen. Ein Markierungsindex von Liquorzellen über 1,7%, d. h. dem höchsten Wert in nicht-neoplastischen Fällen, wurde in 24 von 104 neoplastischen Fällen beobachtet. Der höchste Markierungsindex der Liquorzellen bei Hirntumoren war 14,4% (primäres Reticulumzellsarkom des Gehirns). Hohe Markierungsindexe wurden auch bei primären Gehirnsarkomen, metastatischen Carcinomen, meningealen Leukämien und bei Pinealomen angetroffen. In Fällen von Gliomen — auch bösartigen — war der Markierungsindex der Liquorzellen relativ niedrig. Der hohe Markierungsindex der Liquorzellen entsprach in den meisten Fällen dem Vorkommen von neoplastischen Zellen. Abschließend wird darauf hingewiesen, daß weder die 3H-Thymidin-Autoradiographie noch die Cytologie allein die Beurteilung einer subarachnoidealen Aussaat eines Tumors endgültig gestattet, daß aber durch Anwendung beider Methoden eine größere Genauigkeit erreicht werden kann.

The Cross-Sectional Area of Paraspinal Muscles Predicts the Efficacy of Deep Brain Stimulation for Camptocormia

BACKGROUND Camptocormia, a disturbance of posture, is a well-described clinical feature of PD and other parkinsonian syndromes. Previous reports have shown that DBS of the subthalamic nucleus (STN) or globus pallidus internus is effective in treating camptocormia. However, the efficacy of DBS for camptocormia varies. OBJECTIVE To determine a clinical marker for selecting an appropriate therapy for camptocormia, a disabling manifestation of Parkinsons disease (PD) that has a variable response to systemic and local therapies. METHODS We obtained pre-operative lumbar magnetic resonance imaging of 14 consecutive PD patients with camptocormia who underwent subthalamic nucleus deep brain stimulation (STN-DBS) in this retrospective-designed study. Lumbar MRI was performed three to six months prior to the operation. We measured the cross-sectional area (CSA) and width of each participants paraspinal muscles. RESULTS Four (28.6%) patients were effective (EF), five (35.7%) were partially effective (PE), and five (35.7%) were non-effective (NE) to STN-DBS. The lumbar paraspinal CSA and width were significantly larger in the EF group than in the PE and NE groups. CONCLUSIONS The CSA of paraspinal muscles and erector spinae width can be good predictive markers for improving camptocormia in patients with PD after deep brain stimulation.

Delayed resolution of intracranial germinoma after radiotherapy: a preliminary study of the correlation between histology and magnetic resonance imaging.

A central nervous system germinoma is curable in most cases by radiotherapy, and most of the tumor mass disappears promptly after 20–30 doses. However, some germinomas take a longer period to vanish completely from magnetic resonance imaging (MRI) or computed tomography (CT) scans. In such cases, the tumor may contain components such as teratoma. The aim of this study was to clarify the nature of the persistence of some germinomas. Five cases of histologically verified germinoma in which radiotherapy was performed to treat residual tumor were selected. The doses of focal radiotherapy and whole brain radiotherapy were 10–20 Gy and 20–34 Gy, respectively. In these cases, correlation was made between the degree of persistence of the tumor when assessed by MRI and the amount of interstitial content, as determined by histology. The histological evaluation, using hematoxylin–eosin stain, silver impregnation and Azan staining was carried out independently of clinical information. The tumor vanished soon after radiotherapy in three cases, but 3–15 months passed before the tumor completely vanished from the MRI scans in the other two cases. The histology of the cases in which the tumor disappeared rapidly was predominantly of large tumor cells and only small amounts of reticulin. However, in the persistent tumors, large amounts of reticulin and vascular components were present. Thus, it is proposed that tumors with a large parenchymal component disappear soon after radiotherapy, whereas tumors composed mainly of interstitial component persist. Long‐standing enhancement seen on MRI or CT scans of patients with an intracranial germinoma is indicative of a large amount of interstitial component in the tumor.

The Effectiveness of the Stereotactic Burr Hole Technique for Deep Brain Stimulation

Deep brain stimulation (DBS) is performed by burr hole surgery. In microelectrode recording by multi-channel parallel probe, because all microelectrodes do not always fit in the burr hole, additional drilling to enlarge the hole is occasionally required, which is time consuming and more invasive. We report a stereotactic burr hole technique to avoid additional drilling, and the efficacy of this novel technique compared with the conventional procedure. Ten patients (20 burr holes) that received DBS were retrospectively analyzed (5 in the conventional burr hole group and 5 in the stereotactic burr hole group). In the stereotactic burr hole technique, the combination of the instrument stop slide of a Leksell frame and the Midas Rex perforator with a 14-mm perforator bit was attached to the instrument carrier slide of the arc in order to trephine under stereoguidance. The efficacy of this technique was assessed by the number of additional drillings. Factors associated with additional drilling were investigated including the angle and skull thickness around the entry points. Four of the 10 burr holes required additional drilling in the conventional burr hole group, whereas no additional drilling was required in the stereotactic burr hole group (p = 0.043). The thicknesses in the additional drilling group were 10.9 ± 0.9 mm compared to 9.1 ± 1.2 mm (p = 0.029) in the non-additional drilling group. There were no differences in the angles between the two groups. The stereotactic burr hole technique contributes to safe and exact DBS, particularly in patients with thick skulls.