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Context.—Prostate-specific membrane antigen (PSMA) is expressed in endothelium of vessels in malignant solid tumors but not in normal vessels. Objective.—To examine whether neovasculature of glioblastoma multiforme (GBM) expresses PSMA. Design.—After institutional review board approval at Memorial Sloan-Kettering Cancer Center, formalin-fixed paraffin-embedded tissue from 32 patients who underwent a maximally safe neurologic resection during 2004 to 2005 for GBM (World Health Organization criteria) was obtained. We performed immunohistochemical staining on the vessels of the GBM specimens for PSMA expression in tumor endothelium. The tissue samples were also stained for CD31 to verify that the PSMA was staining tumor vessels. The PSMA percent staining was scored: less than 5%, 6% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. Staining intensity was ranked as follows: 0 (none), 1+ (faint), 2+ (moderately-intense), and 3+ (maximum-intensity). Results.—Immunohistochemical staining on the vessels of 32 paraffin-embedded GBM specimens revealed that all 32 (100%) specimens exhibited staining for PSMA to a variable extent. Of these, 22 of 32 specimens (69%) had more than 51% vascular staining for PSMA. The intensity of staining was 2+ to 3+ in most of the specimens (29 of 32; 91%). Conclusions.—Prostate-specific membrane antigen is expressed in the vasculature of GBM vessels, thus rendering a potential novel therapeutic vascular target. A clinical trial with a cytotoxin-conjugated antibody to PSMA is planned.

Abstract BACKGROUND Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane. OBJECTIVE To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation. METHODS Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume. RESULTS Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles. CONCLUSION MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.

Epileptogenic tumors affecting children and young adults are a morphologically diverse collection of neuroepithelial neoplasms that, as a group, exhibit varying levels of glial and/or neuronal differentiation. Recent advances in molecular profiling technology, including comprehensive DNA sequencing and methylation analysis, have enabled the application of more precise and biologically relevant classification schemes to these tumors. In this report, we describe a morphologically and molecularly distinct epileptogenic neoplasm, the polymorphous low-grade neuroepithelial tumor of the young (PLNTY), which likely accounts for a sizable portion of oligodendroglioma-like tumors affecting the pediatric population. Characteristic microscopic findings most notably include infiltrative growth, the invariable presence of oligodendroglioma-like cellular components, and intense immunolabeling for cluster of differentiation 34 (CD34). Moreover, integrative molecular profiling reveals a distinct DNA methylation signature for PLNTYs, along with frequent genetic abnormalities involving either B-Raf proto-oncogene ( BRAF ) or fibroblast growth factor receptors 2 and 3 ( FGFR2 , FGFR3 ). These findings suggest that PLNTY represents a distinct biological entity within the larger spectrum of pediatric, low-grade neuroepithelial tumors.

Stereotactic needle biopsy, a standard of care for acquiring deep-seated pathology, has limitations and risks in some situations. We present an uncommon case with basal ganglia dematiaceous mycetoma. Due to the firm consistency of the lesion, the initial stereotactic needle biopsy failed to provide a diagnosis. In a second operation, transtubular excisional biopsy was successfully performed to remove the entire mycetoma. We reviewed recent case series of transtubular approaches to deep-seated brain lesions and suggest this method could be a rescue for a non-diagnostic stereotactic needle biopsy and even may be the approach of choice in some cases.

Coronaviruses, mouse hepatitis virus (MHV) strains, exhibit various degrees of neurotropism and hepatotropism following intracerebral (IC) infection of 4-week-old C57Bl/6 mice. Whereas MHV-A59 produces acute meningitis, encephalitis, hepatitis, and chronic demyelination, a closely related strain, MHV-2, produces only acute meningitis and hepatitis. We previously reported that the spike glycoprotein gene of MHV contains determinants of demyelination and hepatitis. To further investigate the site of demyelination and hepatitis determinants within the S gene, we sequenced the S gene of several nondemyelinating recombinant viruses. We found that three encephalitis-positive, demyelination-negative, hepatitis-negative recombinant viruses have an MHV-A59-derived S gene, which contains three identical point mutations (I375M, L652I, and T1087N). One or more of the sites of these mutations in the MHV-A59 genome are likely to contribute to demyelination and hepatitis.

Abstract BACKGROUND AND IMPORTANCE: Solitary fibrous tumor (SFT) has been previously reported for its wide variety of presentations and atypical sites. We report a case of recurrent SFT with multiple intracranial and spinal lesions. CLINICAL PRESENTATION: A 45-year-old female with recurrent right frontoparietal SFT was found to have multiple intracranial and spinal lesions. Most of the lesions are asymptomatic. Each of the intracranial and spinal lesions has been confirmed histologically. In 1999 the patient was found to have a single right temporal SFT and had a gross total resection of the lesion. In 2005 the patient underwent a second gross total resection for the recurrence of the right temporal-parietal lesion, followed by radiation therapy. In 2009 she underwent a third and fourth gross total resection of the right frontoparietal lesion, and the L4-5 mass, as well as a cervical laminectomy for an extramedullary spinal lesion causing spinal compression. CONCLUSION: This is the first case report of recurrent SFT with multiple intracranial and spinal lesions. This case illustrates the nature of recurrence and multiplicity of SFT and raises the importance of a thorough investigation, especially in the entire neuroaxis, in patients with the diagnosis of SFT. This case also questions the justification of the name that was given to this tumor.

Cervical hemangiopericytoma (HPC) is a rare tumor involving dura and bone. Because HPC shares some imaging features with meningioma, hemangioblastoma, schwannoma and solitary fibrous tumors; histology with appropriate immunohistochemistry is essential for its diagnosis and treatment. HPC is highly vascular and has a high rate of local recurrence following resection. Thus it can pose significant therapeutic challenges. To the best of our knowledge this is the 13th reported case of HPC of the cervical spine and the first case of cervical HPC treated using embolization with Onyx-18. In addition, a systematic review of the literature is presented describing previous experience with HPC of the cervical region. The case of a 61-year-old woman is reported who presented with a 7 month history of dizziness, mild ataxia and left-sided tinnitus when supine. MRI of the cervical spine demonstrated a gadolinium enhancing mass arising from the dorsal cervical dura, extending from the occiput to C2, with internal flow voids and extension into the C2 lamina and spinous process. Digital subtraction angiography demonstrated multiple corkscrew-shaped supplying vessels, marked hypervascularity, rapid arteriovenous shunting and delayed contrast washout. Super selective injection of Onyx-18 yielded approximately 90% embolization of the lesion, followed by subtotal resection and radiotherapy. Histology confirmed the presumptive diagnosis of HPC. Preoperative embolization with Onyx-18 should be considered for large HPC as it may decrease the risk of intraoperative hemorrhage. In this case, embolization with Onyx-18 did not preclude histopathologic diagnosis of HPC.