Pilomyxoid astrocytoma (PMA) is a rare disease that is now a recognized variant of pilocytic astrocytoma (PA). Differentiation of PMA from PA is important in patient management because it is more aggressive than PA. However, there have been few reports on image findings for differentiating the 2. This report of a rare case of pathologically proven PMA in a 9-month-old boy addresses the difficulties of differentiation from PA even when magnetic resonance imaging (MRI) findings are typical. The reported image findings typical of PMA raise the possibility of hyperintensity in the T2-weighted MRI, and homogeneous contrast enhancement may reflect the characteristic histopathologic findings in the prominently myxoid background and in the angiocentric arrangement of tumor cells. However, there may be similar MRI findings in PA that are reflected by pathologic features of the compacted tumor cells on the background of a loosely structured tumor matrix. Although, because of a much broader imaging spectrum, no definitive pathognomonic image findings to distinguish PMA from PA have been reported, we confirmed that, even when MRI findings are typical, PMA is difficult to differentiate from PA.
A multicenter early Phase II clinical study of KW-2307, a new vinca alkaloid derivative, in patients (pts) with lung cancer was conducted in 15 hospitals. Ninety-seven pts were enrolled, among whom 95 were eligible. Seventy of the eligible pts had non-small cell cancer (NSCLC) and 25 had small cell cancer (SCLC). PR was obtained in 13 (18.6%) of NSCLC pts and 3 (12%) of SCLC pts. Only those who had no previous chemotherapy showed PR in NSCLC pts, and the response rate in these pts was 29.5% (13/44). As to the correlation between dosage and tumor effect, a better effect was exhibited at higher doses, with response rates of 21.7% (5/23) and 38.1% (8/21) at 20 mg/m2 and 25 mg/m2, respectively. The major adverse effect of this drug was leukopenia (neutropenia), which was Grade 3 or 4 in many cases. Recovery from this complication, however, was rapid. Other adverse effects included mild hepatic dysfunction, anorexia, nausea/vomiting, fever, general fatigue, phlebitis and constipation. The incidence of peripheral nervous disorder such as the paresthesia commonly observed with vinca alkaloids, was as low as 10%, and the symptoms, if any, were mild.
AbstractThe changes in cytochrome oxidase (CYO) activity in the primary somatosensory cortex (SI) induced by unilateral lesions restricted to the posterior ventrobasal region of the thalamus were investigated by histochemical techniques and photometric semi-quantitation in the rat The CYO activity decreased rapidly and dramatically in layer IV of the lesioned side, reaching its lowest level within 2 weeks, and remained depressed at 8 weeks post-lesion. Segmentations normally seen in layer IV corresponding to barrels remained absent. While less marked decreases were also noted in other layers, obvious recovery was subsequently observedattaining levels comparable to those on the intact size at 6 or 8 weeks post-lesion. The persistent decrease in layer IV appears to reflect a reduced thalamocortical activation of the dendritic profiles and neuronal perikarya. The recovery in other layers may represent an increase in the resting level of the initially depressed neuronal activity hear to the original levels. The persistent reduction of function in the inhibitory surround which is normally activated by thalamocortical input, may contribute to the increase in CYO activity. [Neurol Res 1993; 15: 384-388]Keywords: Central paincytochrome oxidasedeafferentation painnucleus ventralis postero-lateralis thalamithalamus
Abstract Primary CNS germ cell tumors (GCTs) are rare neoplasms, therefore, a clinical guideline has not been established so far. While better management has been achieved over recent decades by modifying radiation coverage and selecting appropriate chemotherapy, standardization of treatment remains challenging, partly due to the low volume of cases encountered in each institution. As the incidence is higher in East Asia, including Japan, the Japan Society for Neuro-Oncology established a multidisciplinary task force to create an evidence-based guideline for CNS GCTs. The Medical Information Network Distribution Service (Minds) guideline was referred to and utilized in the course of creating this guideline. We chose 6 topics and 10 clinical questions. This guideline provides recommendations for multiple dimensions of clinical management for CNS GCTs, with particular focus on diagnostic measures including serum markers, treatment algorithms including surgery, radiotherapy and chemotherapy, and under-investigated but important areas such as treatment for recurrent cases, long-term follow-up protocols and long-term sequelae. International collaborations to set standards of clinical management for this rare tumor have proven fruitful, concurrently, many fields continue to show variance in clinical practice, partly due to the rarity of clinical encounters and the absence of documented standards. There still seem to be differences in the treatment concept between Japan and North America or Europe countries. This guideline serves the purpose of helping healthcare professionals keep up to date with current knowledge and standards of management for patients with this rare disease in daily clinical practice, as well as driving future translational and clinical research by recognizing unmet needs concerning this tumor. We discuss about the issues both already clarified and should be cleared in the future.
e12523 Background: Temozolomide (TMZ) is an oral alkylating agent with established antitumor activity in patients with high-grade gliomas. However, oral TMZ cannot be administered to all glioma patients, especially those with difficulty in oral intake, which makes them unable to swallow capsules. Methods: Since intravenous TMZ agent was approved as treatment for malignant gliomas by the Japanese National Ministry of Health and Welfare, we have observed its use in 5 cases and illustrated the effectiveness, toxicity, and safety associated with intravenous TMZ therapy. The primary endpoint was the incidence of adverse events. Results: The study population comprised 3 patients with diffuse intrinsic pontine glioma, 2 patients with pontine glioblastoma and 1 patients with recurrent high-grade gliomas. After intravenous TMZ therapy, 1 patients showed PR and 1 showed SD, whereas 3 patient showed PD during this time. In these 5 cases, we mainly observed hematological toxicities, with the exception of 1 occurrence of extrahematological toxicity (an itching sensation at the infusion site). Grades 2 leukocytopenia and neutropenia were observed in one patients. No grade 3 or 4 leukopenia or neutropenia events occurred in any case. In three cases of brainstem tumor patients, there were tendencies to have difficulty in oral intake of food and medication. In one case, uncontrolled tumor growth despite several treatments caused a great elevation in intracranial pressure, making oral administration difficult. Two cases were pediatric patients suffering from brainstem gliomas. In these cases, the children were not able to swallow large capsules due to esophageal immaturity. Conclusions: As a whole, intravenous TMZ administration has been found to be appropriate for patients with dysphagia resulting from a great elevation in intracranial pressure due to tumor progression, patients unable to take oral medications due to brainstem tumors, and pediatric patients who cannot swallow capsules, especially those under 7 years old. An intravenous formulation provides a useful alternative for these patients, while being generally well tolerated and relatively safe.
Primary CNS germ cell tumors (GCTs) are rare neoplasms predominantly observed in the pediatric and young adult populations. In line with the hypothesis that the primordial germ cell is the cell-of-origin, histopathological examinations for this pathology involve a diverse range of components mirroring the embryogenic developmental dimensions. Chemotherapy and radiotherapy are the mainstays of treatment, with surgery having a limited role for diagnosis and debulking of residual tissue after treatment. While better management has been achieved over recent decades by modifying radiation coverage and selecting appropriate chemotherapy, standardization of treatment remains challenging, partly due to the low volume of cases encountered in each institution. As the incidence is higher in East Asia, including Japan, the Japan Society for Neuro-Oncology established a multidisciplinary task force to create an evidence-based guideline for CNS GCTs. This guideline provides recommendations for multiple dimensions of clinical management for CNS GCTs, with particular focus on diagnostic measures including serum markers, treatment algorithms including surgery, radiotherapy, and chemotherapy, and under-investigated but important areas such as treatment for recurrent cases, long-term follow-up protocols, and long-term sequelae. This guideline serves the purpose of helping healthcare professionals keep up to date with current knowledge and standards of management for patients with this rare disease in daily clinical practice, as well as driving future translational and clinical research by recognizing unmet needs concerning this tumor.
