IntroductionPrimary brain and CNS tumor incidence is approximately 19 per 100,000 individuals per year in the United States compared with seven per 100,000 individuals worldwide. 1,2 Worldwide this accounts for 2% of all primary tumors and 7% of years of life lost from cancer before the age of 70 years. 1,2 Glioblastoma multiforme (GBM) is also the most aggressive brain tumor with poor prognosis; patients with GBM have a median survival time of about 14 months. [3][4][5][6][7][8][9][10] GBM metastases outside the CNS are rare, so therapeutic experience with these types of tumors is limited. 11-15 Normally the brain is immunologically and anatomically separated from the body by the blood brain barrier. Herein, we present the cases of three patients with GBM with extra-CNS metastasis. The variety of metastasis locations demonstrated in these cases helps to illustrate the various mechanism and corresponding risk factors that allow GBM to escape the CNS. Case ReportsPatient 1. A 51-year-old man presented with a general seizure. Magnetic resonance imaging (MRI) revealed a lesion in the left parieto-occipital lobe (Figs 1A and 1B). Coronal T1-weighted postcontrast ( Fig 1A) and axial T2-weighted cranial MRI (Fig 1B) demonstrated an enhancing left parietal mass involving small venules from the superior sagittal sinus (Figs 1A and 1B, arrows). The patient was diagnosed with a mixed diffuse glioma and underwent subtotal resection of the tumor and postoperative radiochemotherapy. The tumor progressed, and 5 years after diagnosis, the patient underwent contrast-enhanced fluorescence imaging-guided tumor reresection with a subsequent diagnosis of GBM. Two years later, follow-up MRI revealed recurrent tumor. After completing radiochemotherapy, the patient was hospitalized for progressive dyspnea. Chest X-ray revealed a pleural effusion requiring thoracic drainage. Axial contrastenhanced computed tomography demonstrated an ill-defined 4-cm mass in the left lower lung lobe (Fig 1C, arrow) and pleural metastases (Figs 1C and 1E, arrowheads) with infiltration of the chest wall and destruction of a ventrolateral left rib (Fig 1E, asterisks).The pleural lesion was biopsied, and histologic examination of the biopsy sample (Fig 1D, hematoxylin and eosin staining, ϫ200 original magnification) revealed a malignant astrocytic glioma.The patient underwent additional radiochemotherapy with concomitant temozolomide. He completed radiotherapy but died 4 weeks later.Patient 2. A 24-year-old man who had undergone resection of a left temporal GBM involving the greater wing of the sphenoid bone with invasion of the middle cranial fossa at an outside facility presented with anxiety and headaches. Postoperative MRI revealed on axial T1w postcontrast images a dural thickening and extraconal or-
There was poor intraobserver agreement using the semiquantitative grading system. The parameters associated with the grade of stenosis assigned to the foramen were as follows: (1) the observer doing the grading, (2) the place it was imaged, and (3) the location of the foramen. There was poor correlation between measurements of the foramina carried out on MRI and the specimens.
The purpose of this four-part series is to show the high-resolution axial and coronal anatomy of the temporal bone from a flat-panel detector-based volume CT (parts 1 and 2); these imaging planes are then used to outline the effect of different surgical procedures commonly applied to the temporal bone (parts 3 and 4). The structures that are removed or altered in 11 different surgical procedures are color-coded and inscribed in axial and coronal sections. Clinically important imaging features and complications following these surgeries will also be discussed. In these high-resolution images, many structures that are below the resolution limit of conventional CT can be seen and localized. It is hoped that one would be able to picture these structures and surgeries, in the mind's eye, even when they fall below the resolution limit using a conventional CT scanner. This article (part 1) focuses on the preoperative axial anatomy.
The mammalian target of rapamycin inhibitors are normally favored as immunosuppressant agents for solid organ transplantation such as kidney, liver or heart. Only in recent years have they been increasingly administered for the treatment of neuroendocrine tumors. Even though mammalian target of rapamycin inhibitors are known to exhibit specific side effects, everolimus-related severe hepatic steatosis has not as yet been described in the literature. We report the case of a 76-year-old man who developed severe hepatic steatosis within four weeks of treatment with everolimus as concomitant tumor therapy for a progressively growing neuroendocrine carcinoma of the ileum. A diagnosis of hepatic steatosis was established using computer tomography and fibroscan©. Other underlying causes for steatosis hepatis could be excluded. Further studies are warranted to explain the underlying mechanisms.
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