The risk for development of hypophyseal adenoma may be greater in patients with the 2G allele. In cases of existing hypophyseal adenoma, those with the homozygous 2G allele tend to be invasive.

Meningioma is a common neoplasm that constitutes almost 30% of all primary central nervous system tumors and is associated with inconsistent clinical outcomes. The extracellular matrix proteins play a crucial role in meningioma cell biology and are important in tumor cell invasion and in progression to malignancy. SPARC (secreted protein, acidic and rich in cysteine) (osteonectin) is a matricellular glycoprotein that regulates cell function by interacting with different extracellular matrix proteins. The aim of this study was to evaluate the expression of SPARC with proliferation index, p53 reactivity in WHO grade 1 (benign), grade 2 (atypical) and grade 3 (anaplastic) meningiomas and correlate with clinical features of the patients, including location of the tumor, recurrence of the tumor and survival of patients. We studied 111 meningiomas, 69 being benign, 34 being atypical and eight being anaplastic meningiomas of various histological types. Using immunohistochemical analysis, we evaluated the expression of SPARC, Ki-67 (MIB-1) and p53 in meningiomas. Immunohistochemical scores of SPARC were determined as the sum of frequency (0-3) and intensity (0-3) of immunolabeling of the tumor cells. A high immunohistochemical score (4-6) for SPARC was more frequent in atypical and in anaplastic meningiomas than in benign meningiomas (p < 0.01). MIB-1 proliferation index showed significant association between tumor grades in meningiomas (p < 0.01). At the end of a follow-up period of 47.53 +/- 25.04 months, 30 tumors recurred. A high SPARC expression was significantly associated with tumor recurrence (p = 0.02). The immunoreactivity of p53 protein and MIB-1 score were significantly higher in recurrent meningiomas than in non-recurrent meningiomas. The cumulative survival of patients with high SPARC expression was significantly lower than patients with low SPARC expression. The high SPARC expression scores were predominantly identified in meningothelial, fibrous and chordoid meningiomas; low SPARC expression scores were mostly spotted in secretory and psammomatous meningiomas. Evaluating SPARC expression might help assessing recurrence risk and survival estimation in meningiomas.

These findings suggest that CT-guided stereotactic surgery of intracranial tuberculomas has advantages over other methods, with a potential to become the first-line modality, particularly as a diagnostic tool, in the management of these lesions.

Nocardial brain abscesses remain a clinical challenge. We successfully treated a patient with nocardial brain abscess, mycetoma, pneumonia, and glomerulonephritis. Nocardial soft tissue involvement, mycetoma, is well known. However, the fact that actinomycetoma can metastasize may not be as well appreciated. The association between nocardiosis and glomerulonephritis should be better clarified. CASE REPORTA 49-year-old male, a businessman, was admitted to our hospital with complaints of severe edema of the lower extremities. Clinically, the diagnosis was nephrotic syndrome. Light microscopy of a renal biopsy showed fibrosis with mesangial hypercellularity and tubular atrophy. Immunofluorescence staining revealed deposition of immunoglobulin G and C 3 at the glomeruli, basal membranes, and mesangia. The diagnosis of a membranoproliferative glomerulonephritis was established, and the patient received oral treatment with prednisolone at 60 mg/kg per day. Because of persistent proteinuria, he underwent monthly intravenous pulse cyclophosphamide therapy. When the patient was hospitalized for his third course of cyclophosphamide therapy 9 months later, he was febrile, and physical examination revealed a tender mass in the anterolateral region of the left thigh. Laboratory findings revealed the following: white blood cell count, 13,360/mm 3 (normal range, 4 ϫ 10 9 to 10 ϫ 10 9 /liter); hemoglobin, 10.4 g/dl (normal range, 11 to 16 g/dl); hematocrit, 32.1% (normal range, 37 to 50%); erythrocyte sedimentation rate, 63 mm/h (normal range, Ͻ25 mm/h); cyclic AMP receptor protein, 16.2 mg/dl (normal range, Ͻ0.8 mg/dl); urea, 35 mg/dl (normal range, 10 to 50 mg/dl); creatinine, 0.8 mg/dl (normal range, 0.7 to 1.2 mg/dl); aspartate aminotransferase, 68 U/liter (normal range, 14 to 36 U/liter); and alanine aminotransferase, 116/liter (normal range, 9 to 52 U/liter). There was 5 g/day of proteinuria. Magnetic resonance imaging of the left lower extremity showed a mass lesion within the vastus lateralis muscle (Fig. 1). The mass had cystic characteristics and was multiloculated. The microbiological diagnosis was made from the aspirated pus of the mass lesion in the left lower extremity. The specimens, cultured on sheep blood agar, brain-heart infusion agar, and Sabouraud dextrose agar plates, were incubated at 37°C in the presence of 10% CO 2 plus air. Direct microscopic examination of aspirated Gram-stained pus showed gram-positive cocci, gram-positive filamentous branching bacilli, and polymorphonuclear neutrophils. The smear was stained with modified acid fast. After a 24-h incubation, typical smooth, yellow-pigmented, hemolyzed colonies were tested with the catalase, oxidase, coagulase, and ID 32 Staph tests (bioMérieux, Nutingen, Germany) and oxacillin on Mueller-Hinton agar. Methicillin-sensitive Staphylococcus aureus was identified. After 3 days of incubation, typical dry, chalky, dull, tough colonies appeared on the media. All species were gram-positive branching bacilli. These bacilli were identified as Nocardia species. ...

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Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT) findings. Because magnetic resonance imaging (MRI) findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms.

ABSTRACTdegeneration should be well understood in parallel to the development of molecular medicine. The prolongation of human life results in formation of degeneration of intervertebral disc and disc herniation with age, and therefore, research into new treatment choices is necessary.The extracellular matrix structure of intervertebral discs consists of collagens, proteoglycans and non-collagen proteins. The biological basis of healthy disc tissue is based on disc cells functioning properly. The intervertebral disc is a tissue that is poor in term of cells. Cells of the disc consist of fibrocytes and chondrocytes. Cells occupy 1-5% of disc █ INTRODUCTIONIntervertebral discs start to degenerate from the moment a human begins to stand and walk (3,8). Degeneration of discs is not a result solely of aging and misuse of the lower back. It is known that many extrinsic, intrinsic and genetic factors play a role in the degeneration of discs (15). Generally, the effect of extrinsic factors such as trauma, heavy load lifting and working conditions on degeneration has been addressed (14). Systemic diseases (14), smoking (5), as well as genetic factors, can also degenerate the disc (3, 12). For this reason, the structure of intervertebral discs and pathophysiology of AIM: The intervertebral disc starts to degenerate when a human being begins to stand and learn to walk. It is known that many extrinsic, intrinsic and genetic factors play a role in disc degeneration. In this study, we examined whether the matrix metalloproteinase 11 might be associated with intervertebral disc degeneration. MATERIAl and METhODS:Fifty-six patients with lumbar disc herniations who were operated at Göztepe Education and Research Hospital, Neurosurgery Clinic between September 2008 and December 2009 were prospectively reviewed. History and complaints were obtained from the case reports. Neuroradiological evaluation was performed with magnetic resonance imaging. Surgical findings of cases were reported in the operation notes. Microscopic posterior hemipartial laminectomy and discectomy were performed in all cases. Degenerated herniated disc material of all cases extracted during surgery was evaluated with immunohistochemical staining in Marmara University, Institute of Neurological Sciences, Pathology Laboratory. RESUlTS:Comparing the immunohistochemical staining of cases who were 50 years or younger and cases who were over 50 years old, statistical significance was determined. CONClUSION:Matrix metalloproteinase 11 has a role in degenerating intervertebral disc disease, but it is not the only factor. Matrix metalloproteinase 11 might be a genetic factor in young-middle aged patients.

ABSTRACTextracellular matrix proteins such as SPARC, Tenascin, matrix metalloproteinase (MMP)-2, MMP-9, . MMP-3 was identified as an enzyme found in the extracellular matrix and synthesized from keratinocytes and was found to have crucial roles in tumor angiogenesis and cellular proliferation (7).To our knowledge, this is the first study dealing with the expression of the MMP-3 in meningiomas. The relationship between MMP-3 and subtypes, grade, Ki-67 proliferation index (PI) and recurrence of meningioma was analysed. RESULTS:Of the MMP-III positive cases; 24 cases (60%) were grade I, 16 cases were grade II. The MMP-3 staining pattern was significantly positive (80%) in grade II meningioma. 14 of the MMP-3 positive cases were atypical meningiomas. Of the 20 cases with high Ki-67 proliferation index (PI), 12 cases (60%) were MMP-3 positive and 8 cases (40%) were MMP-3 negative. Rates of recurrence and preoperative peritumoral edema were high in cases with MMP-3 positivity. CONCLUSION:In this study it was determined that MMP-3 positivity has a strong relationship with meningiomas having an aggressive character. MMP-3 may be used as a proliferation marker for biological behaviour, recurrence rate and prognosis of meningiomas.