We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.
BACKGROUND Esophageal carcinoma rarely metastasizes to the brain. The objectives of the current study were to assess the frequency of brain metastasis from an esophageal primary tumor, to determine correlates of survival, and to describe treatment modalities and their outcomes. METHODS Between June, 1993 and July, 2001, 1588 patients with a primary esophageal carcinoma registered at The University of Texas M. D. Anderson Cancer Center; of those, 27 patients (1.7%) had a diagnosis of brain metastasis. The authors collected demographic and clinical data and performed a statistical analysis. RESULTS The median age at the time patients were diagnosed with brain metastasis was 62 years. Tumor histologies were adenocarcinoma in 22 patients (82%), unclassified carcinoma in 3 patients (11%), and squamous cell carcinoma in 2 patients (7%). Twenty patients (74%) experienced symptoms related to the brain metastasis. The metastases were treated with whole‐brain radiation therapy (WBRT) alone in 15 patients (56%), and 10 patients (37%) underwent surgical resection, 4 of whom (15%) also received WBRT. Two patients (7%) underwent stereotactic radiosurgery. The median survival for the entire cohort after diagnosis of the primary tumor was 12.6 months (95% confidence interval [CI], 2.17–22.5 months), and the median survival after the diagnosis of brain metastasis was 3.8 months (95% CI, 1.1–6.5 months). The longest median survival observed after the diagnosis of brain metastasis (9.6 months) occurred in patients with a single brain lesion who underwent resection and received WBRT. There was a trend toward worse survival in patients with liver metastases and patients in recursive partitioning analysis (RPA) Class II–III versus RPA Class I (P = 0.10 for both; multivariate Cox proportional hazards model analysis). CONCLUSIONS Approximately 2% of patients with esophageal carcinoma had a diagnosis of brain metastasis. Improved outcome was associated with single brain lesions in patients who underwent surgery and received WBRT. Known liver metastasis and higher RPA scores were associated with a poorer survival trend. Cancer 2003. © 2003 American Cancer Society.
Skull base tumors in children affect mainly the anterior and middle cranial fossa. Sarcomas account for the majority of malignant tumors. Treatment of skull base tumors in children and adolescents needs to be tailored to patient age, tumor location, and tumor type.
Intraoperative cytologic evaluation of brain tumors has been used either to render a preliminary interpretation or more often as a complement to frozen section examination. Central neurocytoma is a intraventricular neoplasm, typically located in the region of the foramen of Monro, affecting mostly young to middle age adults. Histologically, central neurocytomas are characterized by monotonous cells with round nuclei and neuronal differentiation within a rich capillary network. Their distinction during intraoperative consultations from oligodendroglioma, ependymoma (mainly clear cell ependymoma), and non-Hodgkin lymphoma can be a diagnostic challenge. We report a case of a 19-year-old female with an intraventricular tumor where imprint cytology preparations were crucial for the intraoperative diagnosis of central neurocytoma. Imprint cytology preparations show a round cell neoplasm associated with neuropil clumps and short straight capillaries admixed with tumor cell clusters. To the best of our knowledge, only a few cases describing the cytologic findings of central neurocytomas have been reported in the medical literature. The differential diagnosis, tissue correlation, clinical-radiologic features, and ancillary studies are discussed.
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