). Palavras-Chave► neuroparacoccidioidomicose ► paracoccidioidomicose ► abscesso fúngico ResumoA paracoccidioidomicose é uma micose sistêmica, endêmica na América Latina, causada pelo fungo Paracoccidioides brasiliensis. O Brasil é o país com maior número de casos. A afecção do sistema nervoso central (SNC), condição potencialmente fatal, ocorre em torno de 12% dos casos. Identificam-se as seguintes formas de apresentação: meníngea, mais rara; meningoencefálica; e pseudotumoral, mais frequente. Os exames de imagem são fundamentais no auxilio diagnóstico, porém a identificação histológica do fungo é necessária para confirmação. O quadro clínico depende da localização no neuroeixo. Apresentamos o caso de um homem, trabalhador rural, com formações expansivas no SNC, compatíveis com paracoccidioidomicose. AbstractParacoccidioidomycosis is a systemic mycosis, endemic in Latin America, caused by the fungus Paracoccidioides brasiliensis. Brazil is the country with the highest number of cases. The affection of the central nervous system (CNS), a potentially fatal condition, occurs in 12% of cases. The following forms of presentation are identified: meningeal, unusual, meningoencephalitis and pseudotumoral the latter two being more frequent. Imaging tests are essential in diagnostic, but the histological identification of the fungus is required for confirmation of the pathology. The clinical picture depends on neuraxial location. We present a case report of a male rural worker, with expansive lesions in the CNS, compatible with paracoccidioidomycosis.
Neurocysticercosis is the most common parasitic infection affecting the central nervous system, usually involving the brain parenchyma, intracranial subarachnoid space, or ventricular system. In rare cases, there is involvement of the spine (vertebral, epidural, subdural, arachnoid, or intramedullary). Even in endemic regions, this variant is rare, with an incidence below 5% of all patients. The diagnosis is made based on the symptoms, which can be very unspecific, imaging and CSF analysis, with biopsy as a possibility. Treatment is usually curative, but important deficits can develop, due to compression of the spinal cord or nerve roots, arachnoiditis, or meningitis. We present the case of a patient who developed this entity, with poor clinical scenario, and review the literature on the topic. Palavras-chave ResumoNeurocisticercose é a infecção parasitária mais comum afetando o sistema nervoso central, geralmente envolvendo o parênquima cerebral, espaço subaracnóide intracraniano ou sistema ventricular. Em raros casos, há envolvimento da coluna vertebral, espaços epidural e subdural, aracnoide, ou intramedular. Mesmo em áreas endêmicas, esta variante é rara, com incidência abaixo de 5% entre todos os pacientes. O diagnóstico é feito com base nos sintomas, que podem ser bastante inespecíficos, neuroimagem e análise do líquor, sendo a biópsia uma possibilidade. O tratamento geralmente é curativo, porém importantes déficits podem se desenvolver, devido à compressão da medula espinhal ou raízes nervosas, aracnoidite ou meningite. Relatamos o caso de um paciente que desenvolveu esta entidade, com sintomatologia escassa, e revisamos a literatura sobre este tópico.
Olfactory groove schwannomas (OGSs) are rare benign tumors of the anterior skull base region. Considering the lack of Schwann cells in the optic and olfactory nerves, their origin remains enigmatic. Despite the precursor cell, total resection of the lesion is curative, as long as the histopathological features of the tumor are compatible with schwannoma. We report the case of a 32-year-old woman, addicted to crack, who was brought to the hospital presenting with cognitive dysfunction after being physically assaulted, whose neuroimaging revealed a large extra-axial mass in the subfrontal sagittal region. The presentation, immunohistochemical markers and histogenesis are discussed in the present study, along with a literature review.
Teratomas are the most common type of Germ Cell Tumors (GCTs). GCTs are classified as extragonadal, if there is no evidence of a primary tumor in neither the testicles, nor in the ovaries. Intracranial Mature Teratomas are tumors with a very low incidence, and clear male predominance. We present the case of a 21 year-old female patient, with a history of two seizures 15 days prior to admission, without any abnormalities upon physical examination. The Magnetic Resonance Imaging (MRI) performed at the admission evidenced an expansive, heterogeneous lesion in the frontal lobe, hypointense on T1-weighted images, hyperintense on T2-weighted images, and restriction on the diffusion imaging and ADC-mapping. The patient underwent microsurgical resection, and it was possible to achieve a near-total resection. During surgery, a welldefined capsule was identified, which was removed after adequate debulking. Tissues resembling hair were taken from inside the lesion. The patient recovered well, without any neurological deficits, and no further intervention was necessary. The authors aim to describe this rare pathology and their option for a surgical approach. Palavras-chave► neoplasia cerebral ► tumor células germinativas ► neurocirurgia ResumoOs teratomas são o tipo mais comum de Tumores de Células Germinativas (TCG). TGC são classificados como extragonadais, quando não há evidências de um tumor primário em nos testículos, ou nos ovários. Os Teratomas Maduros Intracranianas são tumores com uma incidência muito baixa, e com uma predileção pelo sexo masculino. Nós apresentamos o caso de uma paciente, feminina, 21 anos de idade, com história de dois episódios de convulsões tônico-clônicas generalizadas, 15 dias antes da admissão, sem nenhum déficit focal ao exame físico. A Ressonância Magnética realizada na chegada mostrou uma lesão sólida, expansiva, grande e heterogênea, hipointensa em T1, e hiperintensa em T2, com restrição a difusão e ADC-mapping. Foi realizado uma cirurgia, e foi possível obter uma ressecção quase total. Havia uma cápsula bem definida, a qual foi removida após adequada redução do volume tumoral. Dentro da lesão foi encontrado tecido semelhante a cabelo. A paciente se recuperou bem, e foi dado alta sem novos déficits neurológicos, não foi realizado mais nenhuma intervenção, e ela está sendo acompanhada regularmente. Os autores visam descrever essa patologia rara e sua opção por uma abordagem cirúrgica.
Medulloblastoma (MB) is the most common type of malignant pediatric brain tumor. Neuropilin-1 (NRP1), encoded by the NRP1 gene, is a transmembrane glycoprotein overexpressed in several types of cancer. Previous studies indicate that NRP1 inhibition displays antitumor effects in MB models and higher NRP1 levels are associated with poorer prognosis in MB patients. Here, we used a large MB tumor dataset to examine NRP1 gene expression in different molecular subgroups and subtypes of MB. We found overall widespread NRP1 expression across MB samples. Tumors in the sonic hedgehog (SHH) subgroup showed significantly higher NRP1 transcript levels in comparison with Group 3 and Group 4 tumors, with SHH samples belonging to the α, β, Δ, and γ subtypes. When all MB subgroups were combined, lower NRP1 expression was associated with significantly shorter patient overall survival (OS). Further analysis showed that low NRP1 was related to poorer OS, specifically in MB subgroups SHH and Group 3 MB. Our findings indicate that patients with SHH and Group 3 tumors that show lower expression of NRP1 in MB have a worse prognosis, which highlights the need for subgroup-specific investigation of the NRP1 role in MB.
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