BackgroundThe microenvironment of astrocytomas includes infiltrative inflammatory cells that are dynamic in nature, possibly reflecting tumor biology. We evaluated the inflammatory cell infiltrate in astrocytic tumors aiming for a better understanding of their immunobiology.MethodsImmunohistochemical expression of CD68, CD3, and CD20 was investigated in 21 glioblastomas, 21 anaplastic astrocytomas, 13 diffuse astrocytomas, and 18 pilocytic astrocytomas. The inflammatory infiltrate was classified based on microanatomic location as perivascular and intratumoral, and subsequently graded semiquantitatively.ResultsPerivascularly, CD68-positive infiltrate was noted in 71.4% of glioblastomas compared with 14.3% of anaplastic astrocytomas (P = 0.0001), 7.7% of diffuse astrocytomas (P = 0.0001), and 33.3% of pilocytic astrocytomas (P = 0.017). Intratumorally, 85.7% of glioblastomas exhibited CD68-positive infiltrate compared with 42.9% of anaplastic astrocytomas (P = 0.004), 38.5% of diffuse astrocytomas (P = 0.008), and 33.3% of pilocytic astrocytomas (P = 0.001). Among diffusely infiltrating astrocytomas, intratumoral CD3-positive infiltrate was only associated with glioblastoma. A CD20-positive infiltrate was only detected in the perivascular space of a single case of diffuse astrocytoma.ConclusionThese data indicate a distinct immune profile in the glioblastoma microenvironment primarily related to the prevalence of macrophages. Thus, novel glioblastoma therapies should address this key CD68-positive population and its possible role in generating an antitumor immune response.

Background:A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option?Methods:We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge.Results:Five of the eight “stereotactic cases” had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine “neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery.Conclusion:Conventional craniotomy isn’t indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these treatment modalities for CCGSI.

Introduction: In Egypt, few epidemiologic reports have highlighted the national and regional epidemiologic data regarding primary CNS tumors. In this study we aim to identify the frequency of various primary CNS tumors and to demonstrate the age group distribution, gender, topographic data and the different histopathologic types among our patients. Materials and Methods: Data on all cases of primary CNS neoplasms received at Pathology department of Ain Shams University Specialized hospital in addition to a referral neuropathology lab during the period from 2010 to 2015 were collected with a total number of 996 cases. The patients were divided according to their age into two main groups, pediatric group including children and adolescents (from 0-18 years), and adult group (> 18 years). Patients' demographic data and histopathologic tumor types were analyzed. Result: Frequency of primary CNS tumors among males was higher than females (51.7% vs. 49.3% respectively). Regarding patient age, frequency among adults was (89.4%) compared to pediatric age group (10.6%). Gliomas were the most common primary CNS tumors in adults (35%) followed by meningiomas (33.3%) then pituitary adenomas (15.6%); while in pediatric group embryonal tumors (17%) were the second most common following gliomas (59.4%). Conclusion:This study highlighted the frequency, spectrum and prominent features of primary CNS tumors among Egyptian patients, in comparison to many worldwide reports. This study recommends the establishment of specialized national center for CNS tumors in Egypt; this will provide efficient registry system and accurate data analysis for these tumors.

No abstract

No abstract