A biomarker for early diagnosis of central nervous system (CNS) lymphoma would permit early treatment for attenuation of disease progression and neurological deterioration. High interleukin-10 (IL-10) or an IL-10/IL-6 ratio >1.0 are informative parameters for discriminating intraocular lymphomas from uveitis. Recent reports have also shown that CSF IL-10 is a potential diagnostic biomarker for CNS lymphoma. The purpose of this study was to evaluate the diagnostic value of IL-10 in cerebrospinal fluid (CSF) in patients with CNS lymphoma compared with other CNS diseases, including CNS tumors and inflammatory diseases. CSF IL-10, IL-6, beta-2 microglobulin, soluble IL-2 receptor and FDG-PET SUVmax were measured in 19 patients with CNS lymphoma (15 primary and 4 secondary diffuse large B-cell lymphomas) and 26 non-lymphoma patients with various brain tumors and inflammatory diseases. The diagnostic accuracy of the respective examinations for differentiation of CNS lymphomas from non-lymphomas was evaluated by receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) was calculated. CSF IL-10 was detected at significant levels (median, 28 pg/ml; range <2-4,100 pg/ml) in all except one patient with CNS lymphoma, but not detected in any non-lymphoma patients. CSF IL-10 had the highest diagnostic accuracy with AUC = 0.974. At an IL-10 cutoff of 3 pg/ml, the sensitivity and specificity were 94.7 and 100 %, respectively. These results indicate that CSF IL-10 is a superior biomarker for initial screening for patients with CNS lymphoma.

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Radiation-induced glioma (RIG) is a rare secondary glioma. The tumors morphologically resemble their sporadically arising counterparts. Recently, the WHO classification of tumors of the central nervous system was revised to incorporate molecular biomarkers together with classic histological features. The status of molecular biomarkers in RIG, however, remains unclear. The objective of this study was to investigate if commonly accepted glioma-specific biomarkers are relevant in RIGs. Among 269 gliomas diagnosed as WHO grade 2, 3 and 4 in our institution, four were diagnosed as RIGs. Immunohistochemical (IHC) staining for isocitrate dehydrogenase 1 (IDH1), p53, alpha thalassemia/mental retardation syndrome X-linked (ATRX), and H3K27M, and direct DNA sequencing of IDH1/2, telomerase reverse transcriptase (TERT) promoter, Histone H3.3 (H3F3A) and B-Raf (BRAF) genes was performed. All tumor specimens were IDH1-, p53- and H3K27M-negative. The nuclei of tumor cells in all cases exhibited positive staining for ATRX. In direct DNA sequencing analysis, no IDH1, IDH2, TERT promoter, H3F3A or BRAF mutations were found in any of the cases. Our findings suggest that these characteristic glioma-associated molecular mutations may be rare events in RIGs. More RIGs need to be tested for analysis of molecular biomarkers to clarify the clinical and histopathological spectra of this tumor.

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We believe that combining neuroendoscopy with navigation guidance is a safe and precise method for obtaining biopsies of intra-parenchymal tumors. Tumors with rich vasculature will not benefit from this procedure until better hemocoagulation instruments have been developed.

The median nerves of acromegalic patients with CTS were enlarged and had impaired nerve conduction. This finding represents a predominant intrinsic feature in the pathophysiology of the disease rather than an extrinsic feature such as a thickened transverse carpal ligament.

Our study suggests that carotid artery protrusion and dehiscence occur more frequently among acromegalic patients, compared with non-acromegalic patients. It is important for surgeons to be aware of these anatomic variations to avoid vital complications, such as carotid injuries, during surgery.

The intercarotid distance (ICD) between cavernous carotid arteries (CCAs) is an important factor for avoiding injury of the internal carotid artery during transsphenoidal surgery. The ICD between CCAs in pituitary adenoma patients is generally larger than in normal individuals. However, the movement of the CCA during transsphenoidal surgery is not known. The aim of this study is to measure the ICD between CCAs in pituitary adenoma patients before and after surgery. We reviewed 138 pituitary adenoma patients who were treated with resection via the transsphenoidal approach. The CCA diameter and the ICD between CCAs were measured from preoperative and postoperative MR images. The CCA diameter was similar at the preoperative and postoperative time points. On the other hand, the ICD between CCAs was shorter at postoperative time point (19.4 ± 4.5 mm) than at the preoperative time point (20.9 ± 4.9 mm) (P = 0.048). Above all, invasion type adenomas had more significant ICD change at the postoperative time point (23.8 ± 3.8 mm) than at the preoperative time point (21.6 ± 3.9 mm) (P = 0.008). Also in multivariate analysis, cavernous sinus invasion of adenoma was independently associated with ICD contraction >2 mm (P = 0.027). It is important to know the change in ICD between CCAs after transsphenoidal surgery, particularly for pituitary adenomas with cavernous sinus invasion. The position of the CCA should be known before and during transsphenoidal surgery, as well before and during the second operation to avoid vascular injuries.