We reported a case of pathologically confirmed oligodendrocytic tumor not sensitive to PCV and irradiation therapy that was diagnosed nearly as glioblastoma by chromosome analysis.
An 18-year-old man was admitted to our hospital with gait disturbance, headache and nausea. Computed tomography showed low density tumor with calcification in the left frontal lobe. Magnetic resonance (MR)image showed a low intensity tumor on T1-weighted image and hyperintensity on T2-weighted image, and mildly enhanced by Gd-DTPA administration. Partial removal of the tumor was performed 10 days after admission to obtain biopsy specimens and reduce the mass. The histopathological diagnosis was anaplastic oligoastrocytoma. After surgery, conventional irradiation therapy (60Gy) and chemotherapy with procarbazine, ACNU and vincristine (termed PCV therapy). However the patient developed right hemiparesis and MR images showed remarkable tumor growth. At this point, we performed chromosome analysis of the resected tumor tissue, which showed that 1p loss of heterozygosity (LOH) and 19q LOH were negative, but 10q LOH was positive. We could not continue the PCV therapy due to loss of chemo-sensitivity in the present case. The patient died 308 days after admission.
Some authors have reported that oligodendrocytic tumors frequently display 1p and/or 19q LOH, and these chromosomal alternations are predictors of good response to chemotherapy. An oligodendrocytic tumor that is diagnosed nearly glioblastoma by chromosome analysis, as in the present case, might be better treating using another therapeutic strategy instead of PCV therapy.

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Medulloblastoma is the most common primary central nervous system tumor in children. Recently, major advances in the diagnosis and treatment have led to improved outcomes of them. This manuscript reviews my experienced cases and summaries the pathological and clinical features of medulloblastoma.

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Three patients with rare cases of calcified brain metastases are reported. The first patient had left cerebellar metastasis from gastric cancer. Histological examination showed calcification in the tumor necrosis. He died 7 months after surgery due to meningeal carcinomatosis. The second patient had calcified lesions in the right frontal lobe. She died of meningeal carcinomatosis 16 months after the onset. Postmortem examination showed adenocarcinoma with meningeal dissemination. Calcification was noted in the stroma of the tumor. The third patient had left cerebellar metastasis from colon cancer. Histological examination showed adenocarcinoma with calcification in the tumor necrosis. She survives with stable systemic disease 4 months after surgery.

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Among the 107 opereted cases of meningiomas in the last nine years, only 5 cases showed the extracranial extension (4.7%). Histological examination was confirmed that two cases were meningothelial meningioma, one was transitional meningioma, and the other cases were anaplastic meningioma. All cases had a bone defect and subcutaneous invasion. Immunohistochemical staining revealed the high labeled indeces of MIB-1 and VEGF staining in histological benign cases of meiningioma with the extracranial extension. MIB-1 indeces of anaplastic meiningiomas showed more higher than the menigothelial and transitional ones. MIB-1 staining index and VEGF expression are useful in evaluating proliferative activity and predicting the aggressiveness in tumors of the invading the skull.

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Vol. 13 No. 1 p. 53

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