A 33-year-old woman presented with tingling and paresthesia on left extremity for 2 months. Magnetic resonance imaging revealed that the tumor was iso- and hypo-intensity on T1-weighted image, mixed iso- and high-signal intensity on T2-weighted images and heterogeneously enhanced with rim enhancement. Neither arachnoid cleft nor dural tail was certain but mass was located extra-axially so meningioma was suspected. During operation, tumor wasn't attached to dura at all but arachnoid attachment was seen. Pathologically, clear cell type ependymoma was confirmed. Details of diagnosis and treatment of this tumor is described.
Adult ; Arachnoid ; Diagnosis ; Ependymoma* ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Paresthesia ; Tail

Astroblastoma is an uncommon glial tumor with predominant manifestation in the young age. Herein, we report a case of 18-year-old astroblastoma female patient who presented with history of two months headache. Magnetic resonance imaging (MRI) of the brain demonstrated well circumscribed, intra-axial abnormal signal intensity lesion (size=5×4 cm²) in the right parieto-occipital region of the brain. The patient underwent complete surgical resection of the gross tumor, as confirmed by an early post-surgical MRI (i.e., within 24 hours of surgery). Histopathological examination revealed neoplastic lesion exhibiting perivascular pseudo-rosettes with centrally hyalinized blood vessel and focal nuclear pleomorphism. Immunohistochemistry staining illustrated reactivity for glial fibrillary acidic protein and integrase interactor 1 (INI-1). These features rendered the diagnosis of astroblastoma. A comprehensive review of the current literature to summarize the clinicopathological and radiological characteristics, prognostic factors and current treatment strategies of astroblastomas is also presented. Our study would expand the pool of this uncommon tumor towards its better understanding and optimal treatment.
Adolescent ; Blood Vessels ; Brain ; Brain Neoplasms ; Craniotomy ; Diagnosis ; Female* ; Glial Fibrillary Acidic Protein ; Headache ; Humans ; Hyalin ; Immunohistochemistry ; Integrases ; Magnetic Resonance Imaging ; Neoplasms, Neuroepithelial*

Subfrontal schwannomas are rarely reported. They are usually found only in the subfrontal area, but some extend to the nasal cavity. In these cases, prevention of postoperative cerebrospinal fluid (CSF) leakage through thinned or eroded anterior skull base is important. A 51-year-old female with anosmia and mild nausea was diagnosed as subfrontal extraaxial mass with nasal cavity extension. This mass was initially thought to be an olfactory groove meningioma. We performed a bifrontal craniotomy for surgical excision. We did not totally remove the tumor, as we wanted to prevent a skull base defect. The histopathological diagnosis was a schwannoma. There was no postoperative complication such as CSF leakage. The residual tumor was treated with gamma knife radiosurgery. The nasal cavity mass has not grown as of five years after radiosurgery.
Cerebrospinal Fluid ; Cerebrospinal Fluid Leak ; Craniotomy ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Female ; Humans ; Meningioma ; Middle Aged ; Nasal Cavity* ; Nausea ; Neoplasm, Residual ; Neurilemmoma* ; Olfaction Disorders ; Olfactory Nerve ; Postoperative Complications ; Radiosurgery* ; Skull Base

A 19-year-old man presented with bitemporal hemianopsia and was found to have a large sellar and suprasellar tumor, resembling a pituitary macroadenoma. Emergency transsphenoidal approach was attempted because of rapid visual deterioration with headache. However, the approach was complicated and stopped by uncontrolled hemorrhage from the tumor. After conventional cerebral angiography and recognition of an unusual pathology, transcranial approach was achieved to prevent permanent visual loss. The final pathological diagnosis was pituicytoma with epithelioid features. Pituicytoma is a rare low-grade tumor (WHO Grade I) of pituicytes involving the sellar and suprasellar region, and originating from special glial cells of the neurohypophysis. Because of the high vascularity, the firm consistency, and invasion to surrounding neurovascular structures, a pituicytoma should be included in the differential diagnosis of a mass in the sellar and suprasellar area if the tumor shows high enhancement with vascular components. We report a case of rare pituicytoma mimicking a pituitary macroadenoma with massive hemorrhage to disturb surgery.
Cerebral Angiography ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Neuroglia ; Pathology ; Pituitary Gland, Posterior ; Young Adult

Meningiomas and pilocytic astrocytomas are benign intracranial tumors. Pilocytic astrocytomas arises frequently at the posterior fossa in childhood. Meningiomas have several image findings, such as a dural tail sign, bony erosion, and sunburst appearance on angiography. However, pilocytic astrocytomas with these findings have been rarely reported. In this report, we describe a mass with typical image findings of a meningioma, but diagnosed as a supratentorial pilocytic astrocytoma with early anaplastic transformation.
Anaplasia ; Angiography ; Astrocytoma* ; Meningioma* ; Radiography ; Tail

The incidence of leptomeningeal dissemination (LMD) of anaplastic glioma has been increasing. LMD can be observed at the time of initial presentation or the time of recurrence. As a result of both rarity and unusual presentation, a standard therapy has not yet been suggested. In contrast to leptomeningeal carcinomatosis for systemic solid cancers, a relatively prolonged survival is observed in some patients with LMD of anaplastic gliomas. Treatment modalities include whole craniospinal irradiation, intra-cerebrospinal fluid (CSF) chemotherapy, and systemic chemotherapy. In some cases, response to temozolomide (TMZ), with or without combined radiation has been reported. Here, we report two cases of LMD of an anaplastic glioma. In one case LMD presented at the time of diagnosis, and in the other at the time of recurrence after radiation. CSF cytology was positive in both cases, and persisted in spite of intrathecal methotrexate chemotherapy. Later, TMZ was prescribed for progressing brain parenchymal lesions, and both radiological and cytological responses were obtained after oral TMZ treatment.
Brain ; Cerebrospinal Fluid ; Craniospinal Irradiation ; Diagnosis ; Drug Therapy ; Glioma* ; Humans ; Incidence ; Meningeal Carcinomatosis ; Methotrexate ; Recurrence

Ependymoma usually arises within the ventricles and central canal of the spinal cord. These tumors, found in the sellar region, are extremely rare. We report a case of pituitary ependymoma followed up over 10 years. A 59-year-old male patient presented with fatigue, general weakness, erectile dysfunction, and loss of body hair, including pubic hair. Brain magnetic resonance imaging (MRI) revealed a 3.3×3.5×2.3-cm sellar and suprasellar snowman-shaped enhancing mass. The tumor was partially resected via the trans-sphenoidal approach followed by postoperative radiation therapy. The pathologic confirmation was pituitary ependymoma. At the 10-year follow up, MRI revealed no evidence of tumor progression. With lack of knowledge about pituitary ependymoma, our case is the only case in which the disease has been well controlled over a long period of time without tumor progression.
Brain ; Ependymoma* ; Erectile Dysfunction ; Fatigue ; Follow-Up Studies* ; Hair ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Gland ; Pituitary Neoplasms ; Spinal Cord

BACKGROUND: The incidence of brain metastasis (BM) in gynecologic cancers has risen recently, due to prolonged survival times and an early diagnosis. We analyzed treatment outcomes of patients with BM from gynecologic cancers. METHODS: Among 951 patients with BM who were treated in neurosurgical department from July 2003 to February 2016, a total of 20 (2%) patients were from gynecologic cancers. The patients' clinical characteristics were collected by using medical records. There were 14 (66.7%) ovarian cancers, 4 (19.0%) uterine cancers, and 2 (9.5%) cervical cancers. As a primary treatment modality, 11 patients were treated with Gamma Knife surgery (GKS), 6 with surgical resection followed by whole brain radiation therapy (WBRT), and 3 with WBRT only. Overall and progression-free survival according to the primary origin and the primary treatment were analyzed. RESULTS: Median overall survival time was 28 months, and progression-free survival was 15 months. In patients with ovarian cancer, median overall survival did not reach during the follow-up periods and progression-free survival time was 15 months. Median overall survival time in patients who received GKS as the primary treatment was 17 months and that in patients who underwent surgical resection followed by WBRT was 37.3 months (p=0.16). The median value of progression-free survival time in patients who received GKS as the primary treatment was 12 months and that in patients who underwent surgical resection with WBRT was 42 months (p=0.042). Median follow up period of over all patients was 13 months. CONCLUSION: BM from gynecologic cancer is rare (2%), but our findings suggest that the prognosis might not always be poor. In our small series, surgical resection with WBRT was a treatment modality significantly associated with a longer progression-free survival. Additional studies with more cases and multi-institutional cooperation are needed to determine which treatment modality leads to better outcomes.
Brain* ; Disease-Free Survival ; Early Diagnosis ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Medical Records ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Prognosis ; Retrospective Studies* ; Uterine Neoplasms

BACKGROUND: The aim of this study is to investigate the clinical results of adjuvant chemotherapy with hydroxyurea and to compare those with the results of postoperative radiotherapy after incomplete resection of atypical meningiomas (ATMNGs). METHODS: We retrospectively reviewed the medical records of 84 patients with ATMNGs diagnosed in the period from January 2000 to December 2014. Clinical data included patient sex and age at the time of surgery, presenting symptoms at diagnosis, location and size of tumor, extent of surgery, use of postoperative radiotherapy or hydroxyurea chemotherapy, duration of follow-up, and progression. In terms of the extent of surgical resection, incomplete resection was defined as Simpson grade II–V. RESULTS: Among the 85 patients, 55 (65.5%) patients underwent incomplete resection; 24 (43.6%) were treated with adjuvant hydroxyurea (group A), and 20 (36.4%) with postoperative radiotherapy (group B), and 11 (20.0%) underwent conservative treatment after surgery (group C). Twenty-five (45.5%) patients experienced the progression of tumors during the follow-up period (mean 47.7 months, range 12.4-132.1 months); 8 of 24 (33.3%) patients in group A, 7 of 20 (35.0%) patients in group B, and 10 of 11 (90.9%) patients in group C. The mean progression-free survival (PFS) was 30.9 months (range 6.4-62.3 months); 46.2 months in group A, 40.4 months in group B, and 11.9 months in group C (p=0.041). Multivariate analysis showed that Simpson grade (p=0.040), adjuvant treatment after surgery (p<0.001), increased Ki67 (p=0.017), mitotic index (p=0.034), and overexpression of p53 (p=0.026) predicted longer PFS. CONCLUSION: This investigation suggested that adjuvant treatment after incomplete resection of ATMNGs are associated with longer PFS than conservative treatment, and that there is no difference of PFS between hydroxyurea chemotherapy and radiotherapy after surgery. Therefore, hydroxyurea chemotherapy can be considered as another adjuvant tool for the ATMNGs if the postoperative adjuvant radiotherapy cannot be applicable.
Chemotherapy, Adjuvant ; Diagnosis ; Disease Progression ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Hydroxyurea* ; Medical Records ; Meningioma* ; Mitotic Index ; Multivariate Analysis ; Neurosurgery ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies

BACKGROUND: The purpose of this study was to evaluate the prognostic factors and outcomes in patients with ependymoma to management plans. METHODS: Between 1997 and 2013, 33 patients with 25 ependymomas (WHO grade II) and eight anaplastic ependymomas (WHO grade III) were pathologically diagnosed. Six were pediatric patients (mean age, 6.15 years; range, 1.3–11 years), while 27 were adults (mean age, 47.5 years; range, 19–70 years). Of those, there were 12 adult patients with totally resected ependymomas without anaplastic pathology and adjuvant treatment. Prognostic factors were assessed in ependymoma patients. Prognostic factors were studied using Kaplan-Meier estimates in subgroups. RESULTS: For six pediatric patients, the progression-free survival (PFS) was 43.7±13.5 months, and the overall survival (OS) was 58.1±13.7 months. For 27 adult patients, the PFS was 125.6±14.3 months, and the OS was 151.2±12.5 months. Age demonstrated a statistically significant effect on PFS (p=0.03) and OS (p=0.03). In adult ependymomas, the extent of tumor removal significantly affected PFS (p=0.03) and trended towards an effect on OS (p=0.06). Out of 12 patients with totally resected ependymomas without anaplastic pathology and adjuvant treatment, one patient showed tumor recurrence during follow-up (mean, 93.5 months; range, 27.9–162.7 months). CONCLUSION: Adult patients with ependymomas were found to have better survival rates compared to pediatric patients. We suggest that totally resected adult ependymomas without anaplastic pathology could be observed without any adjuvant treatment, regardless of the tumor location.
Adult ; Disease-Free Survival ; Ependymoma* ; Follow-Up Studies ; Humans ; Pathology ; Prognosis ; Radiotherapy ; Recurrence ; Retrospective Studies* ; Survival Rate