Spontaneous regression of nonfunctioning pituitary macroadenoma: A case report

A case involving a 13-year-old girl with nonfunctioning pituitary macroadenoma is discussed. The patient visited the hospital for checkup after experiencing a head injury secondary to syncope. A computed tomography (CT) scan revealed a pituitary mass with mildly higher density. Magnetic resonance imaging (MRI) with contrast enhancement showed that the mass contained a hyperintense area and it elevated the optic chiasm. The patient had blurred vision in her right eye. No endocrinological abnormalities were found. When the patient was admitted for surgical removal of the mass 1 month later, her visual acuity had improved. A repeat MRI showed that the size of the pituitary mass had dramatically reduced. During the following 2 years, the mass showed further reduction in size and did not re-grow. Since symptoms of pituitary apoplexy were not observed, we believe that asymptomatic apoplexy occurring at the time of the first visit may have caused regression of the tumor

Salvage treatment with temozolomide in refractory or relapsed primary central nervous system lymphoma and assessment of the MGMT status

High-dose methotrexate (HD-MTX) is effective in the initial treatment of primary central nervous system lymphoma (PCNSL). Since the treatment options in patients with progressive or recurrent PCNSL are limited, their prognosis is remains poor. Temozolomide, a well-tolerated oral alkylating agent that permeates the blood brain barrier, is effective against malignant glioma and recurrent PCNSL. The gene for the DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT), which is closely related to cellular sensitivity to alkylating agents, is inactivated by promoter hypermethylation. We evaluated the results of temozolomide treatment and the methylation status of the promoter region of the MGMT gene in 17 patients (median age 68 years) with refractory or relapsed PCNSL. They were immunocompetent and had received initial treatment with HD-MTX (3.5 g/m2) with or without irradiation. All were treated with temozolomide 150 to 200 mg/m2, for 5 days in the course of 28 days; treatment was continued until disease progression. We observed 5 complete remissions, 5 partial responses and stable disease, and 7 disease progressions. Median overall survival after the temozolomide treatment was 6.7 months. One patient manifested grade 3 neutropenia and thrombocytopenia. Eleven tumor specimens were available for MGMT analysis. MGMT promoter methylation (mMGMT) in the tumor tissue was found in 4 (36.4%), the other 7 harbored a non-methylated MGMT promoter (nmMGMT). There was no statistically significant difference in median overall survival between patients with mMGMT (11.1 months) and nmMGMT (6.7 months)(p=0.63). Although some patients were elderly and had been heavily pre-treated, temozolomide produced a complete response in 29% and was well tolerated without any major toxicity

Cardiac 123I-MIBG scintigraphy as an outcome-predicting tool for subthalamic nucleus stimulation in Parkinson\u27s disease

Background 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool for differentiating idiopathic Parkinson\u27s disease (PD) from other parkinsonian syndromes, but its prognostic value in PD has not been established. The objective of this study was to clarify the correlation between cardiac MIBG uptake parameters and the outcome in PD patients subjected to the subthalamic nucleus stimulation. Method We enrolled 31 consecutive PD patients and calculated the heart-to-mediastinum ratio (H/M) and washout rate (WR) based on the activity measured at 15 min (early phase) and 3 h (delayed phase) after the intravenous injection of MIBG (111 MBq). Cardinal motor symptoms and activity of daily living (ADL) were assessed on the Unified Parkinson\u27s Disease Rating Scale (UPDRS) and Schwab and England (S-E) ADL scale, before and 3 months after surgery. Findings Neither early nor delayed H/M correlated with any of the preoperative subscores on the UPDRS or S-E, nor with postoperative outcome. On the other hand, increased WR was a positive predictor for postoperative improvement rate on S-E in medication-off state (p=0.00003). Also, WR showed a more faint but significant correlation with preoperative levodopa responsiveness on S-E (p=0.008). Conclusion Our findings suggest that 123I-MIBG scintigraphy in combination with levodopa-responsiveness evaluation may represent a useful tool for prediction of outcomes in patients subjected to STN stimulation

Olfactory auras caused by a very focal isolated epileptic network in the amygdala

Epileptic olfactory auras manifesting as simple partial seizures are rare. We report a patient who presented with olfactory auras after hemorrhage from a cavernous angioma in the left mesial temporal region. His olfactory auras persisted 12 years after two surgeries for a cavernous angioma. Intracranial depth electrodes revealed a very focal isolated epileptogenic zone in the amygdala. Olfactory auras were successfully treated by focus resection

Therapy-associated secondary tumor in patients with non-germinomatous malignant germ cell tumors

We report 3 patients with non-germinomatous malignant germ cell tumor (NGMGCT) who developed therapy-associated secondary tumors. They were diagnosed as having NGMGCT by elevated serum levels of β-fetoprotein (AFP), human chorionic gonadotropin (HCG), or β-HCG. Preoperatively, all patients received a combination of etoposide and platinum-based chemotherapy and radiotherapy; neo-adjuvant therapy (NAT) was followed by complete excision of the residual tumor. Postoperatively, all underwent maintenance chemotherapy and all remained free of NGMGCT without recurrence. However, they developed therapy-associated secondary tumors, i.e. glioblastoma, meningioma, or cavernous angioma after an interval of 10.1-, 9.8-, and 8.2 years, respectively. The patient with gliobastoma died 1 year after its detection. The other 2 patients are currently alive; the meningioma was completely removed and the cavernous angioma is being monitored without additional treatment. To our knowledge, therapy-associated secondary tumors in patients treated for NGMGCT are rare