Filtrate of Phellinus linteus Broth Culture Reduces Infarct Size Significantly in a Rat Model of Permanent Focal Cerebral Ischemia

Phellinus linteus, a natural growing mushroom, has been known to exhibit anti-tumor, anti-inflammatory, anti-allergic and anti-oxidant effects. Aiming to exploit the neuroprotective effects of P. linteus, we evaluated its effects on infarct volume reduction in a rat model of focal cerebral ischemia. Male Sprague-Dawley rats were subjected to right middle cerebral artery occlusion. Filtrate of P. linteus broth culture (various doses), fractionated filtrate (based on molecular weight) or control medium was administered intraperitoneally to rats before or after ischemia induction. Rats were killed at 24 h after the stroke surgery. Cortical and caudoputaminal infarct volumes were determined separately using an image analysis program following staining with 2,3,5-triphenyltetrazolium chloride. Significant cortical infarct volume reductions were found in the pre-treatment groups (30 and 60 minutes before onset of cerebral ischemia) compared with the control group, showing dose dependence. Posttreatment (30 minutes after ischemic onset) also significantly reduced cortical infarct volume. Furthermore, the higher molecular weight (≥12 000) fraction of the culture filtrate was more effective compared with the lower molecular weight fraction. The present findings suggest that P. linteus may be a new promising approach for the treatment of focal cerebral ischemia, with the additional benefit of a wide therapeutic time window since significant infarct volume reduction is obtained by administration even after the ischemic event. Our finding that the higher molecular weight fraction of the P. linteus culture filtrate demonstrated more prominent effect may provide a clue to identify the neuroprotective substances and mechanisms

In Reply : Superficial Temporal Artery: Distal Posterior Cerebral Artery Bypass Through the Subtemporal Approach: Technical Note and Pilot Surgical Cases

Non peer reviewe

A Case of Corticotroph Carcinoma that Caused Multiple Cranial Nerve Palsies, Destructive Petrosal Bone Invasion, and Liver Metastasis

A 52-year-old woman experienced sudden onset of double vision due to a right abducens nerve palsy and was diagnosed as having a pituitary macroadenoma that invaded into the right cavernous sinus. Otherwise, she was asymptomatic despite marked elevation of ACTH (293 pg/ml) and cortisol (24.6 μg/dl) levels. The patient underwent transsphenoidal surgery followed by γ-knife radiosurgery (GKR), which healed the diplopia and ameliorated the hypercortisolemia. The excised tumor was diffusely stained for ACTH with a high (15%) Ki-67 labeling index. Early tumor recurrence occurred twice thereafter, producing right lower cranial nerve palsies with petrosal bone destruction at 8 months and an ipsilateral oculomotor nerve palsy at 12 months after GKR; all palsies resolved completely with the second and third GKRs. Hypercortisolemia worsened rapidly soon after the third GKR, and the patient developed marked weight gain, hypokalemia, and hypertension. Multiple liver lesions were incidentally detected with computer tomography and identified as metastatic pituitary tumor on immunohistochemistry. An ACTH-producing adenoma should be followed carefully for early recurrence and/or metastatic spread when the tumor is an invasive macroadenoma with a high proliferation marker level. The unique aggressive behavior and high potential for malignant transformation of this case are discussed

A subcutaneous mass due to a glioblastoma which invaded and destroyed the bone: A case report

Background: Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor. However, it rarely invades and destroys bone. We report the first case of GBM of a very old patient, which eroded the dura and bone and finally resulted in a large facio-cranial subcutaneous lesion in the absence of prior surgery or radiation. Case description: A 93-year-old woman was presumed with a low-grade glioma (LGG), and the lesion was followed up with magnetic resonance imaging (MRI). Serial monitoring revealed no tumor growth until 2 years later, when the patient was admitted to our institution for anorexia and lack of spontaneity and flow of conversation. On admission, she oftentimes complained of severe right forehead skin pain. Computed tomography (CT) revealed enhancing mass lesions in the right frontal lobe and bone destruction. Upon inspection and palpation, a soft and swelling subcutaneous mass was evident at the forehead, the site of bone destruction. Contrast-enhanced MRI revealed ring-enhancing lesions with irregular borders, and the malignant transformation of LGG into GBM was suspected. The patient had severe skin pain at the region of the subcutaneous mass, so tumor resection of the subcutaneous mass was performed for removing the pain and a definitive diagnosis. The pathological diagnosis was isocitrate dehydrogenase (IDH)-mutated glioblastoma. Immunostaining revealed that the tumor was positive for IDH-1 and p53mutations but negative for ATRX. The patient died due to aspiration pneumonitis. Conclusions: We report a first case of GBM in a very old patient untreated with surgery or radiation that invaded and destroyed the calvaria during the natural progression of the disease. Calvarial destruction without prior surgery or radiation in very old patients association with extra- and intra-axial neoplasm should include GBM in the differential diagnosis, although this is very rare