Tumors of pineal cell origin

Tumors of pineal cell origin are rare intracranial lesions. They are the second most common entity encountered in the pineal gland, after tumors of germ cell origin. They are classified according to their differentiation in pineocytomas (World Health Organization [WHO] grade I tumor), pineal parenchymal tumors of intermediate differentiation, papillary tumors of the pineal region, and pineoblastomas (WHO grade 4 tumor). Differentiation between pineal and germ cell tumors is essential, and for this purpose serum and cerebrospinal fluid (CSF) markers are used, alongside imaging techniques. Often, the only way to differentiate these two types of tumors is through a biopsy, which may be carried out with or without a simultaneous third ventriculocisternostomy. Retrospective series show an association between the extent of resection and improved outcomes, and benign lesions may be cured by performing a gross total resection. However, the approaches to this region are highly complex, because of the plethora of essential neuroanatomical structures in the area. The approaches need to be tailored to the specific anatomy of the patient and should aim at minimizing surgical morbidity. Because of their complexity, these lesions should mainly be performed in centers with sufficient experience in the treatment of pineal region lesions.</p

Lower pre-treatment T cell activation in early- and late-onset tuberculosis-associated immune reconstitution inflammatory syndrome

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an inflammatory complication in HIV-TB co-infected patients receiving antiretroviral therapy (ART). The role of disturbed T cell reconstitution in TB-IRIS is not well understood. We investigated T cell activation and maturation profiles in patients who developed TB-IRIS at different intervals during ART.Twenty-two HIV-TB patients who developed early-onset TB-IRIS and 10 who developed late-onset TB-IRIS were matched for age, sex and CD4 count to equal numbers of HIV-TB patients who did not develop TB-IRIS. Flow cytometry analysis was performed on fresh blood, drawn before and after ART initiation and during TB-IRIS events. T cell activation and maturation was measured on CD4+ and CD8+ T cells using CD45RO, CD38, HLA-DR, CCR7 and CD27 antibodies.CD8+ T cell activation before ART was decreased in both early-onset (77% vs. 82%, p = 0.014) and late-onset (71% vs. 83%, p = 0.012) TB-IRIS patients compared to non-IRIS controls. After ART initiation, the observed differences in T cell activation disappeared. During late-onset, but not early-onset TB-IRIS, we observed a skewing from memory to terminal effector CD4+ and CD8+ T cell populations (p≤0.028).Our data provide evidence of reduced CD8+ T cell activation before ART as a common predisposing factor of early- and late-onset TB-IRIS. The occurrence of TB-IRIS itself was not marked by an over-activated CD8+ T cell compartment. Late- but not early-onset TB-IRIS was characterized by a more terminally differentiated T cell phenotype