Expression of RCAS1 protein in microglia/macrophages accompanying brain tumours : an immunofluorescence study

The expression of protein RCAS1 (receptor-binding cancer antigen expressed on SiSo cells), possibly involved in the mechanisms of evasion of immune surveillance by tumours, has been studied in brain astrocytomas grade III and IV and in metastatic carcinomas to the brain by means of double immunofluorescence with antibodies against RCAS1 and respectively anti-GFAP (astroglia) or CD68 or CD74 (macrophages/microglia). Expression of RCAS1 has been reported in many types of carcinomas and in some normal cells, including bone marrow macrophages. Nakabayashi and coworkers recently reported expression of RCAS1 in gliomas. So far no attention has been paid to expression of RCAS1 in non-neoplastic cellular elements of tumours such as macrophages and to the expression of RCAS1 in metastatic carcinomas. We found expression of RCAS1 co-localizing with GFAP+ cells of gliomas and with CD68 and CD74 in large macrophages infiltrating metastatic and primary tumours and sometimes in cells which had morphological characteristics of microglia. Moreover, sometimes strong RCAS1 positivity has been found in metastatic carcinomas. Whether expression of RCAS1 in macrophages accompanying brain tumours is of any importance it is not possible to ascertain at present. However, when elucidating the possible role of RCAS1 in tumour biology, it seems to be necessary to include its presence not only in neoplastic cells

Prothymosin-alpha and Ki-67 expression in pituitary adenomas

Introduction: Prothymosin alpha (PTMA), a nuclear oncoprotein involved in cell cycle regulation, is used as a prognostic marker in many cancers. The histopathology of pituitary carcinomas and locally invasive adenomas is indistinguishable from that of benign tumors. A new marker is needed to differentiate these lesions. We evaluated PTMA in pituitary adenomas to determine its usefulness as a prognostic factor of tumor proliferation.Material/Methods: We conducted a retrospective analysis of a group of 27 patients, including 15 females (56%) and 12 males (44%) with a mean age of 58.6±12 years, who underwent pituitary tumor surgery between 2003 and 2012. The Ki-67 and PTMA-nuclear (PTMA-n) and PTMA-cytoplasmic (PTMA-c) indices were determined by immunohistochemical staining. We studied histopathological features, clinical symptoms, and magnetic resonance imaging or computed tomography performed before surgery and one year following surgery to evaluate tumor size and progression.Results: The expression of Ki-67 was revealed in 77.8% of adenomas, PTMA-n in 81.5% and PTMA-c in 92.6%. The mean value of the Ki-67 index was 1.8%, PTMA-n was 1.84%, and PTMA-c was 35.6%. There was a significant positive correlation between Ki-67 and PTMA-n (p=0.009). We did not find any correlation between Ki-67, PTMA-c, and tumor progression. PTMA-n was found to be correlated with tumor size (p=0.045) and was higher in the case of gonadotropinomas (p=0.026).Conclusions: The positive nuclear expression of Ki-67 and PTMA was observed in the majority of pituitary adenomas. Neither the expression of Ki-67 nor that of PTMA-c was related to tumor recurrence or local invasion

Angiocentric glioma from a perspective of A-B-C classification of epilepsy associated tumors

Angiocentric glioma (AG) is a newly-classified, very rare, WHO grade I central nervous system (CNS) lesion, occurring usually in children and young adults. Only 52 patients with AG have been reported so far, making it one of the rarest neuropathological entities. Hereby we present two new cases of AG in young subjects with detailed neuropathological investigations and a neuroradiological picture along with a brief summary of all already published literature reports of this tumor. Histopathological examination of the resected tissue from both cases revealed similar changes characteristic of AG. The tumors were composed of spindle-like, elongated cells, forming characteristic pseudorosettes around vessels and diffusively infiltrating surrounding tissue, trapping neurons between tumor cells. Noticeably, some neoplastic cells encrusting vessels extended far beyond the main tumor mass. Hypothetically, this may be responsible for the recurrence of the tumor even in the case of apparently total excision. In immunohistochemistry, AG cells were glial fibrillary acidic protein (GFAP) and vimentin positive, also exhibiting a strikingly significant epithelial membrane antigen (EMA) dot-like staining pattern. In one of the cases, electron microscopy revealed ependymal differentiation features such as microvilli and cilia. Taken together, all these data strongly confirm a dual astroglial-ependymal nature of the tumor. Follow up corroborates benign character of this neoplasm. Both AGs reported here were immunonegative for the product of the mutated IDH-1 gene what, according to our best knowledge, has never been reported so far. It may suggest that in their pathogenesis AGs differ from grade II astrocytomas, which in most cases harbor a mutation of IDH-1. Noteworthy, neuroimaging in our cases was relatively characteristic but not conclusive, therefore biopsy (at least) is mandatory. A newly proposed so called "A-B-C" classification of long-term epilepsy-associated tumors (LEATs) places AG in a category named ANET. The authors shortly review the A-B-C classification of LEATs

Health related quality of life of the patient with Immunoglobulin G4-related cranial hypertrophic pachymeningitis (IgG-HP) causing disturbances of cognitive control treated with neurofeedback

Health related quality of life (HRQoL) is the most desired patient centered outcome of medical care (Leplége et al. 1997). In patients with long term illness, such as Hypertrophic Pachymeningitis (HP) still under diagnosis, therefore no possible to properly cure, it might be the only outcome achievable (Netuveli et al. 2005; Trystuła 2017). The problem becomes even more serious when occurs in young person: starting a family and caring for children becomes hard or even impossible, because of his/her physical and psychical conditions. Most clinicians are aware of the importance for quality of life of this functional limitation, but there are no articles describing this problem in the literature. We aimed to fill this gap in knowledge. 29 year old patient, a car mechanic, married, with 4-year-old son, with the long his- tory of the illnes, and especially persistent, diffuse, non-specific headaches, frequent seizures and cognitive deterioration which have been particularly troublesome recently. He was finalny diagnosed with Hypertrophic Pachymeningitis (HP) associated with Immunoglobulin G4-related (IgG4) with the use of specific diagnostic criteria for HP associated with IgG4-RD (IgG4-HP), which rely on histopathologic analysis (Lindstrom et al. 2010; Lu et al 2014). Computed tomography (CT) of the head showed massive calcifications visible along the cerebellar tentorium on the right side, along the cerebral falx, as well as on dura mater on the cranial vault of both cerebral hemispheres. The patient was diagnosed with common variable immunodeficiency (D 83), thrombocytopenia, chronic EBV hepatitis and epilepsy. IgG4-HP was confirmed by CT, MRI and biopsy (IGg4-RHP antibody was detected). The treatment with steroids, and immunosuppressive therapy (RTX) was introduced (as it was suggested by Levraut et al. (2019). It should be stressed that he had a significantly reduced health-related quality of life (HRQoL), mainly because of long-lasting illness, diverse symptoms, often hospitalization, complex differential diagnosis, and especially biopsy which requires neurosurgical intervention, which affect his physical and mental well-being, especially cognitive control, and not possibility to take care of his family. To help the patient we introduce HBI methodology (Kropotov 2016), that is an evaluation of working brain in milliseconds. Quantitative electroencephalography (qEEG), event-related potentials (ERPs) and low-resolution sLORETA tomography were performed. We did not found any paroxysm of 3 Hz rhythm in Eyes Closed (EO) and in Eyes Open (EO) conditions, however the ERPs deviations from the reference indicate deficit of cognitive control (decrease of P3 NOGO wave in comparison to 100 persons from the normative data base from the Human Brain Index in Chur, Switzerland). Therefore, the patient was offered Transcranial Direct Current Stimulation (atDCS) combined with goal-oriented psychotherapy program. It was found that after 40 days of therapy, cognitive control returned, which was translated into a better quality of life related to the patient's health, measure in the 36-Item Short Form Survey (SF-36). The patient returned to his previous job as a head of car mechanic service. Final diagnosis of IgG4-HP and subsequently, proper farmacotherapy, and introduction of HBI methodology allowing for the selection of an adequate method of neurotherapy, for our patient the transcranial direct current stimulation (atDCS) combined with goal- oriented psychotherapy, was helpful in the improvement of his quality of life

A methodological approach to the characterization of brain gliomas, by means of semi-automatic morphometric analysis

The aims of this paper were to present a reliable morphometric procedure for glioma analysis for preliminary prognosis and to develop a semi-automatic procedure that is easy to use. The data presented are important to the extent that they verify the reliability of the results by showing that they are consistent with the findings from more complicated automatic analytical tools. The objects for analysis were digital images of haematoxylin-eosin stained glioma samples. The overall analysis consisted of digital image analysis and the determination of morphometric parameters. Interestingly, an increase in the mean values of aspect ratio with increasing malignancy grade was found. Moreover, the morphometric parameters in relation to the histological origin of gliomas were examined and it was found that, the cellular nuclei of glioblastoma multiforme reveal the biggest mean values of aspect ratio compared with other gliomas