ObjectThe combination approach of Ommaya reservoir placement and Gamma Knife surgery (GKS) was evaluated for the treatment of large cystic metastatic brain tumors.MethodsThe medical records of 22 patients harboring 28 tumors, who underwent Ommaya reservoir placement followed by GKS for large cystic metastatic brain tumors were retrospectively reviewed. The patients' ages ranged 26 to 77 years (mean 57.1 years). The most common locations of primary malignancy were the breast (11 patients) followed by the lung (seven patients). The mean maximum diameter of the tumor was 40.1 mm before Ommaya reservoir placement and 31.2 mm at GKS (mean reduction of 19.9%). The mean calculated tumor volume at GKS was 13.4 cm3. The mean tumor margin dose was 16 Gy in 17 patients treated by GKS only and 11 Gy in five patients treated using both GKS and external radiotherapy. The mean follow-up period was 11.5 months. Nineteen (67.9%) of the 28 tumors were controlled. The median patient survival time was 7 months. Asymptomatic intracystic hemorrhage associated with Ommaya reservoir placement was seen in two patients with four tumors, but no serious complication occurred.Conclusions Ommaya reservoir placement followed by GKS is relatively effective and safe for large cystic metastatic brain tumors. Gamma Knife surgery should be performed within a few days of Ommaya reservoir placement. Reaccumulation and high viscosity of cystic content must be considered.

Objective and Case Presentation:The patient was an 86-year-old woman with histories of surgery for stomach, colon, and pancreatic cancers. In addition to left hemiparesis as a sequela of two past episodes of cerebral infarction, she newly developed right hemiplegia and acute cerebral infarction due to left middle cerebral artery (MCA) occlusion.Since the condition was not an indication for intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA), mechanical thrombectomy was immediately performed, and almost complete recanalization could be achieved about 5 hours after the onset. The retrieved thrombus was a white and elastic hard fibrin thrombus that contained no blood cells. Although temporary symptomatic relief was obtained, bilateral MCA occlusion occurred in succession, and the patient died on the 35th day of illness. Conclusion:Accumulation of cases and pathological evaluation of retrieved thrombi are necessary for the elucidation of the optimal mechanical thrombectomy or antithrombotic therapy for acute cerebral infarction due to Trousseau syndrome.

We investigated the role of monocytes in the production of tumor necrosis factor (TNF) and prostaglandin E2 (PGE2) in 77 cancer patients with malignancies of the digestive tract, using 30 normal individuals and 18 noncancer patients as controls. Monocytes were incubated with lipopolysaccharide for 20 h, and TNF production and PGE2 production were analyzed by bioassays. Elevated levels of TNF (greater than 512 U/ml) and PGE2 (greater than 8 ng/ml) production were demonstrated in many cancer patients when these factors were induced in the medium with 10% fetal bovine serum. The elevated level of TNF was seen to be restricted for the most part to patients with malignancies. Thus, 51 out of 59 cancer patients (86%), consisting of 44 primary cancer patients and 15 recurrent cancer patients, showed an increased level of TNF. In contrast, almost all of 18 postoperative cancer patients showed TNF levels comparable to those of normal individuals. Furthermore, 16 primary cancer patients were also demonstrated to have reduced levels of TNF production by monocytes after curative operation. When 10% cancer-patient plasma was added to the induction culture, TNF production by monocytes was drastically suppressed in the cancer patients. Interestingly, the same addition of plasma induced a prominent enhancement of PGE2 production in the cancer patients. The plasma of noncancer patients did not modulate production of these factors. No TNF activity was found in the plasma of cancer patients, but such plasma did contain an increased level of PGE2 (100-300 pg/ml). Although PGE2 (greater than 2 ng/ml) was able to suppress TNF production by monocytes, the addition of 10% plasma PGE2 was not enough to induce suppression. An unknown factor(s) in the plasma of cancer patients may uniquely modulate the elevated TNF and PGE2 production in these patients.

We experienced a rare case of primary angiomyolipoma (AML) of the liver, preoperatively diagnosed by fine needle aspiration biopsy (FNAB). Radiographic imaging revealed characteristic features of an angiomyolipoma. The diagnosis was confirmed by the presence of epithelioid smooth muscle cells, mature fat cells and blood vessels in the biopsy tissue. Our review of the literature showed this to be the eleventh case to be diagnosed in this way. Despite this preoperative diagnosis, the lesion was resected because of its pleomorphic histological features. Histologically, the epithelioid smooth muscle component included cells with a bizarre appearance and occasional hyperchromatic nuclei, and furthermore, occasional mitotic figures were observed. In own MEDLINE search of the literature we found 11 cases of AML of the liver for which the diagnoses were established by FNAB, and the same features were present in 5 cases for which surgical excision was contemplated.

Malignant fibrous histiocytomas occur principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, they only rarely occur in the chest wall. A rare case of primary malignant fibrous histiocytoma originating from the chest wall is herein presented. The 36 previously reported cases are also reviewed. Of the 32 patients who underwent a resection as the initial treatment, 10 (31.3%) had a local recurrence. Of the 37 patients with this disease, 9 (25.0%) had subsequent metastases. The majority of the deaths (36.1%) from this disease occurred within the first 12 months. The patients who undergo surgical and adjuvant therapy must therefore be monitored carefully by frequent examinations.