Case Report: Primary Pulmonary Angiosarcoma With Brain Metastasis

Primary pulmonary angiosarcoma (PPA) is a rare malignant vascular tumor, of which early diagnosis is challenging due to lack of specific clinical manifestations and a low level of suspicion. Here, we report a case of PPA presented with advanced brain metastasis. A 21-year-old patient with 1 week history of headache and mild cough was hospitalized for a head injury. Head MRI showed multiple intracranial lesions with brain edema. Chest CT displayed bilateral pulmonary infiltrates with mediastinal lymph node enlargement. After 2 months of anti-tuberculosis treatment, the patient was readmitted for persistent headache and cough with occasional hemosputum along with worsening pulmonary and intracranial lesions. Despite seizure prophylaxis and control of intracranial pressure and brain edema, his symptoms progressively aggravated, accompanied by cough with bloody sputum, frequent epileptic seizures, and hypotension. He eventually developed coma and died within 3 months of onset of symptoms. An autopsy confirmed PPA with brain metastasis.

Effects of combat sports on cerebellar function in adolescents: a resting-state fMRI study

Objectives: To evaluate the effects of combat sports on cerebellar function in adolescents based on resting-state functional MRI (rs-fMRI). Methods: Rs-fMRI data were acquired from the combat sports (CS) group (n = 32, aged 14.2 ± 1.1 years) and non-athlete healthy control (HC) group (n = 29, aged 14.8 ± 0.9 years). The amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) within the cerebellum was calculated and then compared between the two groups. Results: None of these participants displayed intracranial lesions on conventional MRI and microhemorrhages on SWI. Compared with the HC group, the CS group showed decreased ALFF and ReHo in the bilateral cerebellum, mainly located in the inferior regions of the cerebellum (Cerebellum_8, Cerebellum_9, Cerebellum_7b, and Cerebellum_Crus2). While increased FC was found within the cerebellar network, mainly located in the superior regions near the midline (bilateral Cerebellum_6, Cerebellum_Crus1_R, and Vermis_6). There is no inter network FC change between the CEN and other networks. Conclusion: This study confirmed extensive effects of combat sports on cerebellar rs-fMRI in adolescents, which could enhance the understanding of cerebellar regulatory mechanism under combat conditions, and provide additional information about cerebellar protective inhibition and compensatory adaptation. Advances in knowledge: Adolescent combat participants are an ideal model to study training-induced brain plasticity and vulnerability. Relative to task-related fMRI, rs-fMRI can bring more information about cerebellar regulation and explain the Central Governor Model more comprehensively.

Xanthogranulomatous hypophysitis: a different rare presentation in a young patient

Hypophysitis is a rare inflammatory condition that may present both clinically and radiologically as a neoplastic lesion. Xanthogranulomas are rare intracranial lesions with controversial etiology. Here, we report a clinical case of histologically confirmed xanthogranuloma in a young female with type I diabetes mellitus and hypothyroidism.

CS-7 A case of Lymphomatoid granulomatosis with skin, lung, and intracranial lesions due to multicentric development

Introduction: LYG is very rare tumor and composed of large EB-positive B cells and reactive T cells. In this study, we experienced a case of LYG with multiple intracranial, cutaneous, and pulmonary masses. We report the pathogenesis and pathophysiology of LYG, including a discussion of the literature. case: A 69-year-old female presented with a growing lump in her lower back that had been present for several years. Six months later, she was found to have multiple masses in her lungs and intracranial region and underwent surgical removal for diagnostic purposes. Intraoperative findings: The tumor was substantial, reddish to grayish-white in color, and the margins of the tumor were whitish and hard, with some areas that could not be detached. Pathological findings: There were no atypical lymphocytes, and a small number of EBER-positive cells were observed. IgVH PCR: IgVH PCR was performed on the skin lesions and intracranial lesions, and bands of different sizes were detected, suggesting that the IgVH clone was present in the polyclonal region. Finally, we diagnosed LYG grade 1. discussion: EB-associated lymphoproliferative disease can lead to polyclonal reactive growth or monoclonal neoplastic growth depending on the balance between morphology and host immunity. The results of IgVH PCR suggest that the skin lesions did not cause multiple metastases, but rather that the enlargement of the skin lesions triggered intracranial and pulmonary lesions in an allo-centric manner. The results of IgVH PCR suggested that the skin lesions did not cause multiple metastases, but rather that the skin lesions grew to cause intracranial and pulmonary involvement in an other-centric manner.

A bi-foraminal craniometric-guided approach to endoscopic third ventriculostomy and biopsy of a pineal tumour

Background: Pineal tumors are very rarely encountered, with an incidence of <1% of intracranial lesions in adults. Life-threatening hydrocephalus due to obstruction of the third ventricle can result from the location of these tumours. Endoscopic third ventriculostomy (ETV) and tumor biopsy is a safe and feasible strategy, particularly if the tumor appears benign. This mitigates the high risks of uncontrollable venous bleeding from open and stereotactic biopsies. While typically performed using either ipsilateral single or dual bur holes, the location of the tumor may require modifications to the standard endoscopic techniques. Case Description: A 55-year-old male presented with signs of intracranial hypertension and was found to have obstructive hydrocephalus due to a pineal tumour. The tumour displayed a right-sided dominance when the pre-operative imaging was assessed, which would risk forniceal injury if biopsied via a right-sided burr hole. Craniometric measurements revealed a superior trajectory to the tumour via the left foramen of Monro. A biforaminal approach was performed, with a traditional ETV using a right coronal bur hole and biopsy via a left frontal bur hole. This minimized forniceal stretching and allowed a safe biopsy. Conclusion: The bi-foraminal approach has not been widely described in the literature but can potentially avoid morbidity with biopsy in patients with right-sided pineal tumours. We believe this technique should be considered, particularly in low-resource settings where neuroendoscopy is not commonly done, and where the use of ipsilateral single or dual-bur holes may lead to forniceal injury.

IMAGING OF INTRACRANIAL SPACE OCCUPYING LESIONS

Introduction: With advanced MRI techniques such as perfusion, diffusion, and spectroscopy, it is now possible to differentiate between various intracranial lesions. Materials and Methods: This prospective cohort study was conducted on 50 patients referred by various clinical departments with clinical suspicion of intracranial space occupying lesions, evaluated by computed tomography & magnetic resonance imaging. Result: Solitary lesions were present in 35 patients (70%) & multiple lesions in 15 patients (30%). 68.00% lesions were Supratentorial & 32.00% infratentorial in location. Most common supratentorial location in adults was frontal lobe 40% followed by parietal lobe 30%. Most common supratentorial locations in children were frontal lobe. Infratentorially, cerebellum & posterior fossa were found to be most common location in adults & children respectively. Supratentorial lesions were most common both in adults & children. 60% lesions were intraaxial & 40 % extra axial in location. In adults, intraaxial lesions were more common than in children. Conclusion: Intracranial space occupying lesions comprise of a diverse group of lesions. With the introduction of CT & MRI scanning, imaging of lesions has acquired a new dimension whereby excellent anatomical detail in axial, sagittal & coronal planes as well as lesion characterization has become possible. Key words: Brain, CT, MRIs

Intraoperative Ultrasound Applications in Intracranial Surgery

The methods and use of intraoperative ultrasound in 33 canine and five feline patients and its ability to localize and identify anatomical structures and pathological lesions in canines and felines undergoing intracranial surgery are described from a case series. All were client-owned referral patients admitted for neurologic evaluation, with an advanced imaging diagnosis of an intracranial lesion, and underwent surgical biopsy or surgical removal of the lesion. Medical records, retrieval and review of imaging reports, and characterization of findings for all canine and feline patients show that intraoperative ultrasound guidance was used in intracranial procedures during the period of 2012 and 2019. Twenty-nine of the canine patients had intracranial tumors. The remainder had various other conditions requiring intracranial intervention. Three of the feline patients had meningiomas, one had a depressed skull fracture, and one had an epidural hematoma. The tumors appeared hyperechoic on intraoperative ultrasound with the exception of cystic portions of the masses and correlated with the size and location seen on advanced imaging. Statistical comparison of the size of images seen on ultrasound and on MRI for 20 of the canine tumors revealed no statistical differences. Neuroanatomical structures, including vascular components, were easily identified, and tumor images correlated well with preoperative advanced imaging. The authors conclude that intraoperative ultrasound is a valuable asset in intracranial mass removals and can augment surgical guidance in a variety of intracranial disorders that require surgery. This is the first known publication in veterinary surgery of using intraoperative ultrasound as a tool in the operating theater to identify, localize, and monitor the removal/biopsy of intracranial lesions in small animals undergoing craniotomy/craniectomy.

STEM-01. PHAGE DISPLAY BIOPANNING IDENTIFIES AMOT REGULATING CELL MOTILITY OF BRAIN METASTATIC STEM-LIKE CELLS

OBJECTIVE Metastatic brain tumors (MBTs) are the most common type of malignant brain tumors. Due to the deviation of MBTs from the parental tumors, the effective therapies for primary tumors often are not useful in brain metastases. Even more new intracranial lesions were developed though the primary lesion was under control. The model of brain metastatic stem-like cells (BMSCs) could partially explain the progression of intracranial lesions. Here we aimed to explore the biological behavior in cell motility of BMSCs and understand the potential mechanisms. METHODS In vitro and in vivo phage display biopanning strategies were used to isolate dodecapeptides that specifically target BMICs by selecting against primary lung cancer cells and normal brain cells. In silico analysis was used to derive specific protein targets in BMICs. Potential targets were narrowed down through analysis in patient databases and verified for their presence in BMIC through RT-PCR. Cell migration and adhesion in BMICs were analyzed using Transwell, scratch, and adhesion assays. Protein expression and cell morphology were detected by immunofluorescence. Immune blot was performed to detect the epithelial-mesenchymal related molecules and explore protein-protein interactions. RESULTS In silico analysis of BMSCs specific peptides revealed Angiomotin (Amot) as a potential target in BMSCs. Amot was found to be overexpressed in BMSCs compared to primary lung cancer cells. Kaplan-Meier analysis demonstrated Amot was negatively correlated with overall survival among lung adenocarcinoma patients. Functionally, knockdown of AMOT in BMSCs decreased the capability of cell migration and adhesion by reduced active Cdc42/Rac1 signals caused by downregulation of E-Cadherin. Amot was found to maintain the E-Cadherin in BMSCs through reducing ubiquitination of E-Cadherin. CONCLUSIONS Amot plays a role in promoting migration and adhesion in BMSCs through preservation of E-cadherin.