A radiopathological classification of dural tail sign of meningiomas

2012 ◽  
Vol 117 (4) ◽  
pp. 645-653 ◽  
Author(s):  
Song-tao Qi ◽  
Yi Liu ◽  
Jun Pan ◽  
Silky Chotai ◽  
Lu-xiong Fang
Keyword(s):  
Tumor Cells ◽  
Histopathological Examination ◽  
Who Grade ◽  
Simpson Grade ◽  
Mri Studies ◽  
Dural Tail Sign ◽  
Significant Difference ◽  
Different Types ◽  
Dural Tail

Object The completeness of meningioma resection depends on the resection of dura mater invaded by the tumor. The pathological changes of the dura around the tumor can be interpreted by evaluating the dural tail sign (DTS) on MRI studies. The goal of this study was to clarify the pathological characteristics of the DTSs, propose a classification based on the histopathological and radiological correlation, and identify the invasive range of tumor cells in different types of DTS. Methods The authors retrospectively reviewed 179 patients with convexity meningiomas who underwent Simpson Grade I resection. All patients underwent an enhanced MRI examination preoperatively. The convexity meningiomas were dichotomized into various subtypes in accordance with the 2007 WHO classification of tumors of the CNS, and the DTS was identified based on the Goldsher criteria. The range of resection of the involved dura was 3 cm from the base of the tumor, which corresponded with the length of DTS on MRI studies. Histopathological examination of dura at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 cm from the base of the tumor was conducted, and the findings were correlated with the preoperative MRI appearance of the DTS. Results A total of 154 (86%) of 179 convexity meningiomas were classified into WHO Grade I subtype, including transitional (44 [28.6%] of 154), meningothelial (36 [23.4%] of 154), fibrous (23 [14.9%] of 154), psammomatous (22 [14.3%] of 154), secretory (10 [6.5%] of 154), and angiomatous (19 [12.3%] of 154). The other 25 (14%) were non–Grade I (WHO) tumors, including atypical (12 [48%] of 25), anaplastic (5 [20%] of 25), and papillary (8 [32%] of 25). The DTS was classified into 5 types: smooth (16 [8.9%] of 179), nodular (36 [20.1%] of 179), mixed (57 [31.8%] of 179), symmetrical multipolar (15 [8.4%] of 179), and asymmetrical multipolar (55 [30.7%] of 179). There was a significant difference in distribution of DTS type between Grade I and non–Grade I tumors (p = 0.004), whereas the difference was not significant among Grade I tumors (0.841) or among non–Grade I tumors (p = 0.818). All smooth-type DTSs were encountered in Grade I tumors, and the mixed DTS (52 [33.8%] of 154) was the most common type in these tumors. Nodular-type DTS was more commonly seen in non–Grade I tumors (12 [48%] of 25). Tumor invasion was found in 88.3% (158 of 179) of convexity meningiomas, of which the range of invasion in 82.3% (130 of 158) was within 2 cm and that in 94.9% (150 of 158) was within 2.5 cm. The incidence of invasion and the range invaded by tumor cells varied in different types of DTS, and differences were statistically significant (p < 0.001). Conclusions Nodular-type DTS on MRI studies might be associated with non–Grade I tumors. The range of dural resection for convexity meningiomas should be 2.5 cm from the tumor base, and if this extent of resection is not feasible, the type of DTS should be considered. However, for skull base meningiomas, in which mostly Simpson Grade II resection is achieved, the use of this classification should be further validated. The classification of DTS enables the surgeon to predict preoperatively and then to achieve the optimal range of dural resection that might significantly reduce the recurrence rate of meningiomas.

Schwannoma Arising from the Tentorium at an Unusual Location: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1352-1355 ◽  
Author(s):  
Akihiro Oikawa ◽  
Naoto Takeda ◽  
Nobuhiko Aoki ◽  
Touichiro Takizawa ◽  
Takaaki Sakoma
Keyword(s):  
Case Report ◽  
Tumor Cells ◽  
Cystic Mass ◽  
Dense Adhesion ◽  
Inferior Surface ◽  
Truncal Ataxia ◽  
Dural Tail Sign ◽  
S 100 ◽  
Dural Tail ◽  
History Of

Abstract OBJECTIVE AND IMPORTANCE We present a case of schwannoma attached to the tentorium. CLINICAL PRESENTATION A 41-year-old woman without evidence of neurofibromatosis presented with a 3-month history of headache, positional vertigo, and truncal ataxia. Magnetic resonance imaging revealed an extra-axial cystic mass lesion in the left anteromedial cerebellar region with a dural tail sign. INTERVENTION The tumor was removed completely by retrosigmoid craniotomy. Dense adhesion of the tumor to the inferior surface of the tentorium was confirmed during surgery. On light microscopic study, this neoplasm was composed of spindle cells and showed palisaded structures. Immunohistochemically, the tumor cells stained positive for S-100 protein and vimentin. Reticulin staining revealed a pericellular pattern of distribution of reticulin fibers. Electron microscopy confirmed the presence of a basement membrane encompassing the tumor cells. From these findings, the tumor was diagnosed as a schwannoma arising from the tentorium. CONCLUSION To our knowledge, this case report is the first to describe a schwannoma arising from the tentorium. Our case report indicates that schwannoma is a possible pathology in the differential diagnosis of dura-based tumors.

scholarly journals Assessment of relationship between biometric characteristics of stone and crown morphotype of Prunus Pumila L.

2021 ◽  
Vol 38 ◽  
pp. 00072
Author(s):  
Mikhail Lezin ◽  
Larisa Ufimtseva
Keyword(s):  
Acidic Soils ◽  
Natural Habitats ◽  
Significance Level ◽  
First Case ◽  
Significant Difference ◽  
Different Types ◽  
Length Width ◽  
Plant Habit ◽  
Chelyabinsk Region

Prunus pumila is an introductory species with a disjunctive culturing area, which is caused by the instability of plants to rotting on waterlogged soils with unstable winters and high snow cover. One of the varieties of Prunus pumila in natural habitats grows on acidic soils and sometimes in wetlands. In the introduction population of the Chelyabinsk region, not all varieties could take part in the formation of the introduction population. In terms of stone shape and plant habit, no specimens matching the description of the P. pumila var. depressa variety could be identified. On the basis of the classification of plant morphotypes developed by us it was possible in some cases to obtain significant differences in the distribution of stone indices in groups with different types of crowns. The maximum differences were found in groups with the crown type of raised shrub and tree shrub for the index length / width and length / thickness of the stone. In the first case, a significant difference was obtained at the 1% significance level (tf = 2.81), and in the second even at the 0.1% significance level (tf = 3.78).

scholarly journals Outcomes of Single-Institution Retrospective Case Series on Observation Alone Following Atypical Meningioma Resection

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lauren Stone ◽  
Hugh D Moulding ◽  
Nimisha Deb ◽  
Charles T Lee
Keyword(s):  
Median Time ◽  
Tumor Resection ◽  
Case Series ◽  
Single Institution ◽  
Retrospective Case ◽  
Who Grade ◽  
Entire Cohort ◽  
Simpson Grade ◽  
Retrospective Case Series ◽  
Significant Difference

Abstract INTRODUCTION Observation alone vs adjuvant radiotherapy (RT) following gross total resection (GTR) of WHO Grade II (G2) meningiomas is controversial. Local recurrence (LR) rates have been reported to be similar. We present LR rates in patients who were observed following G2 meningioma resection and correlate with Simpson grades. METHODS Patients from 2005 to 2018 who underwent observation alone following surgical resection of G2 meningiomas at a single institution were analyzed in a retrospective case series. Simpson grades were used to classify extent of tumor resection. Patients were followed with magnetic resonance imaging (MRI) or computed tomography (CT) imaging at 1-mo, 3-mo, 6-mo, and 12-mo postoperatively, then annually thereafter to monitor for recurrence. Descriptive 2-yr, and 5-yr LR rates for our entire cohort and time to recurrence by Simpson grade are reported. RESULTS A total of 28 patients with Simpson 1 to 4 resections for G2 meningiomas did not undergo adjuvant RT and were included. Median follow-up (FU) was 34 mo [Interquartile range (IQR): 18-55 mo]. Median time to LR was 55 mo (IQR: 44-65 mo) across our entire cohort. Of 14 patients with Simpson 1 resection, there was 1 LR at 68 mo. Of 3 patients with Simpson 2 resection, there was 1 LR at 49 mo. Of 9 patients with Simpson 3 resection, there were 5 recurrences; median time to LR was 61 mo. Of 2 patients with Simpson 4 resections, there was 1 LR at 3 mo. Overall, 2-yr LR was 3.6% and 5-yr LR was 10.7%. There was no statistically significant difference in LR rate between Simpson 1 vs Simpson 2 to 4 resections (P = .11). CONCLUSION Our results are consistent with the low recurrence rate of G2 meningiomas undergoing observation along following GTR in current literature. Simpson grade 1 resections have low overall LR rate and larger scale studies are needed to determine if statistical significance exists.

Novel histopathological classification of meningiomas based on dural invasion

2020 ◽  
pp. jclinpath-2020-206592
Author(s):  
Makoto Murase ◽  
Ryota Tamura ◽  
Yuki Kuranari ◽  
Mizuto Sato ◽  
Kentaro Ohara ◽  
...  
Keyword(s):  
Brain Parenchyma ◽  
Ki 67 ◽  
Who Grade ◽  
Histopathological Classification ◽  
Simpson Grade ◽  
Grade Ii ◽  
Meningioma Recurrence

AimsHistological invasion into the adjacent brain parenchyma is frequently investigated in meningioma because it is an important morphological criterion for grade II meningioma according to the 2016 WHO classification. However, few studies have focused on dural invasion of meningiomas. Herein, we propose a novel histopathological classification based on dural invasion of meningiomas.MethodsForty-nine cases with WHO grade I meningiomas who underwent Simpson grade I removal were collected. After the meningeal layer (ML) and periosteal layer (PL) of dura mater were visualised by Masson’s trichrome stain, we evaluated the depth (to the ML and PL) and the patterns (1, expanding; 2, infiltrating) of dural invasion of meningiomas using serial paraffin sections. Invasion-associated markers, including Ki-67, matrix metalloproteinase (MMP)-1, MMP-9 and MMP-13, aquaporin 1 and Na-K-2Cl cotransporter, were quantitatively analysed by immunohistochemistry.ResultsThirty-five cases (71.4%) showed the dural invasion. In 27 of these 35 cases (77.1%), dural invasion was localised in ML. Type 1 (expanding type) and type 2 (infiltrating type) invasions were observed in 23 and 12 cases, respectively. The recurrence rate in cases with type 2 invasion was significantly higher than that in cases with type 1 invasion. The percentage of MMP-1-positive tumour cells was also significantly higher in cases with dural invasion than those without, suggesting involvement of MMP-1 in dural invasion.ConclusionsWe quantitatively evaluated the depth and patterns of dural invasion in meningiomas. The patterns of dural invasion were associated with meningioma recurrence.

Significance of Simpson grading system in modern meningioma surgery: integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO Grade I meningiomas

2012 ◽  
Vol 117 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Soichi Oya ◽  
Kensuke Kawai ◽  
Hirofumi Nakatomi ◽  
Nobuhito Saito
Keyword(s):  
Clinical Significance ◽  
Management Strategies ◽  
Labeling Index ◽  
Proliferation Index ◽  
Grading System ◽  
Who Grade ◽  
Simpson Grade ◽  
Significant Difference ◽  
Meningioma Surgery ◽  
Mib 1

Object Techniques for the surgical treatment of meningioma have undergone many improvements since Simpson established the neurosurgical dogma for meningioma surgery in his seminal paper published in 1957. This study aims to assess the clinical significance and limitations of the Simpson grading system in relation to modern surgery for WHO Grade I benign meningiomas and to explore the potential of the cell proliferation index to complement the limitations in predicting their recurrence. Methods The surgical records of patients who underwent resection of intracranial meningiomas at the University of Tokyo Hospital between January 1995 and August 2010 were retrospectively analyzed. The authors investigated the relationships between recurrence-free survival (RFS) and Simpson grade or MIB-1 labeling index value. Results A total of 240 patients harboring 248 benign meningiomas were included in this study. Simpson Grade IV resection was associated with a significantly shorter RFS than Simpson Grade I, II, or III resection (p < 0.001), while no statistically significant difference was noted in RFS between Simpson Grades I, II, and III. Among meningiomas treated by Simpson Grade II and III resections, however, multivariate analysis revealed that an MIB-1 index of 3% or higher was associated with a significantly shorter time to recurrence. Conclusions The clinical significance of the different management strategies related to Simpson Grade I–III resection may have been diluted in the modern surgical era. The MIB-1 index can differentiate tumors with a high risk of recurrence, which could be beneficial for planning tailored optimal follow-up strategies. The results of this study appear to provide a significant backing for the recent shift in meningioma surgery from attempting aggressive resection to valuing the quality of the patient's life.

The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas

2010 ◽  
Vol 113 (5) ◽  
pp. 1029-1035 ◽  
Author(s):  
Michael E. Sughrue ◽  
Ari J. Kane ◽  
Gopal Shangari ◽  
Martin J. Rutkowski ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Information ◽  
Progression Free Survival ◽  
World Health ◽  
Rank Test ◽  
Who Grade ◽  
Free Survival ◽  
Simpson Grade ◽  
Kaplan Meier ◽  
Significant Difference

Object In 1957, Simpson published a seminal paper defining the risk factors for recurrence following surgical treatment of intracranial meningiomas. Given that Simpson's study was published more than 50 years ago, preceding image guidance technology and MR imaging, the authors reviewed their own experience with surgical treatment of Grade I meningiomas to determine if Simpson's grading scale is still relevant to modern neurosurgical practice. Methods From this cohort, the authors evaluated all patients undergoing craniotomy for resection of a histologically proven WHO Grade I meningioma as their initial therapy. Clinical information was retrospectively reconstructed using patient medical records and radiological data. Recurrence analysis was performed using the Kaplan-Meier method. Results The 5-year recurrence/progression-free survival for all patients receiving a Simpson Grade I, II, III, or IV resection was 95, 85, 88, and 81%, respectively (p = not significant, log-rank test). Kaplan-Meier analysis revealed no significant difference in recurrence-free survival between patients receiving a Simpson Grade I, II, III, or IV resection. Analysis limited to meningiomas arising from the skull base (excluding the cavernous sinus) similarly found no significant benefit to Simpson Grade I or II resection, and the survival curves were nearly superimposed. Conclusions In this study of a cohort of patients undergoing surgery for WHO Grade I meningiomas, the authors demonstrate that the benefit of more aggressive attempts to resect the tumor with dura and underlying bone was negligible compared with simply removing the entire tumor, or even leaving small amounts of tumor attached to critical structures. The authors believe that these data reflect an evolution in the nature of meningioma surgery over the past 2 decades, and bring into question the relevance of using Simpson's grading system as the sole predictor of recurrence.

Dual stain kit for the microscopic gram classification of ocular infection bacteria

1993 ◽  
Vol 51 ◽  
pp. 248-249
Author(s):  
Jacob S. Hanker ◽  
Dale N. Holdren ◽  
Kenneth L. Cohen ◽  
Beverly L. Giammara
Keyword(s):  
Contact Lenses ◽  
Ocular Infection ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Staining ◽  
Ocular Infections ◽  
Different Types ◽  
Culture Positive ◽  
Increased Susceptibility

Keratitis and conjunctivitis (infections of the cornea or conjunctiva) are ocular infections caused by various bacteria, fungi, viruses or parasites; bacteria, however, are usually prominent. Systemic conditions such as alcoholism, diabetes, debilitating disease, AIDS and immunosuppressive therapy can lead to increased susceptibility but trauma and contact lens use are very important factors. Gram-negative bacteria are most frequently cultured in these situations and Pseudomonas aeruginosa is most usually isolated from culture-positive ulcers of patients using contact lenses. Smears for staining can be obtained with a special swab or spatula and Gram staining frequently guides choice of a therapeutic rinse prior to the report of the culture results upon which specific antibiotic therapy is based. In some cases staining of the direct smear may be diagnostic in situations where the culture will not grow. In these cases different types of stains occasionally assist in guiding therapy.

Explanatory Power for Medical Expert Systems: Studies in the Representation of Causal Relationships for Clinical Consultations

1982 ◽  
Vol 21 (03) ◽  
pp. 127-136 ◽  
Author(s):  
J. W. Wallis ◽  
E. H. Shortliffe
Keyword(s):  
Explanatory Power ◽  
Prototype System ◽  
Inference Rules ◽  
Medical Expert ◽  
Comprehensive Knowledge ◽  
Different Types ◽  
Medical Expert Systems ◽  
Explanation System ◽  
Systems Studies

This paper reports on experiments designed to identify and implement mechanisms for enhancing the explanation capabilities of reasoning programs for medical consultation. The goals of an explanation system are discussed, as is the additional knowledge needed to meet these goals in a medical domain. We have focussed on the generation of explanations that are appropriate for different types of system users. This task requires a knowledge of what is complex and what is important; it is further strengthened by a classification of the associations or causal mechanisms inherent in the inference rules. A causal representation can also be used to aid in refining a comprehensive knowledge base so that the reasoning and explanations are more adequate. We describe a prototype system which reasons from causal inference rules and generates explanations that are appropriate for the user.

Households Discrimination in School Enrolment in Pakistan: Does gender matter?

2018 ◽  
Vol 2 (1) ◽  
pp. 29-36
Author(s):  
Ali Muhammad ◽  
Zahoor Ul Haq ◽  
Imad Khan
Keyword(s):  
Low Income ◽  
Gender Discrimination ◽  
Rural Areas ◽  
Gender Disparity ◽  
School Enrollment ◽  
Female Education ◽  
Public And Private ◽  
Significant Difference ◽  
Different Types ◽  
Socio Economic Factors

This study uses Pakistan Social and Living Measurement Survey 2016 to study gender discrimination in school enrollment across the four provinces of Pakistan using bi-variate analysis. Results show that there is highly significant difference between male and female education in rural areas (x^2=4940.50 and p<0.05). Analysis indicate that gender disparity in enrollment is significantly higher in low income households (x^2=115.468 and P<0.05). The study also showed that as compared to male, fewer female are enrolled in both public and private sectors. Hence, socio-economic factors play important role in making decision about children enrollment in different types of school. The study recommends that government to take appropriate steps to reduce gender discrimination in school enrollment by offering subsidy on female education in the country.

Using Histological and Chemical Methods for Detection of Unauthorized Tissues Addition in Emulsion Type Meat Product

2020 ◽  
Keyword(s):  
Vascular Tissue ◽  
Meat Product ◽  
Calcium Content ◽  
Processed Meat ◽  
Low Protein ◽  
Significant Difference ◽  
Different Types ◽  
Plant Stem ◽  
High Level ◽  
Reliable Methods

Total twenty different processed meat plant producing emulsion type sausage were histologically and chemically examined for detection of adulteration with unauthorized tissues. Results revealed that samples were adulterated with different types of animal tissues included; hyaline cartilage, tendon, spongy bone, peripheral nerve trunk, basophilic matrix, lymphatic tissue, fascia, fibrocartilage and vascular tissue. Moreover, these samples were adulterated Also, adulterated with plant tissue included; plant stem, leaves and root. Chemical analysis showed a significant difference in their chemical composition (moisture, fat, protein, ash and calcium) content. Moisture and fat content varied around the permissible limit of E.S.S. while low protein, high ash and calcium content was detected in the examined samples. Therefore, Histological and chemical examinations can be used as reliable methods to detect adultration using unauthorized addition of both animal and plant tissues in processed meat product samples which revealed a high level of falsification.

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