ABSTRACTS OF PAPERS AT THE 81TH RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 13TH NOVEMBER 2000, 2.30 PM, SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)
1. PLEOMORPHIC XANTHOASTROCYTOMA
Pradnya S Gaitonde, Daya K Manghani, Darab K Dastur, Uday Andhar
Pleomorphic Xanthoastrocytoma by definition is an astrocytic neoplasm with relatively favourable prognosis and usually occurring in children and young adults. The adjective pleomorphism refers to the variable histological appearance of the tumour in which spindle-shaped cells are mixed with multinucleated giant cells and the nuclei show great variation in size and shape. The term ‘Xanthoma’ suggests lipidized neoplastic cells i.e. cells with eosinophilic droplets. Discussed here is a rare case of ‘recurrent’ pleomorphic xanthoastrocytoma in a young patient aged 35 years who presented with a right parieto-occipital SOL.
On histopathology in 1995, the tumour was pleomorphic, very vascular and with many multinucleated giant cells. The nuclei of these cells appeared large; with chromatin pushed to the periphery and appeared degenerating. The possibility of this tumour being SEGA was suggested. The patient developed a recurrence after a symptom-free period of 5 years and was operated the second time. Microscopic examination on the second operation showed eosinophilic protein droplets as well as more uniform granular bodies in addition to the changes seen in the first biopsy specimen. Patchy GFAP positivity and strong S-100 positivity was seen on immunohistochemistry. Pleomorphic xanthoastrocytomas show slow evolution with long symptom free period (5 years in this case), even after incomplete resection. Cases with survival as long as 40 years after surgery have been published (Kleihues and Cavenee, 2000).
Ravindra Urkude, Nadir Bharucha, Meher Ursekar
The incidence of neurosyphilis has decreased since the introduction of penicillin. The gumma is a non-specific granulomatous inflammatory lesion that can involve any organ and which responds dramatically to penicillin.
A 25 year old man admitted with a history of fever, headache, vomiting, and subsequent loss of consciousness for about 3 hours. On regaining consciousness, he noted weakness in both legs. He had a past history of sexual contact with commercial sex workers. On physical examination, he had terminal neck stiffness, hyperpigmented macular patches and inguinal lymphadenopathy. On neurological examination, there was a bilateral papilloedema and flaccid paraplegia with absent touch, pain and temperature sense below T11. Deep tendon reflexes were absent in both legs.
Routine blood investigations were normal. Serology was negative for HIV 1 and 2, but was positive for syphilis (VDRL 1:64 and TPHA). MRI brain examination showed heterogeneous non enhancing lesion within the pons appearing predominantly, hyperintense on T2 weighted image. MRI examination of cervical and dorsal spine were unremarkable. In view of clinical and serological findings, a gummatous lesion was considered to be highly probable, although the lack of enhancement was considered. The possibility of an ischaemic lesion was also considered. CSF examination showed 1837 WBC/cumm (lymphocytes 80%, polymorphs 20%), raised CSF proteins (87 mg%) and a positive CSF VDRL. These findings indicated active neurosyphilis. The patient was treated with 24 million units per day of penicillin G intravenously for 21 days.
One month after completion of treatment he regained leg strength and could walk with support. At this time repeat CSF examination revealed 17 WBC per cumm and serum VDRL titre of 1.8. Repeat MR brain showed complete regression of the pontine lesion. The rapid response of this lesion to therapy made the diagnosis of gummatous lesion most likely.
Majority of the cerebral gumma are located in the cerebral convexity. There are case reports of gumma in the mid-brain, pons and cerebellar pontine angle. We feel that in patients with a clinical diagnosis of neuro syphilis a mass lesion, a therapeutic trial of penicillin may result in regression of the mass and obviate the need for brain biopsy.