Pub Date : 2017-12-25DOI: 10.3969/CJCNN.V17I12.1700
Yan Chen, Fangfei Hu, Bo Wu
Chinese classification of cerebrovascular diseases (2015), published in 2017, attracts much attention. Cerebrovascular diseases are separated into 13 categories according to their etiology, pathogenesis, lesion arteries, lesion sites, clinical manifestations and complications. Some new contents or differences are discussed and compared with the earlier version, which is expected to acquire deeper comprehension and make better choices of clinical work. DOI: 10.3969/j.issn.1672-6731.2017.12.002
{"title":"Interpretation of \"Chinese classification of cerebrovascular diseases (2015)\"","authors":"Yan Chen, Fangfei Hu, Bo Wu","doi":"10.3969/CJCNN.V17I12.1700","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I12.1700","url":null,"abstract":"Chinese classification of cerebrovascular diseases (2015), published in 2017, attracts much attention. Cerebrovascular diseases are separated into 13 categories according to their etiology, pathogenesis, lesion arteries, lesion sites, clinical manifestations and complications. Some new contents or differences are discussed and compared with the earlier version, which is expected to acquire deeper comprehension and make better choices of clinical work. DOI: 10.3969/j.issn.1672-6731.2017.12.002","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"865-868"},"PeriodicalIF":0.0,"publicationDate":"2017-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44574688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-25DOI: 10.3969/CJCNN.V17I12.1708
Xiao-chun Zhang, Xinguo Yuan, Yu-rong Zhang, Le Zhang, Xiao-li Liu, Juan Zhang, Guo-Gang Luo
Objective To investigate the occurrence rate and related risk factors for post-stroke emotional incontinence (PSEI). Methods The clinical data [sex, age, body mass index (BMI), education, marital status, medical history (hypertension, heart disease, diabetes, hyperlipemia, smoking and drinking) and family history of stroke] of 162 stroke patients were recorded. Serum homocysteine (Hcy) level was examined. Head CT and/or MRI were used to indicate stroke subtype, site of lesion and number of lesion. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-Ⅴ) Chinese version and Hamilton Depression Rating Scale-17 Items (HAMD-17) were used to evaluate the degree of depression. House diagnostic standard was used to diagnose PSEI. Univariate and multivariate backward Logistic regression analysis was used to screen related risk factor for PSEI. Spearman rank correlation analysis was used to discuss the correlation between PSEI and post-stroke depression (PSD). Results Among 162 stroke patients, 12 cases were diagnosed as PSEI (7.41% ). The ratio of age < 60 years in PSEI group was significantly higher than non-PSEI group ( P = 0.045). The ratio of smoking in PSEI group was significantly lower than non-PSEI group ( P = 0.036). Univariate and multivariate backward Logistic regression analysis showed age < 60 years was independent risk factor for PSEI ( OR = 4.000, 95%CI: 1.149-13.924; P = 0.029). Ten cases were combined with PSD in 12 PSEI patients, and the co-morbidity rate of PSEI and PSD was83.33%. Spearman rank correlation analysis showed PSEI was positively related to PSD ( r s = 0.305, P = 0.000). Conclusions PSEI is common affective disorder in stroke patients, which easily happens in patients under 60 years of age. DOI: 10.3969/j.issn.1672-6731.2017.12.010
{"title":"Analysis on risk factors for post-stroke emotional incontinence","authors":"Xiao-chun Zhang, Xinguo Yuan, Yu-rong Zhang, Le Zhang, Xiao-li Liu, Juan Zhang, Guo-Gang Luo","doi":"10.3969/CJCNN.V17I12.1708","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I12.1708","url":null,"abstract":"Objective To investigate the occurrence rate and related risk factors for post-stroke emotional incontinence (PSEI). Methods The clinical data [sex, age, body mass index (BMI), education, marital status, medical history (hypertension, heart disease, diabetes, hyperlipemia, smoking and drinking) and family history of stroke] of 162 stroke patients were recorded. Serum homocysteine (Hcy) level was examined. Head CT and/or MRI were used to indicate stroke subtype, site of lesion and number of lesion. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-Ⅴ) Chinese version and Hamilton Depression Rating Scale-17 Items (HAMD-17) were used to evaluate the degree of depression. House diagnostic standard was used to diagnose PSEI. Univariate and multivariate backward Logistic regression analysis was used to screen related risk factor for PSEI. Spearman rank correlation analysis was used to discuss the correlation between PSEI and post-stroke depression (PSD). Results Among 162 stroke patients, 12 cases were diagnosed as PSEI (7.41% ). The ratio of age < 60 years in PSEI group was significantly higher than non-PSEI group ( P = 0.045). The ratio of smoking in PSEI group was significantly lower than non-PSEI group ( P = 0.036). Univariate and multivariate backward Logistic regression analysis showed age < 60 years was independent risk factor for PSEI ( OR = 4.000, 95%CI: 1.149-13.924; P = 0.029). Ten cases were combined with PSD in 12 PSEI patients, and the co-morbidity rate of PSEI and PSD was83.33%. Spearman rank correlation analysis showed PSEI was positively related to PSD ( r s = 0.305, P = 0.000). Conclusions PSEI is common affective disorder in stroke patients, which easily happens in patients under 60 years of age. DOI: 10.3969/j.issn.1672-6731.2017.12.010","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"917-923"},"PeriodicalIF":0.0,"publicationDate":"2017-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-25DOI: 10.3969/CJCNN.V17I12.1699
Jun Wang
{"title":"Talk after spring: current status of stroke and therapeutics in acute phase","authors":"Jun Wang","doi":"10.3969/CJCNN.V17I12.1699","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I12.1699","url":null,"abstract":"","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"861-864"},"PeriodicalIF":0.0,"publicationDate":"2017-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44942519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-25DOI: 10.3969/CJCNN.V17I12.1710
Li Zhou, Qiao-Shu Wang
Moyamoya disease (MMD) is a chronic progressive obstructive cerebrovascular disease. At present, the etiology and pathogenesis of MMD are still not clear. Recently, many studies confirmed the genetic susceptibility of MMD and reported that the genetic factors are more important than acquired causes. We summarize the domestic and foreign studies on the genetics of MMD, and expect to provide a guidance for early diagnosis and precise treatment. DOI: 10.3969/j.issn.1672-6731.2017.12.012
{"title":"Genetic study on moyamoya disease","authors":"Li Zhou, Qiao-Shu Wang","doi":"10.3969/CJCNN.V17I12.1710","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I12.1710","url":null,"abstract":"Moyamoya disease (MMD) is a chronic progressive obstructive cerebrovascular disease. At present, the etiology and pathogenesis of MMD are still not clear. Recently, many studies confirmed the genetic susceptibility of MMD and reported that the genetic factors are more important than acquired causes. We summarize the domestic and foreign studies on the genetics of MMD, and expect to provide a guidance for early diagnosis and precise treatment. DOI: 10.3969/j.issn.1672-6731.2017.12.012","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"929-932"},"PeriodicalIF":0.0,"publicationDate":"2017-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49497664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/CJCNN.V17I11.1692
Guan-jun Li, Jun Xu, Gang Mei, Ling Yue, Jing-hua Wang, Huafang Li
Background Although the early behavioral symptoms of behavioral variant frontotemporal dementia (bvFTD) are prominent, early diagnosis for bvFTD is difficult due to confusion with other mental disorders, and lack of sensitivity and specificity of diagnostic criteria, etc. In this paper, we summarized the important reviews in recent years and analyzed the clinical characteristics of bvFTD patients to improve the detection of early symptoms in bvFTD. Methods Twenty-three possible or probable bvFTD patients were diagnosed according to International Behavioral Variant Frontotemporal Dementia Criteria Consortium (FTDC). Self-designed questionnaires designed by Shanghai Mental Health Center were used to collect sociodemographic data and general information of patients. Their clinical characteristics were summarized, including abnormal behaviors, cognitive impairment, psychotic symptoms and other symptoms. Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL) and Clinical Dementia Rating Scale (CDR) were used to make neuropsychological tests and compare with similar overseas studies (control group, N = 66). Results Eleven male patients and 12 female patients were included in our study. Compared with control group, the average age of onset [(50.83 ± 11.55) years vs. (57.00 ± 10.00) years; t = 3.863, P = 0.000] and average age of diagnosis [(53.22 ± 11.55) years vs. (61.00 ± 9.00) years; t = 13.423, P = 0.000] of bvFTD patients were smaller. The study showed that bvFTD patients had more apathy or indolence [95.65% (22/23) vs. 65.15% (43/66); χ 2 = 8.057, P = 0.005], loss of sympathy or empathy [95.65% (22/23) vs. 33.33% (22/66); χ 2 = 26.499, P = 0.000], while patients in control group showed more derepression behavior [98.48% (65/66) vs. 52.17% (12/23); χ 2 = 27.514, P = 0.000] and continuous, stiff, obsessive and/or ritualized behavior [95.45% (63/66) vs. 30.43% (7/23); adjusted χ 2 = 39.159, P = 0.000]. For cognitive impairment, bvFTD patients presented apraxia [69.56% (16/23) vs. 22.73% (15/66); χ 2 = 16.484, P = 0.000] and executive dysfunction [82.61% (19/23) vs. 59.09% (39/66); χ 2 = 4.156, P = 0.041]. In psychotic symptoms, patients in control group showed hallucination and delusion [33.33% (22/66) vs. 4.35% (1/23); χ 2 = 7.477, P = 0.006]. Conclusions While the behavioral symptoms of bvFTD patients are varied, memory disorder can be one of the primal symptoms. Compared with similar foreign studies, the different composition of behavior symptoms of our bvFTD patients may be caused by cultural differences among evaluators in the understanding of some clinical symptoms in patients. DOI: 10.3969/j.issn.1672-6731.2017.11.010
{"title":"Analysis on early clinical features of behavioral variant frontotemporal dementia","authors":"Guan-jun Li, Jun Xu, Gang Mei, Ling Yue, Jing-hua Wang, Huafang Li","doi":"10.3969/CJCNN.V17I11.1692","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1692","url":null,"abstract":"Background Although the early behavioral symptoms of behavioral variant frontotemporal dementia (bvFTD) are prominent, early diagnosis for bvFTD is difficult due to confusion with other mental disorders, and lack of sensitivity and specificity of diagnostic criteria, etc. In this paper, we summarized the important reviews in recent years and analyzed the clinical characteristics of bvFTD patients to improve the detection of early symptoms in bvFTD. Methods Twenty-three possible or probable bvFTD patients were diagnosed according to International Behavioral Variant Frontotemporal Dementia Criteria Consortium (FTDC). Self-designed questionnaires designed by Shanghai Mental Health Center were used to collect sociodemographic data and general information of patients. Their clinical characteristics were summarized, including abnormal behaviors, cognitive impairment, psychotic symptoms and other symptoms. Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL) and Clinical Dementia Rating Scale (CDR) were used to make neuropsychological tests and compare with similar overseas studies (control group, N = 66). Results Eleven male patients and 12 female patients were included in our study. Compared with control group, the average age of onset [(50.83 ± 11.55) years vs. (57.00 ± 10.00) years; t = 3.863, P = 0.000] and average age of diagnosis [(53.22 ± 11.55) years vs. (61.00 ± 9.00) years; t = 13.423, P = 0.000] of bvFTD patients were smaller. The study showed that bvFTD patients had more apathy or indolence [95.65% (22/23) vs. 65.15% (43/66); χ 2 = 8.057, P = 0.005], loss of sympathy or empathy [95.65% (22/23) vs. 33.33% (22/66); χ 2 = 26.499, P = 0.000], while patients in control group showed more derepression behavior [98.48% (65/66) vs. 52.17% (12/23); χ 2 = 27.514, P = 0.000] and continuous, stiff, obsessive and/or ritualized behavior [95.45% (63/66) vs. 30.43% (7/23); adjusted χ 2 = 39.159, P = 0.000]. For cognitive impairment, bvFTD patients presented apraxia [69.56% (16/23) vs. 22.73% (15/66); χ 2 = 16.484, P = 0.000] and executive dysfunction [82.61% (19/23) vs. 59.09% (39/66); χ 2 = 4.156, P = 0.041]. In psychotic symptoms, patients in control group showed hallucination and delusion [33.33% (22/66) vs. 4.35% (1/23); χ 2 = 7.477, P = 0.006]. Conclusions While the behavioral symptoms of bvFTD patients are varied, memory disorder can be one of the primal symptoms. Compared with similar foreign studies, the different composition of behavior symptoms of our bvFTD patients may be caused by cultural differences among evaluators in the understanding of some clinical symptoms in patients. DOI: 10.3969/j.issn.1672-6731.2017.11.010","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"834-839"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41641133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1696
Dandan Song, Qingqing Wang, Q. Guo, X. Qi, F. Qiu
{"title":"Meningoencephalomyelitis associated with Epstein-Barr virus infection: one case report","authors":"Dandan Song, Qingqing Wang, Q. Guo, X. Qi, F. Qiu","doi":"10.3969/cjcnn.v17i11.1696","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1696","url":null,"abstract":"","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"856-859"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49168803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome. Methods A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded. Results Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis ( OR = 0.316, 95% CI: 0.102-0.982; P = 0.046). Conclusions Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better. DOI: 10.3969/j.issn.1672-6731.2017.11.004
{"title":"Thrombectomy with Solitaire stent for treating acute middle cerebral artery occlusion","authors":"Xiao-hui Chen, Meng-fei Zhong, Zhi-jie Yang, Zai-gang Lü, Mengxiao Liu, Hai-ting Li, Xiuyan Chen, Zong-en Gao","doi":"10.3969/CJCNN.V17I11.1686","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1686","url":null,"abstract":"Objective To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome. Methods A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded. Results Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis ( OR = 0.316, 95% CI: 0.102-0.982; P = 0.046). Conclusions Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better. DOI: 10.3969/j.issn.1672-6731.2017.11.004","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"793-799"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45005650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/CJCNN.V17I11.1691
J. Gong, Yan-yan Su, S. Lei, Xiao-Yu Liu, Shang-fu Zhang
Objective To summarize clinical and pathological features, diagnosis and differential diagnosis, as well as treatment and prognosis through analyzing one case of collision tumor in the sellar region (pituitary adenoma combined with malignant triton tumor). Methods and Results A 59-year-old male was admitted to hospital with decreased vision, vision field defect and dizziness. Head MRI demonstrated space-occupying lesion in the sellar region. Therefore, the patient underwent a transsphenoidal surgery with subtotal tumor resection. Three months later, the patient was admitted to hospital again with vision loss and headache. Head CT demonstrated space-occupying lesions in sellar/suprasellar region, therefore, the patient underwent saddle tumor resection. Histological findings revealed that the tumor was composed of two different types of tumors, one was pituitary adenoma with epithelial cells arranged in nest-like and trabecular pattern, and the other was diffused spindle cell tumor. The two tumors were distributed separately or mixed togenther. The morphology of spindle cell tumor was bland with scarce mitosis in the first surgery, whereas additional features including increased cell density, dark nuclei, frequent mitosis and scattering distributed rhabdomyoblasts were found in the second surgery. Immunohistochemically, the pituitary adenoma (epithelial cell region) cells were positive for cytokeratin 8 (CK8), chromogranin A (CgA), synaptophysin (Syn) and thyroid stimulating hormone (TSH), while the malignant triton tumor cells (spindle cell region) were positive for CD56, CD57, calretinin (CR) and focally positive for S-100 protein (S-100), desmin (Des) and myogenin. Ultrastructural findings revealed abundant rough endoplasmic reticules and secretary granules in the cytoplasm of pituitary adenoma cells, and discontinuous basal lamina located outside the spindle cell membrane. The final pathological diagnosis was sellar collision tumor (non-functional TSH adenoma combined with malignant triton tumor). The patient died 6 months after the second surgery. Conclusions Collision tumor of the sellar region with pituitary adenoma and malignant triton tumor is a rare tumor which can hardly be diagnosed by clinical and neuroimaging examination. The diagnosis relies on morphological characteristics, immunophenotype and ultrastructural features. The prognosis of collision tumor with malignant triton tumor component is poor. DOI: 10.3969/j.issn.1672-6731.2017.11.009
{"title":"Collision tumor of the sellar region","authors":"J. Gong, Yan-yan Su, S. Lei, Xiao-Yu Liu, Shang-fu Zhang","doi":"10.3969/CJCNN.V17I11.1691","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1691","url":null,"abstract":"Objective To summarize clinical and pathological features, diagnosis and differential diagnosis, as well as treatment and prognosis through analyzing one case of collision tumor in the sellar region (pituitary adenoma combined with malignant triton tumor). Methods and Results A 59-year-old male was admitted to hospital with decreased vision, vision field defect and dizziness. Head MRI demonstrated space-occupying lesion in the sellar region. Therefore, the patient underwent a transsphenoidal surgery with subtotal tumor resection. Three months later, the patient was admitted to hospital again with vision loss and headache. Head CT demonstrated space-occupying lesions in sellar/suprasellar region, therefore, the patient underwent saddle tumor resection. Histological findings revealed that the tumor was composed of two different types of tumors, one was pituitary adenoma with epithelial cells arranged in nest-like and trabecular pattern, and the other was diffused spindle cell tumor. The two tumors were distributed separately or mixed togenther. The morphology of spindle cell tumor was bland with scarce mitosis in the first surgery, whereas additional features including increased cell density, dark nuclei, frequent mitosis and scattering distributed rhabdomyoblasts were found in the second surgery. Immunohistochemically, the pituitary adenoma (epithelial cell region) cells were positive for cytokeratin 8 (CK8), chromogranin A (CgA), synaptophysin (Syn) and thyroid stimulating hormone (TSH), while the malignant triton tumor cells (spindle cell region) were positive for CD56, CD57, calretinin (CR) and focally positive for S-100 protein (S-100), desmin (Des) and myogenin. Ultrastructural findings revealed abundant rough endoplasmic reticules and secretary granules in the cytoplasm of pituitary adenoma cells, and discontinuous basal lamina located outside the spindle cell membrane. The final pathological diagnosis was sellar collision tumor (non-functional TSH adenoma combined with malignant triton tumor). The patient died 6 months after the second surgery. Conclusions Collision tumor of the sellar region with pituitary adenoma and malignant triton tumor is a rare tumor which can hardly be diagnosed by clinical and neuroimaging examination. The diagnosis relies on morphological characteristics, immunophenotype and ultrastructural features. The prognosis of collision tumor with malignant triton tumor component is poor. DOI: 10.3969/j.issn.1672-6731.2017.11.009","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"825-833"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41997092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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