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Cummings, Thomas John

Overview:

Clinical and Research interests: Neuropathology; Ophthalmic pathology; Orthopaedic pathology; Bone and soft tissue tumors; Neuromuscular pathology; General surgical pathology; Leprosy; Tropical diseases.

Positions:

Professor of Pathology

Pathology
School of Medicine

Professor of Ophthalmology

Ophthalmology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1991

M.D. — University of Medicine and Dentistry of New Jersey

Publications:

Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis

Authors
Kent, CL; Mowery, YM; Wright, AO; Kim, GJ; Desjardins, A; Peters, KB; Vlahovic, G; Friedman, HS; Cummings, TJ; McLendon, RE; Friedman, AH; Sampson, JH; Kirkpatrick, JP
MLA Citation
Kent, CL, Mowery, YM, Wright, AO, Kim, GJ, Desjardins, A, Peters, KB, Vlahovic, G, Friedman, HS, Cummings, TJ, McLendon, RE, Friedman, AH, Sampson, JH, and Kirkpatrick, JP. "Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E83
End Page
E84

Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis.

Authors
Kent, CL; Mowery, YM; Wright, AO; Kim, GJ; Desjardins, A; Peters, KB; Vlahovic, G; Friedman, HS; Cummings, TJ; McLendon, RE; Friedman, AH; Sampson, JH; Kirkpatrick, JP
MLA Citation
Kent, CL, Mowery, YM, Wright, AO, Kim, GJ, Desjardins, A, Peters, KB, Vlahovic, G, Friedman, HS, Cummings, TJ, McLendon, RE, Friedman, AH, Sampson, JH, and Kirkpatrick, JP. "Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With Radiation Therapy: A Single-Institution Retrospective Analysis." International journal of radiation oncology, biology, physics 96.2S (October 2016): E83-E84.
PMID
27675478
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E83
End Page
E84
DOI
10.1016/j.ijrobp.2016.06.802

"Diagnostic Algorithm for Patients With Suspected Giant Cell Arteritis" Useful, but No Substitute for Thorough Histopathology: Response.

Authors
Tariq Bhatti, M; El-Dairi, MA; Cummings, TJ; Proia, AD
MLA Citation
Tariq Bhatti, M, El-Dairi, MA, Cummings, TJ, and Proia, AD. ""Diagnostic Algorithm for Patients With Suspected Giant Cell Arteritis" Useful, but No Substitute for Thorough Histopathology: Response." Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 36.3 (September 2016): 343-344.
PMID
27227465
Source
epmc
Published In
Journal of Neuro-Ophthalmology
Volume
36
Issue
3
Publish Date
2016
Start Page
343
End Page
344
DOI
10.1097/wno.0000000000000393

Diagnostic Algorithm for Suspected Giant Cell Arteritis: Response.

Authors
Bhatti, MT; El-Dairi, MA; Cummings, TJ; Proia, AD
MLA Citation
Bhatti, MT, El-Dairi, MA, Cummings, TJ, and Proia, AD. "Diagnostic Algorithm for Suspected Giant Cell Arteritis: Response." Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 36.2 (June 2016): 225-227.
PMID
27058311
Source
epmc
Published In
Journal of Neuro-Ophthalmology
Volume
36
Issue
2
Publish Date
2016
Start Page
225
End Page
227
DOI
10.1097/wno.0000000000000367

Rhabdomyomatous mesenchymal hamartoma presenting as a sacral skin tag in two neonates with spinal dysraphism.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital malformation involving the dermis and subcutaneous tissue, of which there were 62 reported cases through 2014. We report RMH in two neonates presenting as a sacral skin tag. In both cases, magnetic resonance imaging (MRI) of the spine showed evidence of spinal dysraphism, including a lipomyelomeningocele and a tethered cord. Surgical repair of the defects was performed. Histopathologic examination of the skin tags showed a haphazard arrangement of mature skeletal muscle fibers and adnexal elements, consistent with RMH. The second patient also had a hemangioma on the sacrum and was diagnosed with LUMBAR (lower body hemangioma and other cutaneous defects, urogenital anomalies/ulceration, myelopathy, bony deformities, anorectal/arterial anomalies, and renal anomalies) syndrome, an association between cutaneous infantile hemangiomas of the lower body and regional congenital anomalies. The apparent association of paraspinal RMH with spinal dysraphism suggests that aberrant migration of mesodermally derived tissues (including skeletal muscle fibers) during neural tube development may be responsible for the pathologic findings in the skin. Additional study of patients with spinal dysraphism and congenital cutaneous lesions may further support this hypothesis.

Authors
McKinnon, EL; Rand, AJ; Selim, MA; Fuchs, HE; Buckley, AF; Cummings, TJ
MLA Citation
McKinnon, EL, Rand, AJ, Selim, MA, Fuchs, HE, Buckley, AF, and Cummings, TJ. "Rhabdomyomatous mesenchymal hamartoma presenting as a sacral skin tag in two neonates with spinal dysraphism." Journal of cutaneous pathology 42.10 (October 2015): 774-778.
PMID
25989364
Source
epmc
Published In
Journal of Cutaneous Pathology
Volume
42
Issue
10
Publish Date
2015
Start Page
774
End Page
778
DOI
10.1111/cup.12538

Diagnostic Algorithm for Patients With Suspected Giant Cell Arteritis.

To identify clinical and laboratory factors contributing to the diagnosis of giant cell arteritis (GCA) and develop a diagnostic algorithm for the evaluation of GCA.Retrospective review of 213 consecutive cases of temporal artery biopsy (TAB) seen at a single academic center over a 10-year period (2000-2009). Pathologic specimens were re-reviewed and agreement between the original and second readings was assessed. A composite clinical suspicion score was created by adding 1 point for each of the following criteria: anterior extracranial circulation ischemia, new onset headache, abnormal laboratory results (erythrocyte sedimentation rate, C-reactive protein (CRP), or platelet count), jaw claudication, abnormal or tender superficial temporal artery, constitutional symptoms, and polymyalgia rheumatica; one point was subtracted if a comorbid condition could explain a criterion.Of the 204 TABs analyzed, pathologic findings were confirmatory in 49 (24.0%) and suggestive in 12 (5.9%). TAB-positive patients were more likely to be older (age 75.2 ± 7.8 vs 69.7 ± 11.0 years, P = 0.0002), complain of jaw claudication (relative-risk = 3.26, P = 0.0014), and have thrombocytosis (relative-risk = 3.3, P = 0.0072) and elevated CRP (relative-risk = 1.8, P = 0.037). None of the patients with a clinical score less than 2 had a positive TAB. Diabetes mellitus and kidney disease were often the explanation for the symptoms and abnormal clinical finding(s) that led to a negative TAB.We propose a clinical algorithm that is highly predictive for a positive TAB and can be valuable in the evaluation process of suspected cases of GCA.

Authors
El-Dairi, MA; Chang, L; Proia, AD; Cummings, TJ; Stinnett, SS; Bhatti, MT
MLA Citation
El-Dairi, MA, Chang, L, Proia, AD, Cummings, TJ, Stinnett, SS, and Bhatti, MT. "Diagnostic Algorithm for Patients With Suspected Giant Cell Arteritis." Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 35.3 (September 2015): 246-253.
PMID
25802967
Source
epmc
Published In
Journal of Neuro-Ophthalmology
Volume
35
Issue
3
Publish Date
2015
Start Page
246
End Page
253
DOI
10.1097/wno.0000000000000234

An Extraordinary Association of Glomus Tumor and Pacinian Hyperplasia in the Hand of a Female Patient.

Glomus tumor is a benign neoplasm of the glomus body, a neuromyoarterial structure that regulates temperature and pressure in the cutaneous vasculature. Approximately 1%-4.5% of glomus tumors present in the hands of females; of these, 65% are seen in the subungual region of the index and long fingers. Pacinian hyperplasia is a benign lesion of the Pacinian corpuscle, a mechanoreceptor located in the subcutis of the hands and feet.A 65-year-old woman with a history of hand trauma and a 1-year chief complaint of tingling, pain, and burning sensations in her proximal thumb underwent exploration of the digital nerve after an x-ray and 2 magnetic resonance imaging examinations failed to detect a mass. Two lesions immediately adjacent to each other were excised.Microscopic examination showed Pacinian hyperplasia, and a second proliferation of solid epithelioid cells related to benign blood vessels. Immunohistochemistry confirmed the epithelioid cells to be strongly positive for smooth muscle actin, CD34, and type 4 collagen, which is consistent with the phenotype of a glomus tumor. The cells were negative for S100 protein.The association of glomus tumor with Pacinian hyperplasia has rarely been reported in the literature. We present another rare case to bring awareness to this differential diagnostic consideration.

Authors
Komforti, M; Cummings, TJ
MLA Citation
Komforti, M, and Cummings, TJ. "An Extraordinary Association of Glomus Tumor and Pacinian Hyperplasia in the Hand of a Female Patient." The American Journal of dermatopathology 37.9 (September 2015): 719-720.
PMID
25943240
Source
epmc
Published In
American Journal of Dermatopathology
Volume
37
Issue
9
Publish Date
2015
Start Page
719
End Page
720
DOI
10.1097/dad.0000000000000374

Eye and ocular adnexa

Authors
Odashiro, AN; Cummings, TJ; Burnier, MN
MLA Citation
Odashiro, AN, Cummings, TJ, and Burnier, MN. "Eye and ocular adnexa." Sternberg's Diagnostic Surgical Pathology: Sixth Edition. January 21, 2015.
Source
scopus
Volume
1-2
Publish Date
2015

Conjunctival pseudotumor caused by herpes simplex virus infection.

Authors
Vora, GK; Marr, B; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Vora, GK, Marr, B, Cummings, TJ, and Mruthyunjaya, P. "Conjunctival pseudotumor caused by herpes simplex virus infection." JAMA ophthalmology 133.1 (January 2015): 105-107.
PMID
25232655
Source
epmc
Published In
JAMA Ophthalmology
Volume
133
Issue
1
Publish Date
2015
Start Page
105
End Page
107
DOI
10.1001/jamaophthalmol.2014.3316

Choroid plexus in the eye: a case study.

PURPOSE: The purpose of this report is to describe a pediatric case of total retinal detachment (RD) with secondary glaucoma in the setting of posterior coloboma with the metaplastic retinal pigment epithelium showing abrupt transition to choroid plexus tissue. METHODS: Retrospective case report. RESULTS: A 3-month-old patient presented with leukocoria and enlarged right eye. She was found to have a funnel RD with anterior displacement of lens-iris diaphragm and secondary glaucoma. Orbital imaging ruled out retinoblastoma, and posterior coloboma was identified. Intraocular pressures remained significantly elevated despite maximal medical therapy on glaucoma drops and transscleral cycloablation, and the eye was enucleated for comfort. Histologic analysis confirmed neovascularization of the iris, total RD, and posterior coloboma with the associated metaplastic retinal pigment epithelium showing abrupt transition to choroid plexus tissue. CONCLUSION: This is the first reported case of choroid plexus in the human eye. A close association of choroid plexus with coloboma and RD raises possibility that this tissue may have functionally contributed to pathogenesis of RD by secreting cerebrospinal fluid within subretinal space.

Authors
Todorich, B; Cummings, TJ; Freedman, S
MLA Citation
Todorich, B, Cummings, TJ, and Freedman, S. "Choroid plexus in the eye: a case study." Retinal cases & brief reports 9.1 (January 2015): 78-82.
PMID
25383853
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
9
Issue
1
Publish Date
2015
Start Page
78
End Page
82
DOI
10.1097/icb.0000000000000089

Conjunctival melanoma.

Authors
Yiu, G; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Yiu, G, Cummings, TJ, and Mruthyunjaya, P. "Conjunctival melanoma." JAMA ophthalmology 132.12 (December 2014): 1432-.
PMID
25340828
Source
epmc
Published In
JAMA Ophthalmology
Volume
132
Issue
12
Publish Date
2014
Start Page
1432
DOI
10.1001/jamaophthalmol.2014.585

Ophthalmologic Pathology: SY20-1 OCULAR PATHOLOGY, AN OVERVIEW: RETINA AND OPTIC NERVE.

The goal of this symposium is to present an overview of ocular pathology, and this lecture is dedicated to an overview of the pathology of the retina and optic nerve. The retina is a complex tissue lining the inner surface of the eye. It receives images from the outside world and transmits signals to the visual cortex in the occipital pole of the brain. The retina is basically neuroglial tissue, composed of ganglion cells (neurons) and glia (astrocytes within the nerve fiber layer and ganglion cell layer, and, Müller radial glia which extend from the inner limiting membrane to the outer limiting membrane). The pathology of some retinal disorders, including retinoblastoma, hemangioblastoma, and age-related macular degeneration, will be presented. The optic nerve is a white matter tract containing glia and axons, but not ganglion cells or Schwann cells. The axons originate from the retinal ganglion cells and course posteriorly within the retinal nerve fiber layer. Optic nerve pathology including optic nerve gliomas, optic nerve meningiomas, optic nerve choristoma, demyelinating disease, granulomatous inflammation, and ischemia, will be presented.

Authors
Cummings, TJ
MLA Citation
Cummings, TJ. "Ophthalmologic Pathology: SY20-1 OCULAR PATHOLOGY, AN OVERVIEW: RETINA AND OPTIC NERVE." Pathology 46 Suppl 2 (October 2014): S30-.
PMID
25188127
Source
epmc
Published In
Pathology
Volume
46 Suppl 2
Publish Date
2014
Start Page
S30
DOI
10.1097/01.pat.0000454185.97418.8c

Choroidal metastatasis from a neuroendocrine tumor masquerading as choroidal melanoma.

A mushroom-shaped choroidal mass is classically suggestive of melanoma, due to the ability of these tumors to erupt through Bruch's membrane. In contrast, choroidal metastases rarely adopt this growth pattern. The authors present an unusual case of a patient with a large choroidal metastasis from a pancreatic neuroendocrine tumor that shows a collar-button configuration. The diagnosis was confirmed by histology and immunohistochemistry following enucleation. The authors review the typical appearance of choroidal metastases from neuroendocrine tumors and discuss mechanisms by which uveal tumors may extend through Bruch's membrane.

Authors
Yiu, G; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Yiu, G, Cummings, TJ, and Mruthyunjaya, P. "Choroidal metastatasis from a neuroendocrine tumor masquerading as choroidal melanoma." Ophthalmic surgery, lasers & imaging retina 45.5 (September 2014): 456-458.
PMID
25153655
Source
epmc
Published In
OSLIRetina
Volume
45
Issue
5
Publish Date
2014
Start Page
456
End Page
458
DOI
10.3928/23258160-20140725-01

Unilateral microsporidia keratitis in a healthy non-contact lens wearer.

Authors
Espandar, L; Cummings, TJ; Boehlke, CS
MLA Citation
Espandar, L, Cummings, TJ, and Boehlke, CS. "Unilateral microsporidia keratitis in a healthy non-contact lens wearer." JAMA ophthalmology 132.7 (July 2014): 822-.
PMID
24830662
Source
epmc
Published In
JAMA Ophthalmology
Volume
132
Issue
7
Publish Date
2014
Start Page
822
DOI
10.1001/jamaophthalmol.2013.4079

Concurrent split cord malformation and teratoma: Dysembryology, presentation, and treatment

Split cord malformation (SCM) is a rare form of spinal dysraphism in which the spinal cord is divided in the sagittal plane, forming a double neural tube. In addition to being associated with a variety of malformations, SCM may occur with spinal cord tumors, with only exceptional cases involving teratomas. As only eight patients with a teratoma associated with SCM have been reported, their presentation characteristics and treatment are currently unclear. We review the literature of all patients with SCM with concurrent spinal teratoma, discuss the potential dysembryology, and report the first case of SCM with concurrent spinal teratoma in an elderly patient. The mean age of those with concurrent SCM and teratomas was 39.4 years, with 55.6% occurring in females. The lumbar spine was the most frequent location for teratomas (66.7%), with the Type II malformation more commonly occurring with these tumors (75%). The duration of symptoms varied widely, ranging from 1 month to 5 years, with the average duration being nearly 2 years. Back pain (87.5%) and lower extremity weakness (75%) were the most common presenting symptoms. As SCM may be associated with progressive neurological deterioration and teratomas can contain immature or malignant components, surgery should be attempted with the goal of gross total resection. Nonetheless, in patients with a concurrent tumor and spinal dysraphism, spinal teratomas should be considered in the differential diagnosis. Gross total resection of these lesions may be safely achieved even in the presence of SCM using intraoperative electrophysiologic monitoring. © 2013 Elsevier Ltd. All rights reserved.

Authors
Babu, R; Reynolds, R; Moreno, JR; Cummings, TJ; Bagley, CA
MLA Citation
Babu, R, Reynolds, R, Moreno, JR, Cummings, TJ, and Bagley, CA. "Concurrent split cord malformation and teratoma: Dysembryology, presentation, and treatment." Journal of Clinical Neuroscience 21.2 (February 1, 2014): 212-216.
Source
scopus
Published In
Journal of Clinical Neuroscience
Volume
21
Issue
2
Publish Date
2014
Start Page
212
End Page
216
DOI
10.1016/j.jocn.2013.04.027

TTF-1 Is Expressed in a Subset of Esophageal Adenocarcinomas

Authors
Layne, AC; Cummings, TJ; Guy, CD; Cardona, DM; Bentley, RC; Shealy, MJ; Zhang, X; McCall, SJ
MLA Citation
Layne, AC, Cummings, TJ, Guy, CD, Cardona, DM, Bentley, RC, Shealy, MJ, Zhang, X, and McCall, SJ. "TTF-1 Is Expressed in a Subset of Esophageal Adenocarcinomas." February 2014.
Source
wos-lite
Published In
Modern Pathology
Volume
27
Publish Date
2014
Start Page
188A
End Page
188A

TTF-1 Is Expressed in a Subset of Esophageal Adenocarcinomas

Authors
Layne, AC; Cummings, TJ; Guy, CD; Cardona, DM; Bentley, RC; Shealy, MJ; Zhang, X; McCall, SJ
MLA Citation
Layne, AC, Cummings, TJ, Guy, CD, Cardona, DM, Bentley, RC, Shealy, MJ, Zhang, X, and McCall, SJ. "TTF-1 Is Expressed in a Subset of Esophageal Adenocarcinomas." February 2014.
Source
wos-lite
Published In
Laboratory Investigation
Volume
94
Publish Date
2014
Start Page
188A
End Page
188A

Imaging microscopic pigment chemistry in conjunctival melanocytic lesions using pump-probe laser microscopy.

To report the application of a novel imaging technique, pump-probe microscopy, to analyze patterns of pigment chemistry of conjunctival melanocytic lesion biopsies.Histopathologic specimens of eight previously excised conjunctival melanocytic lesions were analyzed with pump-probe microscopy. The technique uses a laser scanning microscope with a two-color pulsed laser source to distinguish hemoglobin, eumelanin, and pheomelanin pigment based on differences in transient excited state and ground state photodynamics. The pump-probe signatures of conjunctival melanins were compared with cutaneous melanins. The distributions of hemoglobin, eumelanin, and pheomelanin were analyzed, and pump-probe images were correlated with adjacent hematoxylin and eosin (H&E)-stained sections.The pump-probe signatures of conjunctival melanins are similar, but not identical to cutaneous melanins. In addition, there are qualitative and quantitative differences in the structure and pigment chemistry of conjunctival benign nevi, primary acquired melanosis of the conjunctiva (PAM), and conjunctival melanomas. The pump-probe images correlated well with histopathologic features observed in the adjacent H&E-stained sections, and provided a label-free means of discerning conjunctival anatomic features and pathologic benign or malignant tissue.Pump-probe laser microscopy shows promise as an adjuvant diagnostic tool in evaluation of ocular melanocytic lesions based on morphologic correlation with the histopathology results and pigment chemistry. This initial study suggests systematic differences in pigmentation patterns among conjunctival benign nevi, primary acquired melanosis, and melanomas. In addition, pump-probe microscopy has the potential for use as a noninvasive "in vivo" optical biopsy technique to aid clinical and surgical management of conjunctival melanocytic lesions.

Authors
Wilson, JW; Vajzovic, L; Robles, FE; Cummings, TJ; Mruthyunjaya, P; Warren, WS
MLA Citation
Wilson, JW, Vajzovic, L, Robles, FE, Cummings, TJ, Mruthyunjaya, P, and Warren, WS. "Imaging microscopic pigment chemistry in conjunctival melanocytic lesions using pump-probe laser microscopy." Investigative ophthalmology & visual science 54.10 (October 21, 2013): 6867-6876.
PMID
24065811
Source
epmc
Published In
Investigative Ophthalmology and Visual Science
Volume
54
Issue
10
Publish Date
2013
Start Page
6867
End Page
6876
DOI
10.1167/iovs.13-12432

Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature.

Pituitary adenomas and Rathke's cleft cysts (RCCs) share a common embryological origin. Occasionally, these two lesions can present within the same patient. We present a case of a 39-year-old male who was found to have a large sellar lesion after complaints of persistent headaches and horizontal nystagmus. Surgical resection revealed components of a RCC co-existing with a pituitary adenoma. A brief review of the literature was performed revealing 38 cases of co-existing Rathke's cleft cysts and pituitary adenomas. Among the cases, the most common symptoms included headache and visual changes. Rathke's cleft cysts and pituitary adenomas are rarely found to co-exist, despite having common embryological origins. We review the existing literature, discuss the common embryology to these two lesions and describe a unique case from our institution of a co-existing Rathke's cleft cyst and pituitary adenoma.

Authors
Babu, R; Back, AG; Komisarow, JM; Owens, TR; Cummings, TJ; Britz, GW
MLA Citation
Babu, R, Back, AG, Komisarow, JM, Owens, TR, Cummings, TJ, and Britz, GW. "Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature." Asian journal of neurosurgery 8.4 (October 2013): 183-187.
PMID
24551002
Source
epmc
Published In
Asian Journal of Neurosurgery
Volume
8
Issue
4
Publish Date
2013
Start Page
183
End Page
187
DOI
10.4103/1793-5482.125662

Treatment and outcomes of epithelioid sarcoma of the spine.

Epithelioid sarcoma (ES) is a rare soft-tissue neoplasm which is most commonly found in the extremities of young adult males. ES has a poor prognosis due to its aggressiveness as it frequently recurs locally and can undergo lymphatic metastasis to soft tissue, fascia, bone, lymph nodes, lung, and brain. The most common form is the classic-type (granuloma-like), though a more aggressive subtype known as the proximal- or axial-type has also been described. As ES of the spine is exceedingly rare, with only seven patients being reported in the literature, the outcomes of these patients is unclear. We have reviewed the literature of all existing spinal ES cases to recommend treatment strategies and report the first case of proximal-type ES in the cervical spine. Patients with spinal ES had an average age of 20.7 years, with 71.4% of cases being in males. Metastasis was common and was found in 83.3% of patients, with lung metastasis being found in 60% of these patients. Due to the high rates of local recurrence and distant metastasis, the goal of surgery remains gross total resection of all tumor and involved bony elements if feasible without significant neurological deficits. Ligation of involved nerve roots may be necessary to achieve adequate resection of the tumor mass as nerve sheaths can serve as a pathway for extension. In the cervical spine, resection of these lesions is difficult due to involvement of the vertebral arteries in addition to nerve roots, increasing the surgical risk.

Authors
Babu, R; Karikari, IO; Cummings, TJ; Gottfried, ON; Bagley, CA
MLA Citation
Babu, R, Karikari, IO, Cummings, TJ, Gottfried, ON, and Bagley, CA. "Treatment and outcomes of epithelioid sarcoma of the spine." J Clin Neurosci 20.10 (October 2013): 1342-1345. (Review)
PMID
23623614
Source
pubmed
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
10
Publish Date
2013
Start Page
1342
End Page
1345
DOI
10.1016/j.jocn.2012.12.009

Uncorrectable ptosis: primary cutaneous signet-ring cell carcinoma.

Primary cutaneous signet-ring cell carcinoma (PCSRCC) is a rare but aggressive tumor. Our case highlights a 60-year-old man who presented with eyelid ptosis, for which he underwent multiple surgical procedures over a 3-year period prior to referral to our clinic. These procedures were complicated by scarring, delayed healing, and poor cosmetic outcome. In addition, the patient was noted to develop progressive enophthalmos. These concerning signs led to a CT scan and subsequent eyelid biopsy, which revealed a diagnosis of PCSRCC. Further management has involved an MRI and orbitotomy with biopsy revealing widespread extension of the carcinoma. Exenteration was performed to reduce the likelihood of metastasis. There are few documented case reports of PCSRCC of the eyelid in the literature. Of the 33 published cases of PCSRCC, 27 cases involve the eyelids and the other 6 cases involve the axilla. The unique clinical features of this case will be discussed, in particular the presentation as ptosis, an otherwise commonplace complaint in the oculoplastics clinic. The surgical course and histopathologic findings will be presented. The literature regarding PCSRCC will be reviewed including demographics, management, and prognosis. Although rare, PCSRCC follows an aggressive course with characteristically delayed diagnosis. Early identification and treatment likely offer a better prognosis. Thus, description of the clinical presentation of this rare tumor may aid in recognition and earlier treatment.

Authors
Hansen, MS; Chi, SL; Cummings, T; Woodward, JA
MLA Citation
Hansen, MS, Chi, SL, Cummings, T, and Woodward, JA. "Uncorrectable ptosis: primary cutaneous signet-ring cell carcinoma. (Published online)" Dermatol Online J 19.9 (September 14, 2013): 19615-.
PMID
24050289
Source
pubmed
Published In
Dermatology online journal
Volume
19
Issue
9
Publish Date
2013
Start Page
19615

Uncorrectable ptosis: primary cutaneous signet-ring cell carcinoma.

Primary cutaneous signet-ring cell carcinoma (PCSRCC) is a rare but aggressive tumor. Our case highlights a 60-year-old man who presented with eyelid ptosis, for which he underwent multiple surgical procedures over a 3-year period prior to referral to our clinic. These procedures were complicated by scarring, delayed healing, and poor cosmetic outcome. In addition, the patient was noted to develop progressive enophthalmos. These concerning signs led to a CT scan and subsequent eyelid biopsy, which revealed a diagnosis of PCSRCC. Further management has involved an MRI and orbitotomy with biopsy revealing widespread extension of the carcinoma. Exenteration was performed to reduce the likelihood of metastasis. There are few documented case reports of PCSRCC of the eyelid in the literature. Of the 33 published cases of PCSRCC, 27 cases involve the eyelids and the other 6 cases involve the axilla. The unique clinical features of this case will be discussed, in particular the presentation as ptosis, an otherwise commonplace complaint in the oculoplastics clinic. The surgical course and histopathologic findings will be presented. The literature regarding PCSRCC will be reviewed including demographics, management, and prognosis. Although rare, PCSRCC follows an aggressive course with characteristically delayed diagnosis. Early identification and treatment likely offer a better prognosis. Thus, description of the clinical presentation of this rare tumor may aid in recognition and earlier treatment.

Authors
Hansen, MS; Chi, SL; Cummings, T; Woodward, JA
MLA Citation
Hansen, MS, Chi, SL, Cummings, T, and Woodward, JA. "Uncorrectable ptosis: primary cutaneous signet-ring cell carcinoma." Dermatology online journal 19.9 (September 1, 2013): 19615-.
Source
scopus
Published In
Dermatology online journal
Volume
19
Issue
9
Publish Date
2013
Start Page
19615

Adult primitive neuroectodermal tumors: the prognostic value of supratentorial location.

Primitive neuroectodermal tumors (PNETs) are tumors which primarily consist of undifferentiated round neuroepithelial cells. Central nervous system PNETs can be divided into two genetically distinct groups: infratentorial PNET (iPNET)/medulloblastoma and supratentorial PNET (sPNET). Currently, the comparative outcome of adult patients with sPNETs and iPNETs is unknown. In this study we have utilized the Surveillance, Epidemiology, and End Results database to perform a comparative analysis of 103 cases of adult sPNET and 669 adult medulloblastoma cases. Additionally we have analyzed various factors to identify their prognostic significance and characterize the optimal treatment for these tumors. Patients with sPNETs were seen to have a significantly worse survival than those diagnosed with medulloblastomas (16 vs. 155 months, p < 0.0001). Elderly patients (15 vs. 114 months, p < 0.0001) and those over the age of 40 (68 vs. 147 months, p < 0.0001) experienced significantly worse survival than younger patients. In contrast, radiotherapy (143 vs. 26 months, p < 0.0001), surgical resection (116 vs. 22 months, p = 0.0010) and the extent of resection (EOR) (173 vs. 81 months, p = 0.0005) resulted in significantly improved patient survival. Multivariate analysis revealed age greater than 40 years (HR: 1.57; 95 % CI: 1.17-2.11; p = 0.0028) and sPNET pathology (HR: 3.41; 95 % CI: 2.47-4.72; p < 0.0001) to be poor prognostic factors for survival while radiotherapy (HR: 0.52; 95 % CI: 0.38-0.71; p < 0.0001) and the EOR (HR: 0.73; 95 % CI: 0.55-0.96; p = 0.023) were associated with significantly improved survival. The treatment of sPNETs should therefore include maximal surgical resection when feasible followed by radiotherapy as these treatments have been demonstrated to confer a survival benefit. Additional studies are needed to identify effective chemotherapeutics and specific treatment regimens for adults with sPNETs.

Authors
Gandhi, R; Babu, R; Cummings, TJ; Adamson, C
MLA Citation
Gandhi, R, Babu, R, Cummings, TJ, and Adamson, C. "Adult primitive neuroectodermal tumors: the prognostic value of supratentorial location." J Neurooncol 114.1 (August 2013): 141-148.
PMID
23720066
Source
pubmed
Published In
Journal of Neuro-Oncology
Volume
114
Issue
1
Publish Date
2013
Start Page
141
End Page
148
DOI
10.1007/s11060-013-1163-x

Clinicopathological characteristics and treatment of rhabdoid glioblastoma Clinical article

Authors
Babu, R; Hatef, J; McLendon, RE; Cummings, TJ; Sampson, JH; Friedman, AH; Adamson, C
MLA Citation
Babu, R, Hatef, J, McLendon, RE, Cummings, TJ, Sampson, JH, Friedman, AH, and Adamson, C. "Clinicopathological characteristics and treatment of rhabdoid glioblastoma Clinical article." JOURNAL OF NEUROSURGERY 119.2 (August 2013): 412-419.
PMID
23641829
Source
wos-lite
Published In
Journal of neurosurgery
Volume
119
Issue
2
Publish Date
2013
Start Page
412
End Page
419
DOI
10.3171/2013.3.JNS121773

Spinal cavernous and capillary hemangiomas in adults.

STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. SUMMARY OF BACKGROUND DATA: Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. METHODS: We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). RESULTS: A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). CONCLUSION: Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.

Authors
Babu, R; Owens, TR; Karikari, IO; Moreno, J; Cummings, TJ; Gottfried, ON; Bagley, CA
MLA Citation
Babu, R, Owens, TR, Karikari, IO, Moreno, J, Cummings, TJ, Gottfried, ON, and Bagley, CA. "Spinal cavernous and capillary hemangiomas in adults." Spine (Phila Pa 1976) 38.7 (April 1, 2013): E423-E430.
PMID
23354109
Source
pubmed
Published In
Spine
Volume
38
Issue
7
Publish Date
2013
Start Page
E423
End Page
E430
DOI
10.1097/BRS.0b013e318287fef7

Glioblastoma of the Optic Nerve

Authors
Jiang, X; Cummings, TJ
MLA Citation
Jiang, X, and Cummings, TJ. "Glioblastoma of the Optic Nerve." February 2013.
Source
wos-lite
Published In
Modern Pathology
Volume
26
Publish Date
2013
Start Page
420A
End Page
421A

Glioblastoma of the Optic Nerve

Authors
Jiang, X; Cummings, TJ
MLA Citation
Jiang, X, and Cummings, TJ. "Glioblastoma of the Optic Nerve." February 2013.
Source
wos-lite
Published In
Laboratory Investigation
Volume
93
Publish Date
2013
Start Page
420A
End Page
421A

Treatment and outcomes of epithelioid sarcoma of the spine

Epithelioid sarcoma (ES) is a rare soft-tissue neoplasm which is most commonly found in the extremities of young adult males. ES has a poor prognosis due to its aggressiveness as it frequently recurs locally and can undergo lymphatic metastasis to soft tissue, fascia, bone, lymph nodes, lung, and brain. The most common form is the classic-type (granuloma-like), though a more aggressive subtype known as the proximal- or axial-type has also been described. As ES of the spine is exceedingly rare, with only seven patients being reported in the literature, the outcomes of these patients is unclear. We have reviewed the literature of all existing spinal ES cases to recommend treatment strategies and report the first case of proximal-type ES in the cervical spine. Patients with spinal ES had an average age of 20.7 years, with 71.4% of cases being in males. Metastasis was common and was found in 83.3% of patients, with lung metastasis being found in 60% of these patients. Due to the high rates of local recurrence and distant metastasis, the goal of surgery remains gross total resection of all tumor and involved bony elements if feasible without significant neurological deficits. Ligation of involved nerve roots may be necessary to achieve adequate resection of the tumor mass as nerve sheaths can serve as a pathway for extension. In the cervical spine, resection of these lesions is difficult due to involvement of the vertebral arteries in addition to nerve roots, increasing the surgical risk. © 2013 Elsevier Ltd. All rights reserved.

Authors
Babu, R; Karikari, IO; Cummings, TJ; Gottfried, ON; Bagley, CA
MLA Citation
Babu, R, Karikari, IO, Cummings, TJ, Gottfried, ON, and Bagley, CA. "Treatment and outcomes of epithelioid sarcoma of the spine." Journal of Clinical Neuroscience 20.10 (2013): 1342-1345.
Source
scival
Published In
Journal of Clinical Neuroscience
Volume
20
Issue
10
Publish Date
2013
Start Page
1342
End Page
1345
DOI
10.1016/j.jocn.2012.12.009

Spinal cavernous and capillary hemangiomas in adults

STUDY DESIGN.: Retrospective cohort analysis. OBJECTIVE.: To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. SUMMARY OF BACKGROUND DATA.: Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. METHODS.: We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). RESULTS.: A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). CONCLUSION.: Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas. © 2013, Lippincott Williams & Wilkins.

Authors
Babu, R; Owens, TR; Karikari, IO; Moreno, J; Cummings, TJ; Gottfried, ON; Bagley, CA
MLA Citation
Babu, R, Owens, TR, Karikari, IO, Moreno, J, Cummings, TJ, Gottfried, ON, and Bagley, CA. "Spinal cavernous and capillary hemangiomas in adults." Spine 38.7 (2013): E423-E430.
Source
scival
Published In
Spine
Volume
38
Issue
7
Publish Date
2013
Start Page
E423
End Page
E430
DOI
10.1097/BRS.0b013e318287fef7

Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy

We extend nonlinear pump-probe microscopy, recently demonstrated to image the microscopic distribution of eumelanin and pheomelanin in unstained skin biopsy sections, to the case of melanocytic conjunctival lesions. The microscopic distribution of pigmentation chemistry serves as a functional indicator of melanocyte activity. In these conjunctival specimens (benign nevi, primary acquired melanoses, and conjunctival melanoma), we have observed pump-probe spectroscopic signatures of eumelanin, pheomelanin, hemoglobin, and surgical ink, in addition to important structural features that differentiate benign from malignant lesions. We will also discuss prospects for an in vivo 'optical biopsy' to provide additional information before having to perform invasive procedures. © 2013 Copyright SPIE.

Authors
Wilson, JW; Vajzovic, L; Robles, FE; Cummings, TJ; Mruthyunjaya, P; Warren, WS
MLA Citation
Wilson, JW, Vajzovic, L, Robles, FE, Cummings, TJ, Mruthyunjaya, P, and Warren, WS. "Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy." 2013.
Source
scival
Volume
8567
Publish Date
2013
DOI
10.1117/12.2003137

Adult primitive neuroectodermal tumors: The prognostic value of supratentorial location

Primitive neuroectodermal tumors (PNETs) are tumors which primarily consist of undifferentiated round neuroepithelial cells. Central nervous system PNETs can be divided into two genetically distinct groups: infratentorial PNET (iPNET)/medulloblastoma and supratentorial PNET (sPNET). Currently, the comparative outcome of adult patients with sPNETs and iPNETs is unknown. In this study we have utilized the Surveillance, Epidemiology, and End Results database to perform a comparative analysis of 103 cases of adult sPNET and 669 adult medulloblastoma cases. Additionally we have analyzed various factors to identify their prognostic significance and characterize the optimal treatment for these tumors. Patients with sPNETs were seen to have a significantly worse survival than those diagnosed with medulloblastomas (16 vs. 155 months, p < 0.0001). Elderly patients (15 vs. 114 months, p < 0.0001) and those over the age of 40 (68 vs. 147 months, p < 0.0001) experienced significantly worse survival than younger patients. In contrast, radiotherapy (143 vs. 26 months, p < 0.0001), surgical resection (116 vs. 22 months, p = 0.0010) and the extent of resection (EOR) (173 vs. 81 months, p = 0.0005) resulted in significantly improved patient survival. Multivariate analysis revealed age greater than 40 years (HR: 1.57; 95 % CI: 1.17-2.11; p = 0.0028) and sPNET pathology (HR: 3.41; 95 % CI: 2.47-4.72; p < 0.0001) to be poor prognostic factors for survival while radiotherapy (HR: 0.52; 95 % CI: 0.38-0.71; p < 0.0001) and the EOR (HR: 0.73; 95 % CI: 0.55-0.96; p = 0.023) were associated with significantly improved survival. The treatment of sPNETs should therefore include maximal surgical resection when feasible followed by radiotherapy as these treatments have been demonstrated to confer a survival benefit. Additional studies are needed to identify effective chemotherapeutics and specific treatment regimens for adults with sPNETs. © 2013 Springer Science+Business Media New York (outside the USA).

Authors
Gandhi, R; Babu, R; Cummings, TJ; Adamson, C
MLA Citation
Gandhi, R, Babu, R, Cummings, TJ, and Adamson, C. "Adult primitive neuroectodermal tumors: The prognostic value of supratentorial location." Journal of Neuro-Oncology 114.1 (2013): 141-148.
Source
scival
Published In
Journal of Neuro-Oncology
Volume
114
Issue
1
Publish Date
2013
Start Page
141
End Page
148
DOI
10.1007/s11060-013-1163-x

Ophthalmic Pathology A Concise Guide

The volume differs from the available classic and comprehensive ophthalmic pathology textbooks in its basic and simplified ‘one month approach’ concept.

Authors
Cummings, TJ
MLA Citation
Cummings, TJ. Ophthalmic Pathology A Concise Guide. Springer Science & Business Media, October 2, 2012.
Source
google-books
Publish Date
2012

Normal Eye and Ocular Adnexa

Authors
Klintworth, GK; Cummings, TJ
MLA Citation
Klintworth, GK, and Cummings, TJ. "Normal Eye and Ocular Adnexa." Histology for Pathologists: Fourth Edition. July 16, 2012.
Source
scopus
Publish Date
2012

Disseminated Intracranial Ewing's Sarcoma in an Adult: A Rare and Difficult Diagnosis.

The Ewing sarcoma family of tumors comprises a rare class of cancers of mesenchymal origin. Cases of Ewing's sarcoma in the central nervous system - specifically, intracranial Ewing's - are extremely rare. Almost all reported cases have occurred in children. However, this rare presentation can also occur in the adult population. It is important to distinguish these tumors from primitive neuroectodermal tumors at the time of diagnosis. Testing for EWSR1(22q12) gene rearrangement using fluorescence in situ hybridization is a useful tool for making the distinction between these 2 similar but distinct entities. We present here the case of a middle-aged male patient with intracranial Ewing's sarcoma, and discuss diagnostic challenges and potential new treatment approaches for this rare disease.

Authors
Lou, E; Sumrall, AL; Cummings, TJ; Korones, DN; Weaver, SA; Peters, KB
MLA Citation
Lou, E, Sumrall, AL, Cummings, TJ, Korones, DN, Weaver, SA, and Peters, KB. "Disseminated Intracranial Ewing's Sarcoma in an Adult: A Rare and Difficult Diagnosis." Case Rep Oncol 5.2 (May 2012): 325-331.
PMID
22933997
Source
pubmed
Published In
Case Reports in Oncology
Volume
5
Issue
2
Publish Date
2012
Start Page
325
End Page
331
DOI
10.1159/000339721

Catecholamine-secreting paraganglioma of the thoracic spinal column: report of an unusual case and review of the literature.

BACKGROUND AND IMPORTANCE: Paragangliomas are rare tumors of neuroendocrine origin that arise from paraganglionic tissue of the extrachromaffin cell system. These lesions may be seen at various sites along the neuraxis. Primary thoracic paragangliomas have rarely been reported in the literature, with secretory thoracic lesions being exceedingly rare as only 3 previous cases have been cited. CLINICAL PRESENTATION: A 49-year-old woman presented with episodes of hypertension, palpitations, and diaphoresis. Workup revealed positive urine catecholamines and a thoracic spine mass extending into the thoracic apex. Preoperative α-blockade with phenoxybenzamine was used followed by posterior decompression and tumor resection. Arthrodesis from C5 to T4 was subsequently performed, and the patient received postoperative radiation. CONCLUSION: Two years postoperatively, the patient has continued to have regression of her symptoms. We report a rare case of a catecholamine-secreting primary thoracic paraganglioma in a 49-year-old woman. These tumors should be treated carefully by the neurosurgeon with preoperative assistance from endocrinology for α-blockade, followed by gross total resection and postoperative radiation if residual tumor remains.

Authors
Simpson, LN; Hughes, BD; Karikari, IO; Mehta, AI; Hodges, TR; Cummings, TJ; Bagley, CA
MLA Citation
Simpson, LN, Hughes, BD, Karikari, IO, Mehta, AI, Hodges, TR, Cummings, TJ, and Bagley, CA. "Catecholamine-secreting paraganglioma of the thoracic spinal column: report of an unusual case and review of the literature." Neurosurgery 70.4 (April 2012): E1049-E1052. (Review)
PMID
21788916
Source
pubmed
Published In
Neurosurgery
Volume
70
Issue
4
Publish Date
2012
Start Page
E1049
End Page
E1052
DOI
10.1227/NEU.0b013e31822e5aae

The eye and ocular adnexa

Authors
Klintworth, GK; Cummings, TJ
MLA Citation
Klintworth, GK, and Cummings, TJ. "The eye and ocular adnexa." Sternberg's Diagnostic Surgical Pathology: Fifth Edition. February 3, 2012. 965-993.
Source
scopus
Volume
1-2
Publish Date
2012
Start Page
965
End Page
993

Rapidly regulating platelet activity in vivo with an antidote controlled platelet inhibitor.

Millions of individuals are prescribed platelet inhibitors, such as aspirin and clopidogrel, to reduce their risk of thrombosis-related clinical events. Unfortunately many platelet inhibitors are contraindicated in surgical settings because of their inherent bleeding risk complicating the treatment of patients who require surgery. We describe the development of a potent antiplatelet agent, an RNA aptamer-termed Ch-9.14-T10 that binds von Willebrand factor (VWF) with high affinity and inhibits thrombosis in a murine carotid artery damage model. As expected, when this potent antiplatelet agent is administered, it greatly increases bleeding from animals that are surgically challenged. To improve this antiplatelet agent's safety profile, we describe the generation of antidotes that can rapidly reverse the activity of Ch-9.14-T10 and limit blood loss from surgically challenged animals. Our work represents the first antidote controllable antiplatelet agent, which could conceivably lead to improved medical management of patients requiring antiplatelet medication who also need surgery.

Authors
Nimjee, SM; Lohrmann, JD; Wang, H; Snyder, DJ; Cummings, TJ; Becker, RC; Oney, S; Sullenger, BA
MLA Citation
Nimjee, SM, Lohrmann, JD, Wang, H, Snyder, DJ, Cummings, TJ, Becker, RC, Oney, S, and Sullenger, BA. "Rapidly regulating platelet activity in vivo with an antidote controlled platelet inhibitor." Mol Ther 20.2 (February 2012): 391-397.
PMID
22086230
Source
pubmed
Published In
Molecular Therapy
Volume
20
Issue
2
Publish Date
2012
Start Page
391
End Page
397
DOI
10.1038/mt.2011.226

Primary Signet-Ring/Histiocytoid Carcinoma of the Eyelid

Authors
Layne, A; Richard, M; Woodward, J; Proia, AD; Cummings, TJ
MLA Citation
Layne, A, Richard, M, Woodward, J, Proia, AD, and Cummings, TJ. "Primary Signet-Ring/Histiocytoid Carcinoma of the Eyelid." February 2012.
Source
wos-lite
Published In
Laboratory Investigation
Volume
92
Publish Date
2012
Start Page
439A
End Page
440A

Primary Signet-Ring/Histiocytoid Carcinoma of the Eyelid

Authors
Layne, A; Richard, M; Woodward, J; Proia, AD; Cummings, TJ
MLA Citation
Layne, A, Richard, M, Woodward, J, Proia, AD, and Cummings, TJ. "Primary Signet-Ring/Histiocytoid Carcinoma of the Eyelid." February 2012.
Source
wos-lite
Published In
Modern Pathology
Volume
25
Publish Date
2012
Start Page
439A
End Page
440A

Congenital ectropion uvea and mechanisms of glaucoma in neurofibromatosis type 1:: New insights

Objective: To describe the clinicopathologic features of congenital ectropion uvea associated with glaucoma in neurofibromatosis-1 (NF-1). Design: Retrospective case series. Participants and Controls: Five cases of NF-1 associated with glaucoma, from which enucleated eyes were available, and 2 eye bank eyes used as controls. Methods: The clinical features and courses of these patients were reviewed. Formalin-fixed, paraffin-embedded eyes were examined by light and electron microscopy. Immunohistochemistry using antineurofibromin, anti-glial fibrillary acidic protein, and antivimentin was performed in 3 patients. Gene expression of the mitogen-activated protein kinase (MAPK) signaling pathway was examined in corneal endothelial cells in 1 patient. Main Outcome Measures: Cause of glaucoma in patients with ectropion uvea and NF-1. Results: The age of patients at the time of glaucoma diagnosis ranged from birth to 13 years. Four of the 5 patients had megalocornea and buphthalmos at presentation. Ectropion uvea was noted clinically in 2 patients, but was demonstrated histopathologically in all 5 patients. On histopathologic examination, all patients had varying degrees of angle closure secondary to endothelialization of the anterior chamber angle. Uveal neurofibromas were noted in all patients; anteriorly displaced ciliary processes were noted in 4 of 5 patients who demonstrated ciliary body involvement with neurofibromas. Absence of Schlemm's canal was observed. The endothelial cells lining the closed angle demonstrated positive stain results with the vimentin antibody. Positive antineurofibromin immunolabeling was detected in normal control corneal endothelium, but was absent in corneal endothelium in patients with endothelialization of the angle. Upregulation of genes from the MAPK signaling pathway was demonstrated in the corneal endothelial cells isolated from the NF-1 eyes. Conclusions: Ectropion uvea in NF-1 glaucoma is secondary to endothelialization of the anterior chamber angle and is associated commonly with severe pediatric glaucoma in NF-1 patients. The endothelial cell proliferation may be related to overexpression of the Ras (Rat sarcoma)-MAPK genes in these eyes. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.

Authors
Edward, DP; Morales, J; Bouhenni, RA; Patil, J; Edward, PR; Cummings, TJ; Chaudhry, IA; Alkatan, H
MLA Citation
Edward, DP, Morales, J, Bouhenni, RA, Patil, J, Edward, PR, Cummings, TJ, Chaudhry, IA, and Alkatan, H. "Congenital ectropion uvea and mechanisms of glaucoma in neurofibromatosis type 1:: New insights." Ophthalmology 119.7 (2012): 1485-1494.
PMID
22480745
Source
scival
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
119
Issue
7
Publish Date
2012
Start Page
1485
End Page
1494
DOI
10.1016/j.ophtha.2012.01.027

Inflammatory pseudotumor of the lateral ventricle in a pediatric patient.

Inflammatory pseudotumor (IP) is a benign process that most commonly occurs in the lung and orbit. Extension into the central nervous system is extremely rare, and primary intraventricular lesions of the lateral ventricles are even more infrequent with only 2 cases reported in pediatric patients to date. Here, the authors present an unusual case of IP occurring in a 16-year-old female presenting with a 2-week history of progressive headaches and vomiting, without focal neurological deficits or radiographic evidence of hydrocephalus. The patient underwent left parietal craniotomy and complete resection of the tumor, with no signs of recurrence at 3-month follow-up. Although the rarity of intraventricular IP in pediatric patients can make its initial identification difficult, IP should be considered as a potential diagnosis in this population wherein good outcomes may be achieved following surgical resection.

Authors
Choi, BD; Hodges, TR; Grant, GA; Fuchs, HE; Cummings, TJ; Muh, CR
MLA Citation
Choi, BD, Hodges, TR, Grant, GA, Fuchs, HE, Cummings, TJ, and Muh, CR. "Inflammatory pseudotumor of the lateral ventricle in a pediatric patient." Pediatr Neurosurg 48.6 (2012): 374-378.
PMID
23948719
Source
pubmed
Published In
Pediatric neurosurgery
Volume
48
Issue
6
Publish Date
2012
Start Page
374
End Page
378
DOI
10.1159/000353609

Sudden death from diffuse leptomeningeal oligodendrogliomatosis.

In this paper the authors describe the rare disorder of diffuse leptomeningeal oligodendrogliomatosis in a patient with an oligodendroglioma of the cauda equina who died suddenly. Reviewing this uncommon pathological entity is important so that it can be recognized and treated appropriately. This young, otherwise healthy woman with initial symptoms of low-back pain had a mass lesion of the cauda equina. During a workup, profound refractory intracranial hypertension suddenly developed despite aggressive surgical and medical intervention. Autopsy revealed a spinal cord oligodendroglioma with diffuse leptomeningeal oligodendrogliomatosis of the brain and spinal cord. Given the unforeseen outcome in this patient, this entity, although rare, should be considered in patients with similar presentations and addressed early to prevent similar outcomes. A review of the details of this case as well as the literature is presented below.

Authors
Reynolds, RM; Boswell, E; Hulette, CM; Cummings, TJ; Haglund, MM; Boswell, E; Hulette, CM; Cumm Ings, TJ; Haglund, MM
MLA Citation
Reynolds, RM, Boswell, E, Hulette, CM, Cummings, TJ, Haglund, MM, Boswell, E, Hulette, CM, Cumm Ings, TJ, and Haglund, MM. "Sudden death from diffuse leptomeningeal oligodendrogliomatosis." J Neurosurg Spine 15.6 (December 2011): 625-629.
PMID
21888480
Source
pubmed
Published In
Journal of neurosurgery. Spine
Volume
15
Issue
6
Publish Date
2011
Start Page
625
End Page
629
DOI
10.3171/2011.7.SPINE10728

Survival risk assessment for primary blast exposures to the head.

Many soldiers returning from the current conflicts in Iraq and Afghanistan have had at least one exposure to an explosive event and a significant number have symptoms consistent with traumatic brain injury. Although blast injury risk functions have been determined and validated for pulmonary injury, there is little information on the blast levels necessary to cause blast brain injury. Anesthetized male New Zealand White rabbits were exposed to varying levels of shock tube blast exposure focused on the head, while their thoraces were protected. The specimens were euthanized and evaluated when the blast resulted in respiratory arrest that was non-responsive to resuscitation or at 4?h post-exposure. Injury was evaluated by gross examination and histological evaluation. The fatality data from brain injury were then analyzed using Fisher's exact test to determine a brain fatality risk function. Greater blast intensity was associated with post-blast apnea and the need for mechanical ventilation. Gross examination revealed multifocal subdural hemorrhages, most often near the brainstem, at more intense levels of exposure. Histological evaluation revealed subdural and subarachnoid hemorrhages in the non-responsive respiratory-arrested specimens. A fatality risk function from blast exposure to the head was determined for the rabbit specimens with an LD(50) at a peak overpressure of 750?kPa. Scaling techniques were used to predict injury risk at other blast overpressure/duration combinations. The fatality risk function showed that the blast level needed to cause fatality from an overpressure wave exposure to the head was greater than the peak overpressure needed to cause fatality from pulmonary injury. This risk function can be used to guide future research for blast brain injury by providing a realistic fatality risk to guide the design of protection or to evaluate injury.

Authors
Rafaels, K; Bass, CRD; Salzar, RS; Panzer, MB; Woods, W; Feldman, S; Cummings, T; Capehart, B
MLA Citation
Rafaels, K, Bass, CRD, Salzar, RS, Panzer, MB, Woods, W, Feldman, S, Cummings, T, and Capehart, B. "Survival risk assessment for primary blast exposures to the head." J Neurotrauma 28.11 (November 2011): 2319-2328.
PMID
21463161
Source
pubmed
Published In
Journal of Neurotrauma
Volume
28
Issue
11
Publish Date
2011
Start Page
2319
End Page
2328
DOI
10.1089/neu.2009.1207

Nodular fasciitis presenting in an adult woman.

The authors report a 30-year-old Caucasian woman with nodular fasciitis presenting as a nontender lesion to right temporal area. The lesion was removed by en bloc excision and the base was cauterized. Six months later, the patient returned to the clinic for possible recurrence of lesion or for residual lesion; the patient was then injected with a total of 1 cc of kenalog at 20 mg/kg. Two weeks later, the lesion had greatly subsided and the patient was satisfied with the esthetic appearance. Nodular fasciitis is a rare reactive growth with even fewer cases of recurrence. In young patients, steroid injection is an alternative to repeat resection.

Authors
Husain, A; Cummings, T; Richard, MJ; Woodward, JA
MLA Citation
Husain, A, Cummings, T, Richard, MJ, and Woodward, JA. "Nodular fasciitis presenting in an adult woman." Ophthal Plast Reconstr Surg 27.6 (November 2011): e168-e170.
PMID
21659921
Source
pubmed
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
27
Issue
6
Publish Date
2011
Start Page
e168
End Page
e170
DOI
10.1097/IOP.0b013e31820ccccd

Primary intradural extraosseous Ewing sarcoma of the spine: case report and literature review.

BACKGROUND AND IMPORTANCE: To report a rare case of spinal intradural extraosseous Ewing sarcoma in an adult and review current literature. Although Ewing sarcoma belongs to the family, the treatment modalities are different, and thus the correct diagnosis is very important despite its rare occurrence. CLINICAL PRESENTATION: A 56-year-old woman presented with nocturnal bilateral buttock and leg pain. Magnetic resonance imaging (MRI) showed an enhancing intradural extramedullary extraosseous tumor at L1. INTERVENTION: A T12-L2 laminectomy was performed to resect the tumor. Immunohistochemical analysis confirmed the diagnosis of Ewing sarcoma. A thorough diagnostic workup did not reveal any bony origin of the tumor. Primary intradural central nervous system Ewing sarcoma is infrequently encountered and shares imaging and histopathological features with central primitive neuroectodermal tumors. Establishment of the right diagnosis is crucial because it mandates a distinct workup and treatment modality different from that for central primitive neuroectodermal tumor. Although osseous Ewing sarcoma predominantly occurs in children and young adults, extraosseous central nervous system Ewing sarcoma is not uncommon in adults and should therefore be considered in the differential diagnosis of extraosseous small blue cell tumors in adult patients.

Authors
Karikari, IO; Mehta, AI; Nimjee, S; Hodges, TR; Tibaleka, J; Montgomery, C; Simpson, L; Cummings, TJ; Bagley, CA
MLA Citation
Karikari, IO, Mehta, AI, Nimjee, S, Hodges, TR, Tibaleka, J, Montgomery, C, Simpson, L, Cummings, TJ, and Bagley, CA. "Primary intradural extraosseous Ewing sarcoma of the spine: case report and literature review." Neurosurgery 69.4 (October 2011): E995-E999. (Review)
PMID
21572359
Source
pubmed
Published In
Neurosurgery
Volume
69
Issue
4
Publish Date
2011
Start Page
E995
End Page
E999
DOI
10.1227/NEU.0b013e318223b7c7

Calcifying pseudoneoplasm of the cerebellopontine angle: case report.

BACKGROUND AND IMPORTANCE: Calcifying pseudoneoplasms are rare tumors of the neuraxis. To our knowledge, this is only the second reported case in the literature of calcifying pseudoneoplasm of the cerebellopontine angle. The etiology and natural history of these neoplasms are not well understood. This case report provides a thorough review of the histology and potential origins of calcifying pseudoneoplasm. CLINICAL PRESENTATION: A 34-year-old previously healthy man presented with a 6-month history of progressive worsening headaches, fatigue, tinnitus, dizziness, and blurry vision. Neurological examination was notable for tongue deviation, tongue atrophy, and left uvula deviation. Computed tomography (CT) scanning showed a 3.3 × 3.5 cm densely calcified posterior fossa mass appearing to arise from the occipital bone. Magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 × 2.9 cm left posterior fossa enhancing mass with the margin tip from the left occipital condyle. A transcondylar approach was used to resect the lesion. The mass was found to have eroded through the bone into the foramen magnum. Histopathological examination confirmed the diagnosis of calcifying pseudoneoplasm of the cerebellopontine angle. CONCLUSION: Calcifying pseudoneoplasms should be considered in the differential diagnosis of calcified cerebellopontine angle tumors. Histopathologic diagnosis is extremely important in the characterization of these lesions in order to direct the course of appropriate management. An inaccurate diagnosis of a malignant tumor can result in potentially harmful and unnecessary therapies, as prognosis for these lesions is generally favorable.

Authors
Hodges, TR; Karikari, IO; Nimjee, SM; Tibaleka, J; Friedman, AH; Cummings, TJ; Fukushima, T; Friedman, AH
MLA Citation
Hodges, TR, Karikari, IO, Nimjee, SM, Tibaleka, J, Friedman, AH, Cummings, TJ, Fukushima, T, and Friedman, AH. "Calcifying pseudoneoplasm of the cerebellopontine angle: case report." Neurosurgery 69.1 Suppl Operative (September 2011): onsE117-onsE120.
PMID
21415795
Source
pubmed
Published In
Neurosurgery
Volume
69
Issue
1 Suppl Operative
Publish Date
2011
Start Page
onsE117
End Page
onsE120
DOI
10.1227/NEU.0b013e3182155511

Complications following decompression of Chiari malformation Type I in children: dural graft or sealant?

OBJECT: Posterior fossa decompression with duraplasty for Chiari malformation Type I (CM-I) is a common pediatric neurosurgery procedure. Published series report a complication rate ranging from 3% to 40% for this procedure. Historically, many dural substitutes have been used, including bovine grafts, human cadaveric pericardium, synthetic dura, and autologous pericranium. The authors hypothesized that a recently observed increase in complications was dependent on the graft used. METHODS: Between January 2004 and January 2008, 114 consecutive patients ≤ 18 years old underwent primary CM-I decompression using duraplasty. Records were retrospectively reviewed for short- and intermediate-term complications and operative technique, focusing on the choice of duraplasty graft with or without application of a tissue sealant. RESULTS: The average age of the patients was 8.6 years. The dural graft used was variable: 15 were treated with cadaveric pericardium, 12 with Durepair, and 87 with EnDura. Tisseel was used in 75 patients, DuraSeal in 12, and no tissue sealant was used in 27 patients. The overall complication rate was 21.1%. The most common complications included aseptic meningitis, symptomatic pseudomeningocele, or a CSF leak requiring reoperation. The overall complication rates were as follows: cadaveric pericardium 26.7%, Durepair 41.7%, and EnDura 17.2%; reoperation rates were 13%, 25%, and 8.1%, respectively. Prior to adopting a different graft product, the overall complication rate was 18.1%; following the change the rate increased to 35%. Complication rates for tissue sealants were 14.8% for no sealant, 18.7% for Tisseel, and 50% for DuraSeal. Nine patients were treated with the combination of Durepair and DuraSeal and this subgroup had a 56% complication rate. CONCLUSIONS: Complication rates after CM-I decompression may be dependent on the dural graft with or without the addition of tissue sealant. The complication rate at the authors' institution approximately doubled following the adoption of a different graft product. Tissue sealants used in combination with a dural substitute to augment a duraplasty may increase the risk of aseptic meningitis and/or CSF leak. The mechanism of the apparent increased inflammation with this combination remains under investigation.

Authors
Parker, SR; Harris, P; Cummings, TJ; George, T; Fuchs, H; Grant, G
MLA Citation
Parker, SR, Harris, P, Cummings, TJ, George, T, Fuchs, H, and Grant, G. "Complications following decompression of Chiari malformation Type I in children: dural graft or sealant?." J Neurosurg Pediatr 8.2 (August 2011): 177-183.
PMID
21806360
Source
pubmed
Published In
Journal of neurosurgery. Pediatrics
Volume
8
Issue
2
Publish Date
2011
Start Page
177
End Page
183
DOI
10.3171/2011.5.PEDS10362

Hematolymphoid malignancies with intraocular intravascular involvement: report of 2 cases.

The interaction between the endothelium and malignant hematolymphoid cells within vessels of the eye can result in focal or diffuse intravascular pathology. As a result, correlation of these findings with specific clinical and ophthalmologic features can vary. We review the ophthalmic findings in two cases of hematolymphoid malignancies limited to the intravascular space and review published literature on this topic. In cases of intravascular large B-cell lymphoma, underexpression of β1-integrin and intercellular adhesion molecule-1 by the cells of intravascular large B-cell lymphoma results in diffuse ocular vascular involvement. The widespread degree of intravascular involvement correlates with clinical ophthalmologic findings and may lead to retinal and choroidal detachment that is observed postmortem. Conversely, in the context of acute leukemia, induced overexpression of certain adhesion molecules (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1) in the endothelium of certain vascular beds may result in leukostasis with only selective (choroidal) ocular vessel involvement. As a result of only focal vascular activation and adhesion in the orbit, the gross findings in these cases are minimal and may not correlate with clinical ophthalmologic findings.

Authors
Papalas, JA; Proia, AD; Cummings, TJ
MLA Citation
Papalas, JA, Proia, AD, and Cummings, TJ. "Hematolymphoid malignancies with intraocular intravascular involvement: report of 2 cases." Ann Diagn Pathol 15.4 (August 2011): 286-290. (Review)
PMID
20952284
Source
pubmed
Published In
Annals of Diagnostic Pathology
Volume
15
Issue
4
Publish Date
2011
Start Page
286
End Page
290
DOI
10.1016/j.anndiagpath.2010.04.006

Complications following decompression of Chiari malformation Type I in children: dural graft or sealant? Clinical article

Authors
Parker, SR; Harris, P; Cummings, TJ; George, T; Fuchs, H; Grant, G
MLA Citation
Parker, SR, Harris, P, Cummings, TJ, George, T, Fuchs, H, and Grant, G. "Complications following decompression of Chiari malformation Type I in children: dural graft or sealant? Clinical article." JOURNAL OF NEUROSURGERY-PEDIATRICS 8.2 (August 2011): 177-183.
Source
wos-lite
Published In
Journal of neurosurgery. Pediatrics
Volume
8
Issue
2
Publish Date
2011
Start Page
177
End Page
183
DOI
10.3171/2011.5.PEDS1362

Transformation of juvenile pilocytic astrocytoma to anaplastic pilocytic astrocytoma in patients with neurofibromatosis type I.

Patients with juvenile pilocytic astrocytoma (JPA) and neurofibromatosis type I (NF-1) tend to have a more indolent course than those with sporadic tumors. In rare circumstances, transformation to anaplastic pilocytic astrocytoma (APA) has been known to occur in sporadic cases and is associated with exposure to ionizing radiation. We present 2 patients with NF-1 who were initially diagnosed with JPA that later transformed to APA. Both patients were not exposed to ionizing radiation but instead received alkylator chemotherapy before transformation. Possibility of conversion to APA should be considered in patients with NF-1 and JPA who have rapid tumor recurrence.

Authors
Peters, KB; Cummings, TJ; Gururangan, S
MLA Citation
Peters, KB, Cummings, TJ, and Gururangan, S. "Transformation of juvenile pilocytic astrocytoma to anaplastic pilocytic astrocytoma in patients with neurofibromatosis type I." J Pediatr Hematol Oncol 33.5 (July 2011): e198-e201.
PMID
21572348
Source
pubmed
Published In
Journal of Pediatric Hematology/Oncology
Volume
33
Issue
5
Publish Date
2011
Start Page
e198
End Page
e201
DOI
10.1097/MPH.0b013e318205e230

Primary intracerebral Hodgkin lymphoma with recurrence.

OBJECTIVE: To report a case of primary intracerebral Hodgkin lymphoma with disease recurrence. METHODS: Case report and review of the literature. RESULTS: A 58-year-old immunocompetent male presented with aphasia. Neuroimaging revealed a left temporal lobe lesion. A craniotomy and resection were performed, and the diagnosis of classical Hodgkin lymphoma was made. Systemic work-up for lymphoma was negative. Postoperatively, the patient was treated with whole brain irradiation. 14 months later, the patient developed an enhancing lesion in his pons and received combination chemotherapy and radiation therapy. Repeat imaging demonstrated leptomeningeal enhancement and multiple lesions throughout the cerebral hemispheres, cerebellum and brainstem. COMMENT: We report what appears to be the first case of a patient with aggressive primary intracerebral Hodgkin lymphoma with disease recurrence.

Authors
Foo, W-C; Desjardins, A; Cummings, TJ
MLA Citation
Foo, W-C, Desjardins, A, and Cummings, TJ. "Primary intracerebral Hodgkin lymphoma with recurrence." Clin Neuropathol 30.2 (March 2011): 75-79.
PMID
21329616
Source
pubmed
Published In
Clinical neuropathology
Volume
30
Issue
2
Publish Date
2011
Start Page
75
End Page
79

Chronic Progressive External Ophthalmoplegia: A Report of 2 Cases.

Authors
Varley, RJ; Stoecker, MM; Cummings, TJ
MLA Citation
Varley, RJ, Stoecker, MM, and Cummings, TJ. "Chronic Progressive External Ophthalmoplegia: A Report of 2 Cases." February 2011.
Source
wos-lite
Published In
Laboratory Investigation
Volume
91
Publish Date
2011
Start Page
387A
End Page
388A

Chronic Progressive External Ophthalmoplegia: A Report of 2 Cases

Authors
Varley, RJ; Stoecker, MM; Cummings, TJ
MLA Citation
Varley, RJ, Stoecker, MM, and Cummings, TJ. "Chronic Progressive External Ophthalmoplegia: A Report of 2 Cases." February 2011.
Source
wos-lite
Published In
Modern Pathology
Volume
24
Publish Date
2011
Start Page
387A
End Page
388A

Fourth ventricular schwannoma: identical clinicopathologic features as schwann cell-derived schwannoma with unique etiopathologic origins.

Background. To our knowledge, this is the sixth reported case in the literature of fourth ventricular schwannoma. The etiology and natural history of intraventricular schwannomas is not well understood. A thorough review of potential etiopathogenic mechanisms is provided in this case report. Case Description. A 69-year-old man presented with an incidentally found fourth ventricular tumor during an evaluation for generalized weakness, gait instability, and memory disturbance. Magnetic resonance imaging (MRI) revealed a heterogeneously enhancing lesion in the fourth ventricle. A suboccipital craniotomy was performed to resect the lesion. Histopathological examination confirmed the diagnosis of schwannoma (WHO grade I). Conclusions. Schwannomas should be considered in the differential diagnosis of intraventricular tumors. Although the embryologic origins may be different from nerve sheath-derived schwannomas, the histologic, clinical, and natural history appear identical and thus should be managed similarly.

Authors
Hodges, TR; Karikari, IO; Nimjee, SM; Tibaleka, J; Cummings, TJ; Radhakrishnan, S; Friedman, AH
MLA Citation
Hodges, TR, Karikari, IO, Nimjee, SM, Tibaleka, J, Cummings, TJ, Radhakrishnan, S, and Friedman, AH. "Fourth ventricular schwannoma: identical clinicopathologic features as schwann cell-derived schwannoma with unique etiopathologic origins." Case Rep Med 2011 (2011): 165954-.
PMID
22194753
Source
pubmed
Published In
Case Reports in Medicine
Volume
2011
Publish Date
2011
Start Page
165954
DOI
10.1155/2011/165954

Primary meningeal rhabdomyosarcoma.

Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy.

Authors
Palta, M; Riedel, RF; Vredenburgh, JJ; Cummings, TJ; Green, S; Chang, Z; Kirkpatrick, JP
MLA Citation
Palta, M, Riedel, RF, Vredenburgh, JJ, Cummings, TJ, Green, S, Chang, Z, and Kirkpatrick, JP. "Primary meningeal rhabdomyosarcoma." Sarcoma 2011 (2011): 312802-.
PMID
21772793
Source
pubmed
Published In
Sarcoma
Volume
2011
Publish Date
2011
Start Page
312802
DOI
10.1155/2011/312802

Giant sacral metastasis of Hurthle cell thyroid carcinoma: Case report and review of the literature

Overview Management of spinal sacral masses requires a discrete algorithm for both diagnosis and treatment. Here we use a case report to illustrate the importance of biopsy in the management of a sacral mass. In this case, a woman who had been offered an en bloc resection of a sacral mass resembling a chordoma presented to our tertiary care center for a second opinion. A CT guided needle biopsy demonstrated a Hurthle cell thyroid metastatic mass. An interlesional resection of the mass with preservation of bowel and bladder function was performed avoiding a more extensive sacrectomy. The importance of providing a discrete diagnostic algorithm in the workup of sacral tumors is emphasized with this case report. © 2011 Surgisphere Corporation.

Authors
Mehta, AI; Karikari, IO; Cummings, TJ; Bagley, CA
MLA Citation
Mehta, AI, Karikari, IO, Cummings, TJ, and Bagley, CA. "Giant sacral metastasis of Hurthle cell thyroid carcinoma: Case report and review of the literature." Journal of Surgical Radiology 2.3 (2011): 284-289.
Source
scival
Published In
Journal of Surgical Radiology
Volume
2
Issue
3
Publish Date
2011
Start Page
284
End Page
289

Long-term safety of combined intracerebral delivery of free gadolinium and targeted chemotherapeutic agent PRX321.

OBJECTIVES: While convection enhanced delivery (CED) is an effective delivery method that bypasses the blood-brain barrier, its utility is limited by infusate leakage due to catheter misplacement. Therefore, it is critical to evaluate drug distribution during CED infusion. Gadolinium conjugated to diethylenetriamine penta-acetic acid (Gd-DTPA) is a common, readily available MRI contrast agent, which may be able to predict and actively monitor drug distribution. In this study, we assess the long-term safety and toxicity of intracerebrally infused Gd-DTPA along with an experimental targeted agent PRX321. METHODS: Fifty-four immunocompetent rats were implanted with intracerebral cannulas linked to subcutaneously placed osmotic pumps. After pump implantation, the rats were randomized into six groups of nine rats each in order to assess the toxicities of six different concentrations of human serum albumin (HSA) with and without Gd-DTPA and PRX321. The rats were monitored clinically for 6 weeks before they were autopsied and assessed for histological toxicity to their central nervous system (CNS). RESULTS: There was one unexplained death in a group infusing low concentration HSA, Gd-DTPA and PRX321. Upon microscopic examination of the CNS in that animal, no unexpected histological toxicity was found. Additionally, there were no signs of clinical or histological toxicity in any of the remaining rats, which all survived until the end of the 6 week observation period. DISCUSSION: Free Gd-DTPA can be safely infused via CED in a pre-clinical animal model. Future studies should include its use in predicting and actively monitoring CED drug infusions in early phase human clinical trials.

Authors
Ding, D; Kanaly, CW; Cummings, TJ; Herndon, JE; Raghavan, R; Sampson, JH
MLA Citation
Ding, D, Kanaly, CW, Cummings, TJ, Herndon, JE, Raghavan, R, and Sampson, JH. "Long-term safety of combined intracerebral delivery of free gadolinium and targeted chemotherapeutic agent PRX321." Neurol Res 32.8 (October 2010): 810-815.
PMID
20021739
Source
pubmed
Published In
Neurological Research
Volume
32
Issue
8
Publish Date
2010
Start Page
810
End Page
815
DOI
10.1179/174367509X12581069052090

Angiosarcoma of the eyelid: a clinicopathologic comparison between isolated unilateral tumors and tumors demonstrating extrapalpebral involvement.

Angiosarcomas involving the head and neck are malignant tumors which tend to involve multiple anatomical structures with an overall dismal prognosis. Reports of primary, isolated eyelid involvement are rare. We report 4 cases of angiosarcoma involving the eyelid as either an isolated tumor or as part of a more diffuse malignant process and compare the features of these 2 tumor types to cases reported in the literature. The mean age at which patients develop angiosarcoma involving the eyelid was 72. Patients with isolated tumors most often presented complaining of a discrete mass clinically resembling a stye. Patients with isolated eyelid involvement had better survival (100% at 3.2 years) compared with patients with diffuse disease (57% at 3.3 years). Those with isolated eyelid involvement have an average tumor size of 2.08 cm with no distant metastasis. Patients who have eyelid angiosarcoma with extrapalpebral involvement have tumors ranging between 5 and 10 cm on average and 21% develop metastases. True isolated angiosarcoma of the eyelid is rare. When extrapalpebral involvement is ruled out by clinical and radiographic examination, patients with isolated involvement seem to fare better compared with patients with eyelid involvement secondary to more regionally extensive tumors.

Authors
Papalas, JA; Manavi, CK; Woodward, JA; Sangueza, OP; Cummings, TJ
MLA Citation
Papalas, JA, Manavi, CK, Woodward, JA, Sangueza, OP, and Cummings, TJ. "Angiosarcoma of the eyelid: a clinicopathologic comparison between isolated unilateral tumors and tumors demonstrating extrapalpebral involvement." Am J Dermatopathol 32.7 (October 2010): 694-699.
PMID
20559124
Source
pubmed
Published In
American Journal of Dermatopathology
Volume
32
Issue
7
Publish Date
2010
Start Page
694
End Page
699
DOI
10.1097/DAD.0b013e3181cf7813

Endodermal cyst of the oculomotor nerve.

Authors
Karikari, IO; Grant, G; Cummings, TJ; Petrella, J; Fuchs, HE
MLA Citation
Karikari, IO, Grant, G, Cummings, TJ, Petrella, J, and Fuchs, HE. "Endodermal cyst of the oculomotor nerve." Pediatr Neurosurg 46.2 (August 2010): 155-156.
PMID
20689348
Source
pubmed
Published In
Pediatric neurosurgery
Volume
46
Issue
2
Publish Date
2010
Start Page
155
End Page
156
DOI
10.1159/000319562

Neurothekeoma palpebrae: A report of 3 cases.

Neurothekeoma palpebrae is the diagnostic term used to describe nerve sheath myxoma or neurothekeoma of the eyelid. Although these tumors are not uncommonly found in the head and neck region, eyelid involvement is very uncommon. We present 2 cases of cellular neurothekeoma and 1 case of nerve sheath myxoma occurring in the eyelid. Patient 1 was a 13-year-old girl with a left upper eyelid lesion of 6-months duration. Microscopic examination disclosed a cellular neurothekeoma with mild myxoid change and osteoclast-like multinucleated cells. Tumor cells infiltrated the orbicularis oculi muscle. The tumor cells were immunopositive for NKI.C3, CD34, and focally for S-100 protein. Multinucleated cells were reactive to CD68. Mart-1, smooth muscle actin, CD31, keratin, desmin, myogenin, synaptophysin, and neurofilament protein (NFP) were negative. Patient 2 was a 4-year-old girl with a left upper eyelid lesion diagnosed clinically as a chalazion. The lesion was incised. Five months later, the patient returned with a firm 5.5-mm nodule at the site. Excision revealed cellular neurothekeoma invading the orbicularis oculi. Tumor cells were NKI.C3 immunopositive and S-100 protein negative, and the multinucleated cells were CD68 positive. Patient 3 was a 70-year-old woman with a 10-year history of a subcutaneous right lower eyelid nodule which had recently changed color. The excised specimen demonstrated a hypocellular, well-circumscribed myxoid tumor surrounded by a thin rim of fibrous connective tissue. Tumor cells contained moderate amounts of eosinophilic cytoplasm with irregular, hyperchromatic nuclei. Nucleoli and mitotic figures were not apparent. Tumor cells were NKI.C3 negative, and S100 protein and glial acidic fibrillary protein positive, consistent with a nerve sheath myxoma. Including our 3 cases, 10 cases of nerve sheath myxoma and neurothekeoma occurring in the eyelid have been reported the English language literature. Although uncommon, these lesions should be kept in the differential diagnosis of eyelid tumors that can masquerade as chalazia.

Authors
Papalas, JA; Proia, AD; Hitchcock, M; Gandhi, P; Cummings, TJ
MLA Citation
Papalas, JA, Proia, AD, Hitchcock, M, Gandhi, P, and Cummings, TJ. "Neurothekeoma palpebrae: A report of 3 cases." Am J Dermatopathol 32.4 (June 2010): 374-379.
PMID
20514679
Source
pubmed
Published In
American Journal of Dermatopathology
Volume
32
Issue
4
Publish Date
2010
Start Page
374
End Page
379

Response of malignant scalp dermatofibrosarcoma to presurgical targeted growth factor inhibition.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive, malignant cutaneous tumor that sparingly presents on the scalp. Dermatofibrosarcomas often result from the formation of a fusion oncogene on translocated or supernumerary ring chromosomes 17 and 22, causing the overexpression of PDGFRbeta driven by the COL1A1 promoter. Because of uncertainty surrounding appropriate treatment of aggressive scalp DFSP, the authors performed an extensive review of the available data from a MEDLINE (Ovid) search to describe the clinical presentation and treatment options for this rare tumor. Their search identified 39 different cases, including the illustrative case presented in this study. Adjuvant therapy for this malignant lesion is not universally established in the literature. In the present case, the authors successfully treated a locally invasive scalp DFSP with presurgical therapy that specifically inhibited the PDGFbeta receptor. Imatinib significantly shrank the DFSP tumor mass, reduced hypervascularity, reduced metabolic activity on PET scanning, and permitted a safe gross-total resection. Although wide excision and Mohs micrographic surgery remain the standard surgical treatments for DFSP, the authors illustrate that presurgical chemotherapeutic treatment by imatinib provides a critical adjunct to traditional therapy.

Authors
Mattox, AK; Mehta, AI; Grossi, PM; Cummings, TJ; Adamson, DC
MLA Citation
Mattox, AK, Mehta, AI, Grossi, PM, Cummings, TJ, and Adamson, DC. "Response of malignant scalp dermatofibrosarcoma to presurgical targeted growth factor inhibition." J Neurosurg 112.5 (May 2010): 965-977.
PMID
19681684
Source
pubmed
Published In
Journal of neurosurgery
Volume
112
Issue
5
Publish Date
2010
Start Page
965
End Page
977
DOI
10.3171/2009.7.JNS09522

Convection-enhanced delivery of free gadolinium with the recombinant immunotoxin MR1-1.

A major obstacle in glioblastoma (GBM) therapy is the restrictive nature of the blood-brain barrier (BBB). Convection-enhanced delivery (CED) is a novel method of drug administration which allows direct parenchymal infusion of therapeutics, bypassing the BBB. MR1-1 is a novel recombinant immunotoxin that targets the GBM tumor-specific antigen EGFRvIII and can be delivered via CED infusion. However, drug distribution via CED varies dramatically, which necessitates active monitoring. Gadolinium conjugated to diethylenetriamine penta-acetic acid (Gd-DTPA) is a commonly used MRI contrast agent which can be co-infused with therapies using CED and may be useful in monitoring infusion leak and early distribution. Forty immunocompetent rats were implanted with intracerebral cannulas that were connected to osmotic pumps and subsequently randomized into four groups that each received 0.2% human serum albumin (HSA) mixed with a different experimental infusion: (1) 25 ng/ml MR1-1; (2) 0.1 micromol/ml Gd-DTPA; (3) 25 ng/ml MR1-1 and 0.1 micromol/ml Gd-DTPA; (4) 250 ng/ml MR1-1 and 0.1 micromol/ml Gd-DTPA. The rats were monitored clinically for 6 weeks then necropsied and histologically assessed for CNS toxicity. All rats survived the entirety of the study without clinical or histological toxicity attributable to the study drugs. There was no statistically significant difference in weight change over time among groups (P > 0.999). MR1-1 co-infused with Gd-DTPA via CED is safe in the long-term setting in a pre-clinical animal model. Our data supports the use of Gd-DTPA, as a surrogate tracer, co-infused with MR1-1 for drug distribution monitoring in patients with GBM.

Authors
Ding, D; Kanaly, CW; Bigner, DD; Cummings, TJ; Herndon, JE; Pastan, I; Raghavan, R; Sampson, JH
MLA Citation
Ding, D, Kanaly, CW, Bigner, DD, Cummings, TJ, Herndon, JE, Pastan, I, Raghavan, R, and Sampson, JH. "Convection-enhanced delivery of free gadolinium with the recombinant immunotoxin MR1-1." J Neurooncol 98.1 (May 2010): 1-7.
PMID
19898744
Source
pubmed
Published In
Journal of Neuro-Oncology
Volume
98
Issue
1
Publish Date
2010
Start Page
1
End Page
7
DOI
10.1007/s11060-009-0046-7

Ultrasonographic appearance of intraneural injections in the porcine model.

BACKGROUND: Ultrasonographic (US) images of apparent intraneural injection of local anesthetic solutions have been reported. We aimed to define US signs of intraneural (ie, subepineural) injection using a histologic standard in an animal model and compare these signs with other potential markers of intraneural injection, including low nerve stimulation current thresholds and high injection pressures. METHODS: In 6 anesthetized adult swine, bilateral brachial plexus and femoral nerves were contacted by needles and penetrated. India ink was injected intraneurally under US monitoring. The minimum current that elicited a motor response was recorded. Injection pressures were measured using a digital manometer. Nerves were then excised, processed, and subjected to histologic analysis. RESULTS: Nerve expansion during injection was visualized under ultrasonography in all procedures. Electrical current intensity to elicit motor response to nerve stimulation varied between 0.2 and 3.3 mA with the needle tip positioned intraneurally. The mean injection pressure was 7.40 +/- 8.07 psi (range, 0.07-31.5 psi), with 80% of injections between 0.61 and 15.0 psi. None of 24 intraneural injections resulted in histologic evidence of intrafascicular injection (95% confidence interval, 0.0%-16.3%). CONCLUSIONS: Ultrasonographic images compatible with nerve swelling during an injection are consistent with true intraneural injections as demonstrated by histologic analysis. Under the conditions studied, intensity of the stimulating current required to elicit motor response was not associated with intraneural needle placement. In the absence of fascicular injury, intraneural injections were associated with low injection pressure, although false-positive results can occur.

Authors
Altermatt, FR; Cummings, TJ; Auten, KM; Baldwin, MF; Belknap, SW; Reynolds, JD
MLA Citation
Altermatt, FR, Cummings, TJ, Auten, KM, Baldwin, MF, Belknap, SW, and Reynolds, JD. "Ultrasonographic appearance of intraneural injections in the porcine model." Reg Anesth Pain Med 35.2 (March 2010): 203-206.
PMID
20216038
Source
pubmed
Published In
Regional anesthesia
Volume
35
Issue
2
Publish Date
2010
Start Page
203
End Page
206
DOI
10.1097/AAP.0b013e3181d28396

Symptomatic Traumatic Neuroma Causing Common Bile Duct Stricture Following Orthotopic Liver Transplantation: A Retrospective Three and a Half Year Review

Authors
Shealy, MJ; Cardona, DM; Burchette, JL; Cummings, TJ; Smith, AD; Howell, DN; Guy, CD
MLA Citation
Shealy, MJ, Cardona, DM, Burchette, JL, Cummings, TJ, Smith, AD, Howell, DN, and Guy, CD. "Symptomatic Traumatic Neuroma Causing Common Bile Duct Stricture Following Orthotopic Liver Transplantation: A Retrospective Three and a Half Year Review." February 2010.
Source
wos-lite
Published In
Laboratory Investigation
Volume
90
Publish Date
2010
Start Page
371A
End Page
371A

Symptomatic Traumatic Neuroma Causing Common Bile Duct Stricture Following Orthotopic Liver Transplantation: A Retrospective Three and a Half Year Review

Authors
Shealy, MJ; Cardona, DM; Burchette, JL; Cummings, TJ; Smith, AD; Howell, DN; Guy, CD
MLA Citation
Shealy, MJ, Cardona, DM, Burchette, JL, Cummings, TJ, Smith, AD, Howell, DN, and Guy, CD. "Symptomatic Traumatic Neuroma Causing Common Bile Duct Stricture Following Orthotopic Liver Transplantation: A Retrospective Three and a Half Year Review." February 2010.
Source
wos-lite
Published In
Modern Pathology
Volume
23
Publish Date
2010
Start Page
371A
End Page
371A

Angiosarcoma of the Eyelid: A Clinicopathologic Comparison between Isolated Unilateral Eyelid Tumors and Tumors Demonstrating Extra-Palpebral Involvement

Authors
Papalas, JA; Manavi, CK; Sangueza, OP; Cummings, TJ
MLA Citation
Papalas, JA, Manavi, CK, Sangueza, OP, and Cummings, TJ. "Angiosarcoma of the Eyelid: A Clinicopathologic Comparison between Isolated Unilateral Eyelid Tumors and Tumors Demonstrating Extra-Palpebral Involvement." February 2010.
Source
wos-lite
Published In
Modern Pathology
Volume
23
Publish Date
2010
Start Page
383A
End Page
384A

Angiosarcoma of the Eyelid: A Clinicopathologic Comparison between Isolated Unilateral Eyelid Tumors and Tumors Demonstrating Extra-Palpebral Involvement

Authors
Papalas, JA; Manavi, CK; Sangueza, OP; Cummings, TJ
MLA Citation
Papalas, JA, Manavi, CK, Sangueza, OP, and Cummings, TJ. "Angiosarcoma of the Eyelid: A Clinicopathologic Comparison between Isolated Unilateral Eyelid Tumors and Tumors Demonstrating Extra-Palpebral Involvement." February 2010.
Source
wos-lite
Published In
Laboratory Investigation
Volume
90
Publish Date
2010
Start Page
383A
End Page
384A

Corneal wound architecture and integrity after torsional and mixed phacoemulsification: evaluation of standard and microincisional coaxial techniques.

BACKGROUND AND OBJECTIVE: To compare the effects of torsional and mixed ultrasound on clear corneal incision architecture, wound integrity, and apposition using standard (2.75 mm) and microincisional (2.2 mm) coaxial phacoemulsification. SUBJECTS AND METHODS: Twenty human cadaver eyes (4 groups of 5 eyes) underwent simulated coaxial phacoemulsification for 45 seconds of ultrasound time (group 1 = 2.75 mm, 100% torsional; group 2 = 2.2 mm, 70% torsional; group 3 = 2.2 mm, 100% torsional; group 4 = 2.2 mm, mixed ultrasound). All phacoemulsification settings were kept constant across each group. Following phacoemulsification, intraocular pressure (IOP) was cyclically raised and lowered from 0 to 125 mm Hg. Two eyes from each group had India ink placed over the wound and were observed for leakage and for histopathologic examination. Eyes not exposed to India ink (three eyes of each group) were examined using anterior segment optical coherence tomography (OCT) and scanning electron microscopy (SEM). RESULTS: Wound leakage was evident in one eye from group 1 and no eyes from the other three groups. Histopathologic examination revealed no India ink penetration in any of the eyes studied. Anterior segment OCT showed good wound apposition in each group. SEM demonstrated partially compromised endothelium and Descemet's membrane in all eyes studied from each group. CONCLUSION: No differences in corneal wound architecture and integrity were observed. Torsional and mixed ultrasound settings do not appear to induce any adverse effects on corneal wound architecture and integrity in standard and microincisional coaxial phacoemulsification techniques.

Authors
Jun, B; Berdahl, JP; Kuo, AN; Cummings, TJ; Kim, T
MLA Citation
Jun, B, Berdahl, JP, Kuo, AN, Cummings, TJ, and Kim, T. "Corneal wound architecture and integrity after torsional and mixed phacoemulsification: evaluation of standard and microincisional coaxial techniques." Ophthalmic Surg Lasers Imaging 41.1 (January 2010): 128-134.
PMID
20128583
Source
pubmed
Published In
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Volume
41
Issue
1
Publish Date
2010
Start Page
128
End Page
134
DOI
10.3928/15428877-20091230-23

Disappearing bone disease and Chiari I malformation.

Gorham's disease is a rare disorder in which massive osteolysis occurs within bone, and therefore earns its historical name: disappearing bone disease. We describe a case of Chiari I malformation in a patient with this rare disorder, with treatment consisting of a suboccipital craniectomy, C1 laminectomy, and duraplasty for Chiari decompression.

Authors
Hughes, BD; Grant, GA; Cummings, TJ; Fuchs, HE
MLA Citation
Hughes, BD, Grant, GA, Cummings, TJ, and Fuchs, HE. "Disappearing bone disease and Chiari I malformation." Pediatr Neurosurg 46.1 (2010): 58-61.
PMID
20516742
Source
pubmed
Published In
Pediatric neurosurgery
Volume
46
Issue
1
Publish Date
2010
Start Page
58
End Page
61
DOI
10.1159/000315005

Erratum: Convection-enhanced delivery of free gadolinium with the recombinant immunotoxin MR1-1 (Journal of Neuro-Oncology DOI 10.1007/s11060-009-0046-7)

Authors
Ding, D; Kanaly, CW; Bigner, DD; Cummings, TJ; II, JEH; Pastan, I; Raghavan, R; Sampson, JH
MLA Citation
Ding, D, Kanaly, CW, Bigner, DD, Cummings, TJ, II, JEH, Pastan, I, Raghavan, R, and Sampson, JH. "Erratum: Convection-enhanced delivery of free gadolinium with the recombinant immunotoxin MR1-1 (Journal of Neuro-Oncology DOI 10.1007/s11060-009-0046-7)." Journal of Neuro-Oncology 98.1 (2010): 9--.
Source
scival
Published In
Journal of Neuro-Oncology
Volume
98
Issue
1
Publish Date
2010
Start Page
9-
DOI
10.1007/s11060-010-0183-z

Isolated intracranial Rosai-Dorfman disease in a child.

Authors
Lungren, MP; Petrella, JR; Cummings, TJ; Grant, GA
MLA Citation
Lungren, MP, Petrella, JR, Cummings, TJ, and Grant, GA. "Isolated intracranial Rosai-Dorfman disease in a child." AJNR Am J Neuroradiol 30.10 (November 2009): E148-E149. (Letter)
PMID
19661168
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
30
Issue
10
Publish Date
2009
Start Page
E148
End Page
E149
DOI
10.3174/ajnr.A1812

Primary intramedullary melanocytoma of the spinal cord: case report.

OBJECTIVE: The authors report 2 cases of primary intramedullary spinal melanocytomas in 2 patients who presented with lower extremity numbness and/or weakness. CLINICAL PRESENTATION: Magnetic resonance imaging of the spine, thoracic laminectomy, and histological examination revealed the diagnosis. TECHNIQUE: Microscopic and immunohistochemical analysis revealed the diagnosis of primary melanocytoma. CONCLUSION: Melanocytomas of the spine are rare lesions without distinctive imaging characteristics and pose a preoperative diagnostic challenge. A review of the relevant literature and clinical behavior of this uncommon tumor entity is provided.

Authors
Karikari, IO; Powers, CJ; Bagley, CA; Cummings, TJ; Radhakrishnan, S; Friedman, AH
MLA Citation
Karikari, IO, Powers, CJ, Bagley, CA, Cummings, TJ, Radhakrishnan, S, and Friedman, AH. "Primary intramedullary melanocytoma of the spinal cord: case report." Neurosurgery 64.4 (April 2009): E777-E778.
PMID
19349809
Source
pubmed
Published In
Neurosurgery
Volume
64
Issue
4
Publish Date
2009
Start Page
E777
End Page
E778
DOI
10.1227/01.NEU.0000341516.22126.AA

Adult cases of leukoencephalopathy, cerebral calcifications, and cysts: expanding the spectrum of the disorder.

Leukoencephalopathy with cerebral calcifications and cysts (LCC) was first reported in children who developed cognitive decline and variable extrapyramidal, cerebellar, and pyramidal signs, with or without seizures. Leukoencephalopathy with cerebral calcifications and cysts is characterized by progressive formation of brain cysts that can generate a mass effect simulating a neoplasm. Retinal changes that overlap with Coats disease, a microangiopathy with retinal telangiectasias and exudates, may also occur. We and others have reported LCC cases in adults. Neuroimaging shows diffuse leukoencephalopathy, multifocal calcifications especially of deep gray and white matter, multifocal enhancement, and variably sized cysts that may require surgical decompression. Biopsies adjacent to cysts have shown angiomatous and/or severely hyalinized blood vessels surrounded by myelin loss and gliosis, calcifications, and Rosenthal fibers. We report 2 additional adult-onset cases of LCC. Case 1 is a 40-year-old man who developed neurological symptoms and cirrhosis and died of acute gastrointestinal bleeding; he had numerous retinal microinfarcts at autopsy. Case 2 is a 55-year-old woman who was found by chance to have LCC; one and a half years later, her course remains benign. These cases expand the spectrum of adult-onset LCC, the etiology of which is unknown.

Authors
Kleinschmidt-Demasters, BK; Cummings, TJ; Hulette, CM; Morgenlander, JC; Corboy, JR
MLA Citation
Kleinschmidt-Demasters, BK, Cummings, TJ, Hulette, CM, Morgenlander, JC, and Corboy, JR. "Adult cases of leukoencephalopathy, cerebral calcifications, and cysts: expanding the spectrum of the disorder." J Neuropathol Exp Neurol 68.4 (April 2009): 432-439.
PMID
19287308
Source
pubmed
Published In
Journal of Neuropathology and Experimental Neurology
Volume
68
Issue
4
Publish Date
2009
Start Page
432
End Page
439
DOI
10.1097/NEN.0b013e31819fd897

Ectopic brain in the orbit presenting as disc edema in an adult.

A 59-year-old man presented with disc edema in the right eye. MRI demonstrated a lesion extending to the orbital apex. The lesion was biopsied and pathology revealed ectopic brain tissue. The presence of ectopic brain in the orbit is a rare finding. The few reports in the literature of sequestered ectopic brain in the orbit have all involved neonates or infants. We describe the first case of this rare tumor presenting in the orbit of an adult.

Authors
Price, KM; Cummings, TJ; Etter, JR; Woodward, JA
MLA Citation
Price, KM, Cummings, TJ, Etter, JR, and Woodward, JA. "Ectopic brain in the orbit presenting as disc edema in an adult." Orbit 28.1 (2009): 74-77.
PMID
19229751
Source
pubmed
Published In
Orbit (Informa)
Volume
28
Issue
1
Publish Date
2009
Start Page
74
End Page
77
DOI
10.1080/01676830802599150

Secretory meningiomas of the orbit.

Meningiomas are histologically heterogeneous tumors with at least 15 different subtypes. They can be subdivided into well-differentiated, atypical, and anaplastic or malignant categories. The secretory meningioma is a well-differentiated variant, is relatively rare. Orbital involvement of secretory meningiomas is rarity. We report two cases of secretory meningiomas of orbit and review of current literature.

Authors
Karikari, IO; Syed, NA; Cummings, TJ
MLA Citation
Karikari, IO, Syed, NA, and Cummings, TJ. "Secretory meningiomas of the orbit." Orbit 28.6 (2009): 408-411.
PMID
19929671
Source
pubmed
Published In
Orbit (Informa)
Volume
28
Issue
6
Publish Date
2009
Start Page
408
End Page
411
DOI
10.3109/01676830903104694

Clinical and ocular pathological findings in Von Hippel-Lindau disease

Objectives: To report a patient with Von Hippel-Lindau (VHL) disease demonstrating classic ocular findings. Design'. Retrospective case report. Methods: Clinical and pathological findings. Main Outcome Measures: Clinical course and pathological findings. Results: Clinical and pathological analyses were diagnostic of VHL in a 44-year-old man. He first developed retinal hemangioblastomas and subsequently spinal hemangioblastomas as well as pancreatic, renal, and liver cysts. Unfortunately for this subject, he also developed renal cell carcinoma. Conclusion: Von Hippel-Lindau disease is an autosomal dominant genetic disorder that affects approximately 1 in 50000 individuals. Early recognition of the classic retinal findings of VHL could lead to an earlier diagnosis and be life saving.

Authors
Chong, GT; Cummings, TJ; Mruthyunjaya, P; Richard, MJ
MLA Citation
Chong, GT, Cummings, TJ, Mruthyunjaya, P, and Richard, MJ. "Clinical and ocular pathological findings in Von Hippel-Lindau disease." Clinical and Surgical Ophthalmology 27.6-7 (2009): 174-178.
Source
scival
Published In
Clinical and Surgical Ophthalmology
Volume
27
Issue
6-7
Publish Date
2009
Start Page
174
End Page
178

Hereditary benign intraepithelial dyskeratosis: an evaluation of diagnostic cytology.

CONTEXT: Hereditary benign intraepithelial dyskeratosis (HBID) is a rare autosomal dominant disorder characterized by elevated epibulbar and oral plaques and hyperemic conjunctival blood vessels. The condition is predominantly seen in Native Americans belonging to the Haliwa-Saponi tribe located in northeastern North Carolina. OBJECTIVE: To determine whether HBID can be diagnosed using cytologic preparations of the conjunctiva, and whether the cytologic findings correlated with the genetic linkage involving a duplication in chromosome 4 (4q35). DESIGN: Cytologic preparations from conjunctival brushings in patients afflicted with HBID and from unaffected blood relatives with normal conjunctivas were compared in a masked fashion. Cytologic observations were correlated with molecular genetic analyses. RESULTS: Papanicolaou-stained preparations from the conjunctiva showed the typical cytologic features of HBID, including rounded squamous epithelial cells with dense homogenous orange cytoplasm and hyperchromatic, pyknotic, or crenated nuclei. All cases with the diagnostic cytologic findings of HBID had a duplication in chromosome 4 (4q35). CONCLUSION: HBID is an entity with distinct clinical, histopathologic, and genetic features. The results of this study indicate the diagnosis can also be supported in an appropriate clinical setting when adequate epibulbar cytology preparations are obtained and the characteristic genetic attributes are present.

Authors
Cummings, TJ; Dodd, LG; Eedes, CR; Klintworth, GK
MLA Citation
Cummings, TJ, Dodd, LG, Eedes, CR, and Klintworth, GK. "Hereditary benign intraepithelial dyskeratosis: an evaluation of diagnostic cytology." Arch Pathol Lab Med 132.8 (August 2008): 1325-1328.
PMID
18684035
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
132
Issue
8
Publish Date
2008
Start Page
1325
End Page
1328
DOI
10.1043/1543-2165(2008)132[1325:HBIDAE]2.0.CO;2

The presence of T-lymphocyte subpopulations (CD4 and CD8) in pterygia: evaluation of the inflammatory response.

INTRODUCTION: The aim of our study was to confirm the presence of inflammatory T-lymphocyte subpopulations (CD4 and CD8) in pterygium specimens with regards to clinical severity. Additionally, we examined the effect of topical anti-inflammatory agents on the presence of T-lymphocyte subpopulations. METHODS: Pterygia from nineteen eyes of nineteen patients who underwent surgical excision at Duke University, North Carolina, were included in this study. Normal conjunctiva from one patient was included as a control. Pterygia were pre-operatively graded as mild, moderate or severe based on objective signs of inflammation. Immunohistochemical staining for both CD4 and CD8 subpopulations of T lymphocytes was performed. Distribution of lymphocytes within the epithelium and substantia propria was graded by a masked observer on the following scale: 0 (none/rare), 1+ (mild), 2+ (moderate), or 3+ severe. Statistical analysis was performed using the Fisher exact test and Chi-square test. RESULTS: A total of 16 (84%) pterygia specimens stained for T lymphocytes displayed approximately equal CD4 and CD8 infiltration of both the epithelium and the substantia propria. The majority of CD4 and CD8 lymphocytes were located in aggregates in the epithelium and upper substantia propria. The control specimen contained scant evidence of lymphocytic infiltration. There was no significant difference in the amount of lymphocytic infiltration between mild, moderate or severe pterygia. There was also no significant difference in lymphocytic infiltration between patients with (n=8) or without (n=11) a history of topical anti-inflammatory use. CONCLUSION: The presence of CD4 and CD8 lymphocytes was confirmed in pterygia. There was no significant difference in lymphocytic infiltrate in patients with or without prior topical anti-inflammatory use. Based on these findings, topical immunomodulators may have an adjunctive role in the treatment of pterygia.

Authors
Awdeh, RM; DeStafeno, JJ; Blackmon, DM; Cummings, TJ; Kim, T
MLA Citation
Awdeh, RM, DeStafeno, JJ, Blackmon, DM, Cummings, TJ, and Kim, T. "The presence of T-lymphocyte subpopulations (CD4 and CD8) in pterygia: evaluation of the inflammatory response." Adv Ther 25.5 (May 2008): 479-487.
PMID
18483701
Source
pubmed
Published In
Advances in Therapy
Volume
25
Issue
5
Publish Date
2008
Start Page
479
End Page
487
DOI
10.1007/s12325-008-0056-4

Cholesterol granuloma of the lateral ventricle. Case report.

Cholesterol granulomas (CGs) are benign lesions resulting from an inflammatory reaction to cholesterol and hemosiderin. These masses most often arise within the temporal bone or nasal sinuses; intracerebral CGs are extremely rare. In this report the authors present an unusual case of a CG arising within the lateral ventricle. The patient presented with transient hemiparesis and numbness. Computed tomography and magnetic resonance imaging demonstrated a cystic partially enhancing midline mass within the right lateral ventricle, expanding the ventricle and displacing the septum pellucidum. The patient underwent an interhemispheric, transcallosal resection of the lesion. Microscopic examination revealed a granulomatous inflammatory lesion containing cholesterol clefts, macrophages, and hemosiderin. Embedded within the granulomatous response were foci of tiny cystlike structures lined by nonciliated flattened cuboidal epithelium, consistent with the diagnosis of CG. To the authors' knowledge this is the first reported case of CG presenting as an intraventricular mass. The origin of this lesion is unclear, but it may relate to prior traumatic brain injury. The authors describe the presentation, imaging findings, histopathological characteristics, and surgical treatment of this rare lesion and related pathological entities.

Authors
Grossi, PM; Ellis, MJ; Cummings, TJ; Gray, LL; Fukushima, T; Sampson, JH
MLA Citation
Grossi, PM, Ellis, MJ, Cummings, TJ, Gray, LL, Fukushima, T, and Sampson, JH. "Cholesterol granuloma of the lateral ventricle. Case report." J Neurosurg 108.2 (February 2008): 357-360.
PMID
18240934
Source
pubmed
Published In
Journal of neurosurgery
Volume
108
Issue
2
Publish Date
2008
Start Page
357
End Page
360
DOI
10.3171/JNS/2008/108/2/0357

Unusual case of diffuse choroidal melanoma masquerading as atypical central serous chorioretinopathy.

PURPOSE: To describe an unusual case of diffuse circumpapillary choroidal melanoma masquerading as atypical central serous chorioretinopathy, and to describe fluorescein angiographic and optical coherence tomography characteristics of this diffuse choroidal melanoma. DESIGN: Interventional case report. METHODS: A 46-year-old human immunodeficiency virus-positive man presented with an 11-month history of decreased vision and the absence of an elevated choroidal lesion. The patient failed to return for follow-up. RESULTS: Thirteen months after his initial presentation, circumpapillary diffuse choroidal melanoma was diagnosed. The patient underwent enucleation. No extrascleral extension was present. CONCLUSIONS: Imaging characteristics on fluorescein angiography or optical coherence tomography may be of diagnostic value to aid the ophthalmologist in earlier detection of diffuse choroidal melanomas.

Authors
Scott, AW; Fekrat, S; Mruthyunjaya, P; Cummings, TJ; Cooney, MJ
MLA Citation
Scott, AW, Fekrat, S, Mruthyunjaya, P, Cummings, TJ, and Cooney, MJ. "Unusual case of diffuse choroidal melanoma masquerading as atypical central serous chorioretinopathy." Retinal cases & brief reports 2.4 (January 2008): 280-285.
PMID
25390591
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
2
Issue
4
Publish Date
2008
Start Page
280
End Page
285
DOI
10.1097/icb.0b013e318156d799

Hybrid neurofibroma-schwannoma of the orbit.

PURPOSE: To report a case of an unusual orbital tumor with histologic features of both neurofibroma and schwannoma. METHODS: Clinical and pathological findings are presented in a patient with an orbital tumor. RESULTS: Orbital magnetic resonance imaging in a 51-year-old female revealed a heterogeneously enhancing right orbital mass. An anterior orbitotomy was performed, and pathological evaluation revealed a tumor with discrete areas of both neurofibroma and schwannoma. CONCLUSIONS: Hybrid neurofibroma-schwannomas may arise within the orbit.

Authors
Youens, KE; Woodward, J; Wallace, D; Cummings, TJ
MLA Citation
Youens, KE, Woodward, J, Wallace, D, and Cummings, TJ. "Hybrid neurofibroma-schwannoma of the orbit." Orbit 27.3 (2008): 223-225.
PMID
18569835
Source
pubmed
Published In
Orbit (Informa)
Volume
27
Issue
3
Publish Date
2008
Start Page
223
End Page
225
DOI
10.1080/01676830802009804

Stage IV primitive-appearing sinus and orbital rhabdomyosarcoma presenting in a 68-year-old female previously treated for breast cancer.

A 68-year-old female who had undergone treatment several years previously for breast cancer presented with diplopia and unilateral proptosis and exposure keratopathy related to biopsy-proven rhabdomyosarcoma of the sinus and orbit. Further evaluation revealed multiple metastatic lesions felt to have originated from the primary sinus and orbital tumor. Histopathologic examination showed primitive-appearing rhabdomyosarcoma with some features suggestive of the alveolar subtype. Orbital or sinus rhabdomyosarcoma is seen almost exclusively in the pediatric population, but may very rarely occur in adults. There are several genetic mutations that appear to play a role in both rhabdomyosarcoma and certain breast tumors. There is also increasing evidence that even low doses of radiation may contribute to the future development of cancer, particularly in susceptible individuals. In our patient with atypical demographics for rhabdomyosarcoma, the previous neoplasm and treatment thereof may have predisposed to the development of this rare tumor.

Authors
Morris, CL; Mukundan, S; Heimann, A; Cummings, TJ; Chesnutt, DA
MLA Citation
Morris, CL, Mukundan, S, Heimann, A, Cummings, TJ, and Chesnutt, DA. "Stage IV primitive-appearing sinus and orbital rhabdomyosarcoma presenting in a 68-year-old female previously treated for breast cancer." Orbit 27.1 (2008): 73-77.
PMID
18307153
Source
pubmed
Published In
Orbit (Informa)
Volume
27
Issue
1
Publish Date
2008
Start Page
73
End Page
77
DOI
10.1080/01676830601177489

Choroidal metastasis of follicular thyroid adenocarcinoma diagnosed by 25-gauge transretinal biopsy.

We report a case of a patient with previously treated follicular thyroid carcinoma who presented with a symptomatic amelanotic choroidal mass with low internal reflectivity and a metastatic lytic skull lesion. A 25-gauge vitrector was used to perform transretinal choroidal biopsy (TRCB), confirming the diagnosis of metastatic follicular thyroid carcinoma.

Authors
Scott, AW; Cummings, TJ; Kirkpatrick, JP; Mruthyunjaya, P
MLA Citation
Scott, AW, Cummings, TJ, Kirkpatrick, JP, and Mruthyunjaya, P. "Choroidal metastasis of follicular thyroid adenocarcinoma diagnosed by 25-gauge transretinal biopsy." Ann Ophthalmol (Skokie) 40.2 (2008): 110-112.
PMID
19013920
Source
pubmed
Published In
Annals of ophthalmology (Skokie, Ill.)
Volume
40
Issue
2
Publish Date
2008
Start Page
110
End Page
112

Systemic CTLA-4 blockade ameliorates glioma-induced changes to the CD4+ T cell compartment without affecting regulatory T-cell function.

PURPOSE: Patients with malignant glioma suffer global compromise of their cellular immunity, characterized by dramatic reductions in CD4(+) T cell numbers and function. We have previously shown that increased regulatory T cell (T(reg)) fractions in these patients explain T-cell functional deficits. Our murine glioma model recapitulates these findings. Here, we investigate the effects of systemic CTLA-4 blockade in this model. EXPERIMENTAL DESIGN: A monoclonal antibody (9H10) to CTLA-4 was employed against well-established glioma. Survival and risks for experimental allergic encephalomyelitis were assessed, as were CD4(+) T cell numbers and function in the peripheral blood, spleen, and cervical lymph nodes. The specific capacities for anti-CTLA-4 to modify the functions of regulatory versus CD4(+)CD25(-) responder T cells were evaluated. RESULTS: CTLA-4 blockade confers long-term survival in 80% of treated mice, without eliciting experimental allergic encephalomyelitis. Changes to the CD4 compartment were reversed, as anti-CTLA-4 reestablishes normal CD4 counts and abrogates increases in CD4(+)CD25(+)Foxp3(+)GITR(+) regulatory T cell fraction observed in tumor-bearing mice. CD4(+) T-cell proliferative capacity is restored and the cervical lymph node antitumor response is enhanced. Treatment benefits are bestowed exclusively on the CD4(+)CD25(-) T cell population and not T(regs), as CD4(+)CD25(-) T cells from treated mice show improved proliferative responses and resistance to T(reg)-mediated suppression, whereas T(regs) from the same mice remain anergic and exhibit no restriction of their suppressive capacity. CONCLUSIONS: CTLA-4 blockade is a rational means of reversing glioma-induced changes to the CD4 compartment and enhancing antitumor immunity. These benefits were attained through the conferment of resistance to T(reg)-mediated suppression, and not through direct effects on T(regs).

Authors
Fecci, PE; Ochiai, H; Mitchell, DA; Grossi, PM; Sweeney, AE; Archer, GE; Cummings, T; Allison, JP; Bigner, DD; Sampson, JH
MLA Citation
Fecci, PE, Ochiai, H, Mitchell, DA, Grossi, PM, Sweeney, AE, Archer, GE, Cummings, T, Allison, JP, Bigner, DD, and Sampson, JH. "Systemic CTLA-4 blockade ameliorates glioma-induced changes to the CD4+ T cell compartment without affecting regulatory T-cell function." Clinical cancer research : an official journal of the American Association for Cancer Research 13.7 (April 2007): 2158-2167.
PMID
17404100
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
13
Issue
7
Publish Date
2007
Start Page
2158
End Page
2167
DOI
10.1158/1078-0432.ccr-06-2070

Cerebellar cryptococcoma in a patient with undiagnosed sarcoidosis: case report.

OBJECTIVE: We describe a patient with undiagnosed sarcoidosis who presented with a rare isolated cerebellar cryptococcoma masquerading as a metastatic brain tumor. CLINICAL PRESENTATION: A 58-year-old man with a history of resected squamous cell carcinoma of the larynx and pulmonary nodules was found to have a left cerebellar lesion on neuroimaging after presenting with a 4-month history of occipital headaches. Neuroimaging revealed a large, lobulated, intra-axial, left cerebellar hemispheric mass with peripheral nodular enhancement, mild adjacent edema, and dense focal areas of calcification. INTERVENTION: The patient underwent a left suboccipital craniotomy for gross total resection of the left cerebellar mass. Pathological examination of the resected specimen demonstrated a cryptococcoma, which was confirmed with a positive cerebrospinal fluid cryptococcal antigen. Postoperative evaluation revealed pulmonary sarcoidosis. CONCLUSION: Central nervous system cryptococcoma is a rare infection that may present in a patient with no known history of immunosuppression and no clinical signs of infection. Diagnostically, this can be difficult to distinguish from a brain tumor. Central nervous system cryptococcoma is an opportunistic infection that typically occurs in the presence of an immunosuppressed state. Sarcoidosis should be considered a predisposing factor because patients with this underlying disease have an increased susceptibility to this central nervous system fungal infection.

Authors
Kanaly, CW; Selznick, LA; Cummings, TJ; Adamson, DC
MLA Citation
Kanaly, CW, Selznick, LA, Cummings, TJ, and Adamson, DC. "Cerebellar cryptococcoma in a patient with undiagnosed sarcoidosis: case report." Neurosurgery 60.3 (March 2007): E571-.
PMID
17327765
Source
pubmed
Published In
Neurosurgery
Volume
60
Issue
3
Publish Date
2007
Start Page
E571
DOI
10.1227/01.NEU.0000255338.18404.C1

Primary cerebral ALK-1-positive anaplastic large cell lymphoma in a child. Case report and literature review.

A 4-year-old African American male was referred to the Pediatric Neurosurgery Service for evaluation of new onset seizures and worsening mental status. An MRI of the brain revealed a pineal region mass with diffuse leptomeningeal enhancement and compression of the basilar cisterns. A biopsy of the brain revealed histologic and immunophenotypic findings characteristic of ALK-1+ anaplastic large cell lymphoma (ALCL). ALCL rarely occurs in the central nervous system and poses a significant diagnostic challenge often leading to a delay in the initiation of appropriate treatment. We describe a case of a rapidly deteriorating clinical course in a child with central nervous system ALCL and review the current literature on ALCL occurring in the central nervous system.

Authors
Karikari, IO; Thomas, KK; Lagoo, A; Cummings, TJ; George, TM
MLA Citation
Karikari, IO, Thomas, KK, Lagoo, A, Cummings, TJ, and George, TM. "Primary cerebral ALK-1-positive anaplastic large cell lymphoma in a child. Case report and literature review." Pediatr Neurosurg 43.6 (2007): 516-521. (Review)
PMID
17992044
Source
pubmed
Published In
Pediatric neurosurgery
Volume
43
Issue
6
Publish Date
2007
Start Page
516
End Page
521
DOI
10.1159/000108799

Spinal capillary hemangioma in infants: report of two cases and review of the literature.

We report the case of 2 infants born with a lumbar dermal sinus tract and an overlying angiomatous skin lesion referred to our pediatric neurosurgery service for evaluation of a tethered cord. Both infants were born with a lumbar dimple and were found to have a large cutaneous hemangioma without neurologic symptoms. An MRI of the lumbar spine revealed an isointense mass in the dorsal epidural at L(4) with an adjacent mass effect and extension into the overlying soft tissues. The spinal cord also appeared to be tethered with a fatty filum terminale. We performed a lumbar laminectomy and laminoplasty to remove the mass and to release the tethered cord. Pathologic examination confirmed the diagnosis of capillary hemangioma. Several case reports describe spinal capillary hemangiomas in adults, but only one found in the literature describes a case in an infant. We provide a review of the literature of spinal capillary hemangiomas and support the practice of evaluating infants with cutaneous lumbosacral hemangiomas for underlying spinal cord abnormalities.

Authors
Karikari, IO; Selznick, LA; Cummings, TJ; George, TM
MLA Citation
Karikari, IO, Selznick, LA, Cummings, TJ, and George, TM. "Spinal capillary hemangioma in infants: report of two cases and review of the literature." Pediatr Neurosurg 43.2 (2007): 125-129. (Review)
PMID
17337925
Source
pubmed
Published In
Pediatric neurosurgery
Volume
43
Issue
2
Publish Date
2007
Start Page
125
End Page
129
DOI
10.1159/000098386

Primary spinal intramedullary adrenal cortical adenoma associated with spinal dysraphism: case report.

OBJECTIVE: The authors report a primary spinal intramedullary adrenal cortical adenoma in a patient with spinal dysraphism presenting with bilateral leg pain and urinary frequency. METHODS: Magnetic resonance imaging, L2 laminectomy with resection of mass, and pathological and immunohistochemical analysis of resected mass revealed the diagnosis. RESULTS: Microscopic and immunohistochemical findings confirmed the diagnosis as a primary intramedullary tumor of adrenal cortical origin. CONCLUSION: The occurrence of a primary adrenal tumor in the spinal cord is rare and difficult to explain based on our understanding of embryology. A review of the relevant literature and discussion of the pathophysiology and clinical implications is provided.

Authors
Karikari, IO; Uschold, TD; Selznick, LA; Carter, JH; Cummings, TJ; Friedman, AH
MLA Citation
Karikari, IO, Uschold, TD, Selznick, LA, Carter, JH, Cummings, TJ, and Friedman, AH. "Primary spinal intramedullary adrenal cortical adenoma associated with spinal dysraphism: case report." Neurosurgery 59.5 (November 2006): E1144-.
PMID
17143207
Source
pubmed
Published In
Neurosurgery
Volume
59
Issue
5
Publish Date
2006
Start Page
E1144
DOI
10.1227/01.NEU.0000245588.31334.83

Behavioural testing and histological assessments of rabbit spinal cord following intrathecal administration of ondansetron.

1. Intrathecal injection of ondansetron has the potential to reduce opioid-related side-effects. The aim of the present study was to determine whether this route of administration produces neuraxial injury. 2. Adult, non-pregnant female New Zealand white rabbits received a single bolus injection of a low (40 microg) or high (4.0 mg) dose of ondansetron into the intrathecal space between the 4th and 5th lumbar vertebrae. In some cases, ondansetron was coadministered with morphine (5 microg/kg). Control animals received a bolus injection of normal saline. Behavioural assessments were conducted at 1 and 24 h to determine overt changes in arousal and mobility, followed by histological evaluation of the excised spinal cord. 3. Of 45 animals investigated, 10 rabbits exhibited modest behavioural evidence of spinal injury, the incidence of which was equally distributed between the treatment groups. Haematoxylin and eosin, along with HAM56, staining of cross-sections of the cervical, thoracic and upper and lower lumbar areas revealed mild signs of inflammation. This, too, was equally distributed between the treatment groups, suggesting that any observed neuraxial injury was the result of needle trauma and not ondansetron neurotoxicity. 4. Collectively, these negative findings support conducting further experiments to fully assess the clinical usefulness of intrathecal ondansetron administration.

Authors
Lacassie, HJ; Schultz, JR; Cummings, TJ; Morris, R; Trasti, SL; Reynolds, JD
MLA Citation
Lacassie, HJ, Schultz, JR, Cummings, TJ, Morris, R, Trasti, SL, and Reynolds, JD. "Behavioural testing and histological assessments of rabbit spinal cord following intrathecal administration of ondansetron." Clin Exp Pharmacol Physiol 33.9 (September 2006): 798-801.
PMID
16922809
Source
pubmed
Published In
Clinical and Experimental Pharmacology and Physiology
Volume
33
Issue
9
Publish Date
2006
Start Page
798
End Page
801
DOI
10.1111/j.1440-1681.2006.04442.x

Systemic anti-CD25 monoclonal antibody administration safely enhances immunity in murine glioma without eliminating regulatory T cells.

PURPOSE: Elevated proportions of regulatory T cells (T(reg)) are present in patients with a variety of cancers, including malignant glioma, yet recapitulative murine models are wanting. We therefore examined T(regs) in mice bearing malignant glioma and evaluated anti-CD25 as an immunotherapeutic adjunct. EXPERIMENTAL DESIGN: CD4+CD25+Foxp3+GITR+ T(regs) were quantified in the peripheral blood, spleens, cervical lymph nodes, and bone marrow of mice bearing malignant glioma. The capacities for systemic anti-CD25 therapy to deplete T(regs), enhance lymphocyte function, and generate antiglioma CTL responses were assessed. Lastly, survival and experimental allergic encephalitis risks were evaluated when anti-CD25 was combined with a dendritic cell-based immunization targeting shared tumor and central nervous system antigens. RESULTS: Similar to patients with malignant glioma, glioma-bearing mice show a CD4 lymphopenia. Additionally, CD4+CD25+Foxp3+GITR+ T(regs) represent an increased fraction of the remaining peripheral blood CD4+ T cells, despite themselves being reduced in number. Similar trends are observed in cervical lymph node and spleen, but not in bone marrow. Systemic anti-CD25 administration hinders detection of CD25+ cells but fails to completely eliminate T(regs), reducing their number only moderately, yet eliminating their suppressive function. This elimination of T(reg) function permits enhanced lymphocyte proliferative and IFN-gamma responses and up to 80% specific lysis of glioma cell targets in vitro. When combined with dendritic cell immunization, anti-CD25 elicits tumor rejection in 100% of challenged mice without precipitating experimental allergic encephalitis. CONCLUSIONS: Systemic anti-CD25 administration does not entirely eliminate T(regs) but does prevent T(reg) function. This leads to safe enhancement of tumor immunity in a murine glioma model that recapitulates the tumor-induced changes to the CD4 and T(reg) compartments seen in patients with malignant glioma.

Authors
Fecci, PE; Sweeney, AE; Grossi, PM; Nair, SK; Learn, CA; Mitchell, DA; Cui, X; Cummings, TJ; Bigner, DD; Gilboa, E; Sampson, JH
MLA Citation
Fecci, PE, Sweeney, AE, Grossi, PM, Nair, SK, Learn, CA, Mitchell, DA, Cui, X, Cummings, TJ, Bigner, DD, Gilboa, E, and Sampson, JH. "Systemic anti-CD25 monoclonal antibody administration safely enhances immunity in murine glioma without eliminating regulatory T cells." Clinical cancer research : an official journal of the American Association for Cancer Research 12.14 Pt 1 (July 2006): 4294-4305.
PMID
16857805
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
12
Issue
14 Pt 1
Publish Date
2006
Start Page
4294
End Page
4305
DOI
10.1158/1078-0432.ccr-06-0053

Complex choristoma of the gyrus rectus: a distinct clinicopathologic entity?

We report 2 cases of an unusual central nervous system lesion involving the gyrus rectus and characterized by well-differentiated epithelial and mesenchymal components. One patient was a 30-year-old woman, and the other was a 42-year-old man. Both presented with seizures. Radiologically, the lesions were solid, with ill-defined margins and increased signal on T2-weighted MRI. Both were contrast enhancing. There was no significant mass effect or edema. Histopathologically, the epithelial component was characterized by a tubule-forming, stratified epithelium. The lumina of the tubules were lined, in some areas, by a distinct layer of mature keratinocytes. Smooth muscle actin-immunoreactive myoepithelial cells were present in the basal layer, indicating glandular differentiation. Some lumina were cystically dilated and contained anucleate squames and/or PAS-positive material. In some areas, the epithelial structures were separated by reactive glial tissue resembling pilocytic astrocytoma, with prominent, piloid processes, Rosenthal fibers, and gemistocytic astrocytes. In other areas, glial nuclei formed small clusters reminiscent of subependymoma, but no glioma was identified in either case. Tissue resembling mature adipose was present focally. No mitotic figures were identified. Follow-up interval of up to 2 years showed no evidence of recurrent tumor. By location and histologic features, this lesion appears to represent a rare, distinct clinicopathologic entity, perhaps derived from misplaced cranial neural crest cells.

Authors
Abel, TW; Curtis, M; Lin, DD; Burger, PC; Cummings, TJ
MLA Citation
Abel, TW, Curtis, M, Lin, DD, Burger, PC, and Cummings, TJ. "Complex choristoma of the gyrus rectus: a distinct clinicopathologic entity?." Am J Surg Pathol 30.5 (May 2006): 625-629.
PMID
16699317
Source
pubmed
Published In
American Journal of Surgical Pathology
Volume
30
Issue
5
Publish Date
2006
Start Page
625
End Page
629
DOI
10.1097/01.pas.0000194744.33540.28

Primary myxoma of the parafalcine meninges. Case report.

The authors report on an unusual case of a primary intracranial myxoma in a 39-year-old woman. The patient presented with headache and generalized seizure. Magnetic resonance imaging revealed a large right frontal tumor resembling a parasagittal meningioma. A gross-total resection was performed, and histological review confirmed the lesion as a myxoma. Results of additional workup revealed the absence of a primary myxoma elsewhere. This case represents the third published report of a primary intracranial myxoma and the second report of a supratentorial myxoma.

Authors
Powers, CJ; Pizzi, CC; Cummings, TJ; Friedman, AH
MLA Citation
Powers, CJ, Pizzi, CC, Cummings, TJ, and Friedman, AH. "Primary myxoma of the parafalcine meninges. Case report." J Neurosurg 104.3 (March 2006): 440-443.
PMID
16572660
Source
pubmed
Published In
Journal of neurosurgery
Volume
104
Issue
3
Publish Date
2006
Start Page
440
End Page
443
DOI
10.3171/jns.2006.104.3.440

Capillary hemangioma of the fourth ventricle in an infant. Case report and review of the literature.

A 3-month-old boy presented to the pediatric neurosurgery service with central hypotonia. Magnetic resonance images of the brain revealed a homogeneously enhancing dumbbell-shaped mass located in the fourth ventricle and extending into the left cerebellopontine angle (CPA). A suboccipital craniotomy was performed and a gross-total resection of the mass was achieved. Pathological examination of the resected tissue confirmed the diagnosis of capillary hemangioma. To the authors' knowledge, this is the first reported case of a capillary hemangioma occurring in this location. The authors provide a review of the current literature on intracranial capillary hemangiomas and conclude that, despite the rarity of these lesions, they should be considered in the differential diagnosis of lesions in the fourth ventricle and/or the CPA in children.

Authors
Karikari, IO; Selznick, LA; Cummings, TJ; George, TM
MLA Citation
Karikari, IO, Selznick, LA, Cummings, TJ, and George, TM. "Capillary hemangioma of the fourth ventricle in an infant. Case report and review of the literature." J Neurosurg 104.3 Suppl (March 2006): 188-191.
PMID
16572636
Source
pubmed
Published In
Journal of neurosurgery
Volume
104
Issue
3 Suppl
Publish Date
2006
Start Page
188
End Page
191
DOI
10.3171/ped.2006.104.3.188

Primary spinal intramedullary adrenal cortical adenoma associated with spinal dysraphism: Case report

OBJECTIVE: The authors report a primary spinal intramedullary adrenal cortical adenoma in a patient with spinal dysraphism presenting with bilateral leg pain and urinary frequency. METHODS: Magnetic resonance imaging, L2 laminectomy with resection of mass, and pathological and immunohistochemical analysis of resected mass revealed the diagnosis. RESULTS: Microscopic and immunohistochemical findings confirmed the diagnosis as a primary intramedullary tumor of adrenal cortical origin. CONCLUSION: The occurrence of a primary adrenal tumor in the spinal cord is rare and difficult to explain based on our understanding of embryology. A review of the relevant literature and discussion of the pathophysiology and clinical implications is provided. Copyright © by the Congress of Neurological Surgeons.

Authors
Karikari, IO; Uschold, TD; Selznick, LA; Carter, JH; Cummings, TJ; Friedman, AH
MLA Citation
Karikari, IO, Uschold, TD, Selznick, LA, Carter, JH, Cummings, TJ, and Friedman, AH. "Primary spinal intramedullary adrenal cortical adenoma associated with spinal dysraphism: Case report." Neurosurgery 59.5 (2006): 1155-1159.
Source
scival
Published In
Neurosurgery
Volume
59
Issue
5
Publish Date
2006
Start Page
1155
End Page
1159
DOI
10.1227/01.NEU.0000245588.31334.83

Capillary hemangioma of the fourth ventricle in an infant: Case report and review of the literature

A 3-month-old boy presented to the pediatric neurosurgery service with central hypotonia. Magnetic resonance images of the brain revealed a homogeneously enhancing dumbbell-shaped mass located in the fourth ventricle and extending into the left cerebellopontine angle (CPA). A suboccipital craniotomy was performed and a gross-total resection of the mass was achieved. Pathological examination of the resected tissue confirmed the diagnosis of capillary hemangioma. To the authors' knowledge, this is the first reported case of a capillary hemangioma occurring in this location. The authors provide a review of the current literature on intracranial capillary hemangiomas and conclude that, despite the rarity of these lesions, they should be considered in the differential diagnosis of lesions in the fourth ventricle and/or the CPA in children.

Authors
Karikari, IO; Selznick, LA; Cummings, TJ; George, TM
MLA Citation
Karikari, IO, Selznick, LA, Cummings, TJ, and George, TM. "Capillary hemangioma of the fourth ventricle in an infant: Case report and review of the literature." Journal of Neurosurgery 104 PEDIATRICS.SUPPL. 3 (2006): 188-191.
Source
scival
Published In
Journal of neurosurgery
Volume
104 PEDIATRICS
Issue
SUPPL. 3
Publish Date
2006
Start Page
188
End Page
191
DOI
10.3171/jns.2006.104.2.188

Retinal folds as initial manifestation of orbital lymphangioma.

Authors
Reeves, SW; Miele, DL; Woodward, JA; Cummings, TJ; Eales, MC; Kurz, P; Cooney, MJ
MLA Citation
Reeves, SW, Miele, DL, Woodward, JA, Cummings, TJ, Eales, MC, Kurz, P, and Cooney, MJ. "Retinal folds as initial manifestation of orbital lymphangioma." Arch Ophthalmol 123.12 (December 2005): 1756-1758.
PMID
16344454
Source
pubmed
Published In
Archives of Ophthalmology
Volume
123
Issue
12
Publish Date
2005
Start Page
1756
End Page
1758
DOI
10.1001/archopht.123.12.1756

Intracranial Ewing sarcoma.

The occurrence of primary extraosseous Ewing sarcoma (EES) of the central nervous system (CNS) has only rarely been reported in the literature. It is important to distinguish this entity from the more common central primitive neuroectodermal tumor (PNET) of brain, since the management of these tumors is different from that of EES. We present the clinical, radiologic, and pathologic features of two cases of EES occurring in the brain. The diagnosis was further confirmed by detection of a rearrangement of the FLI1 and/or EWS gene loci in tumors from both patients using fluorescent in situ hybridization (FISH). Although rare, the possibility of EES should be considered particularly when tumors that arise near the meningeal surface of the brain and have the pathologic appearance of a PNET. Demonstration of t(11;22)(q24;q12) by molecular analysis essentially confirms the diagnosis and enables the oncologist to choose appropriate therapy.

Authors
Mazur, MA; Gururangan, S; Bridge, JA; Cummings, TJ; Mukundan, S; Fuchs, H; Larrier, N; Halperin, EC
MLA Citation
Mazur, MA, Gururangan, S, Bridge, JA, Cummings, TJ, Mukundan, S, Fuchs, H, Larrier, N, and Halperin, EC. "Intracranial Ewing sarcoma." Pediatr Blood Cancer 45.6 (November 2005): 850-856.
PMID
15929128
Source
pubmed
Published In
Pediatric Blood & Cancer
Volume
45
Issue
6
Publish Date
2005
Start Page
850
End Page
856
DOI
10.1002/pbc.20430

Collagen-rich crystalloids in a scarred vascularized cornea.

Collagen-rich crystalloids, also referred to as collagenous crystalloids, are uncommon findings in benign salivary gland tumors with myoepithelial differentiation and in cutaneous neoplasms. Herein, we report the presence of collagen-rich crystalloids in the scarred, vascularized cornea of a 56-year-old woman. The patient underwent penetrating keratoplasty, and microscopic examination of hematoxylin-eosin-stained sections disclosed large aggregates of refractile material within the corneal stroma. The deposits were partially birefringent when viewed with polarized light and composed of radially arranged columns (long rectangles) with rounded to pointed tips. The deposits had tinctorial properties of collagen using Masson trichrome and the van Gieson method for collagen, and they stained with Alcian blue, pH 2.5, and Verhoeff elastic stain. They did not stain with Gomori methenamine silver, Snook reticulin stain, or tyrosine using the Baker modification of the Millon reaction. This is the first report, to our knowledge, of collagen-rich crystalloids in the cornea. Their presence in the cornea indicates that these structures may occur in the absence of neoplasia.

Authors
Afshari, NA; Wright, TM; Cummings, TJ; Proia, AD
MLA Citation
Afshari, NA, Wright, TM, Cummings, TJ, and Proia, AD. "Collagen-rich crystalloids in a scarred vascularized cornea." Arch Pathol Lab Med 129.9 (September 2005): 1179-1182.
PMID
16119996
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
129
Issue
9
Publish Date
2005
Start Page
1179
End Page
1182
DOI
10.1043/1543-2165(2005)129[1179:CCIASV]2.0.CO;2

Myxopapillary Ependymoma and Fatty Filum in an Adult with Tethered Cord Syndrome: A Shared Embryological Lesion? Case Report.

Authors
Adamson, DC; Cummings, TJ; Friedman, AH
MLA Citation
Adamson, DC, Cummings, TJ, and Friedman, AH. "Myxopapillary Ependymoma and Fatty Filum in an Adult with Tethered Cord Syndrome: A Shared Embryological Lesion? Case Report." Neurosurgery 57.2 (August 2005): E373-.
PMID
28184710
Source
epmc
Published In
Neurosurgery
Volume
57
Issue
2
Publish Date
2005
Start Page
E373
DOI
10.1227/01.neu.0000166690.35246.dd

Primary intraocular T-cell-rich large B-cell lymphoma.

We report a primary intraocular T-cell-rich large B-cell lymphoma in a 57-year-old woman who underwent 3 diagnostic vitrectomies for a presumed diagnosis of panuveitis. She developed no light perception in the left eye and underwent enucleation. Histopathologic and immunohistochemical studies on the enucleated globe disclosed a primary intraocular large B-cell lymphoma involving the choroid, vitreous, and retina. A large population of T cells was identified among the neoplastic B-cell population. B-cell immunoglobulin gene rearrangement and T-cell receptor gene rearrangement studies using the polymerase chain reaction method indicated that a monoclonal immunoglobulin kappa light chain population was present and that the T-cell population was not monoclonal. This case highlights the importance of interpreting cytologic features in vitreous aspirates in the context of the clinical situation.

Authors
Cummings, TJ; Stenzel, TT; Klintworth, G; Jaffe, GJ
MLA Citation
Cummings, TJ, Stenzel, TT, Klintworth, G, and Jaffe, GJ. "Primary intraocular T-cell-rich large B-cell lymphoma." Arch Pathol Lab Med 129.8 (August 2005): 1050-1053.
PMID
16048400
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
129
Issue
8
Publish Date
2005
Start Page
1050
End Page
1053
DOI
10.1043/1543-2165(2005)129[1050:PITLBL]2.0.CO;2

Myxopapillary ependymoma and fatty filum in an adult with tethered cord syndrome: a shared embryological lesion? Case report.

OBJECTIVE AND IMPORTANCE: Myxopapillary ependymoma and fatty fila are traditionally thought to arise via completely different pathophysiologies. Recognition of these distinct pathologies in the same patient is important for appropriate treatment and prognosis. CLINICAL PRESENTATION: A 28-year-old woman presented with low back pain, bilateral leg radiculopathies, and mild leg weakness suggestive of tethered cord syndrome. Magnetic resonance imaging revealed lesions in the area of the conus medullaris consistent with a myxopapillary ependymoma and fatty filum. INTERVENTION: Under the surveillance of intraoperative electromyographic monitoring, the patient underwent an L4-S2 laminectomy for transection of the fatty filum and gross total resection of the mass. Histopathological examination confirmed the presence of these two distinct pathologies. CONCLUSION: We report an unusual case of a myxopapillary ependymoma coexisting with a fatty filum in an adult patient. To the best of our knowledge, this association has not yet been reported. This raises the interesting question of a possible associative or causative relationship between these distinct pathologies, which have traditionally been thought to arise from different mechanisms.

Authors
Adamson, DC; Cummings, TJ; Friedman, AH
MLA Citation
Adamson, DC, Cummings, TJ, and Friedman, AH. "Myxopapillary ependymoma and fatty filum in an adult with tethered cord syndrome: a shared embryological lesion? Case report." Neurosurgery 57.2 (August 2005): E373-.
PMID
16094143
Source
pubmed
Published In
Neurosurgery
Volume
57
Issue
2
Publish Date
2005
Start Page
E373

Long-term behavioral assessment of guinea pigs following neonatal pneumoperitoneum.

BACKGROUND: Using guinea pigs, we previously demonstrated that pneumoperitoneum during pregnancy produces behavioral deficits in the offspring. In the current study, the purpose was to determine if CO(2) pneumoperitoneum during the early postnatal period also produced behavioral anomalies. METHODS: Following delivery, guinea pig pups were randomly assigned to one of three treatment groups: CO(2) pneumoperitoneum (P), laparotomy (L), or isolation control (I). Surgeries were performed on postnatal day (PND) 5 under isoflurane anesthesia; control pups were isolated from the dams for an equivalent period of time. On PNDs 10, 20, 40, and 60, behavior was assessed by monitoring locomotor and exploratory activity. RESULTS: A total of 29 animals were studied. We observed no immediate morbidity or mortality and the manipulations did not appear to affect postnatal growth. On PND 10, pups in group P exhibited lower levels of locomotor activity compared to L and I neonates, but this difference resolved as the animals got older. Histologic assessment of the adult offspring brains revealed no evidence of neurologic injury. CONCLUSION: These data suggest that unlike insufflation during pregnancy, neonatal pneumoperitoneum does not produce behavioral deficits.

Authors
Fuh, E; de la Fuente, S; Shah, MK; Okodiko, DK; Cummings, TJ; Eubanks, WS; Reynolds, JD
MLA Citation
Fuh, E, de la Fuente, S, Shah, MK, Okodiko, DK, Cummings, TJ, Eubanks, WS, and Reynolds, JD. "Long-term behavioral assessment of guinea pigs following neonatal pneumoperitoneum." Surg Endosc 19.5 (May 2005): 715-719.
PMID
15759194
Source
pubmed
Published In
Surgical Endoscopy
Volume
19
Issue
5
Publish Date
2005
Start Page
715
End Page
719
DOI
10.1007/s00464-004-8181-x

Clear cell hidradenoma: a mimic of metastatic clear cell tumors.

Clear cell hidradenoma is a benign skin appendage tumor that may mimic conventional-type renal cell carcinoma. Histologically, clear cell hidradenoma contains small ductular lumens, focal apocrine and squamoid change, and a less prominent vascular pattern than renal cell carcinoma. Furthermore, immunohistochemical studies can aid in distinguishing the 2 tumors. Knowing the cytologic features of primary skin adnexal neoplasms helps distinguish them from cutaneous metastases, which are more commonly referred for fine-needle aspiration biopsy evaluation. Detailed clinical history, physical findings, and ancillary studies are essential for correct diagnosis and categorization of these tumors. We report the rare case of a patient with renal cell carcinoma who underwent excision of an axillary clear cell hidradenoma, which was clinically suggestive of cutaneous metastatic disease.

Authors
Volmar, KE; Cummings, TJ; Wang, WH; Creager, AJ; Tyler, DS; Xie, HB
MLA Citation
Volmar, KE, Cummings, TJ, Wang, WH, Creager, AJ, Tyler, DS, and Xie, HB. "Clear cell hidradenoma: a mimic of metastatic clear cell tumors." Arch Pathol Lab Med 129.5 (May 2005): e113-e116.
PMID
15859654
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
129
Issue
5
Publish Date
2005
Start Page
e113
End Page
e116
DOI
10.1043/1543-2165(2005)1292.0.CO;2

Loss of chromosome 13 in a case of soft tissue perineurioma.

Soft tissue perineuriomas are rare mesenchymal tumors that are derived from perineurial cells of the peripheral nerve sheath. Although the histological and immunohistochemical features of soft tissue perineuriomas are well described, little is known regarding the cytogenetic abnormalities in these tumors. Herein, we describe a case of a large (12.2 cm) soft tissue perineurioma that arose in the thigh of a 26-year-old Caucasian female. Histologically, the tumor was composed of a diffuse to fascicular arrangement of spindle cells with bland, elongated nuclei with long, thin, tapering cytoplasmic processes. The immunohistochemical profile was consistent with a perineurial cell origin with expression of epithelial membrane antigen, vimentin, and collagen type IV. Cytogenetic evaluation revealed loss of chromosome 13 as the sole abnormality in the majority of examined cells. In contrast to previous reports, we were unable to demonstrate deletion or structural abnormalities of chromosome 22 by either fluorescence in situ hybridization (FISH) or metaphase cytogenetics. This is the first report of loss of chromosome 13 in soft tissue perineurioma. Although never described in this group of neoplasms, loss of chromosome 13 has been identified in a large number of other soft tissue tumors, particularly sarcomas and malignant peripheral nerve sheath tumors. Herein, we discuss this case and provide a review of the literature.

Authors
Mott, RT; Goodman, BK; Burchette, JL; Cummings, TJ
MLA Citation
Mott, RT, Goodman, BK, Burchette, JL, and Cummings, TJ. "Loss of chromosome 13 in a case of soft tissue perineurioma." Clin Neuropathol 24.2 (March 2005): 69-76. (Review)
PMID
15803806
Source
pubmed
Published In
Clinical neuropathology
Volume
24
Issue
2
Publish Date
2005
Start Page
69
End Page
76

PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model.

BACKGROUND AND PURPOSE: Laparoscopic bipolar instruments are commonly employed to cauterize and divide tissue. A next-generation bipolar device has been developed that employs vapor pulse coagulation energy. We assessed the vessel-sealing capability of this device and quantified thermal spread during application. MATERIALS AND METHODS: Bilateral laparoscopic nephrectomy was performed on six common swine >25 kg. Five-millimeter clips and surgical staplers (US Surgical, Norwalk, CT) were utilized to perform nephrectomy on one side, while the Gyrus PlasmaKinetic bipolar device (Minneapolis, MN) was employed for the contralateral nephrectomy. Vessel-sealing capabilities were assessed via burst-pressure studies. The extent of thermal spread was measured after tissue fixation and hematoxylin and eosin staining. RESULTS: Surgical clips/vascular staplers adequately controlled/sealed renal hilar vessels with burst pressures nearing 300 mm Hg. The Gyrus bipolar device reliably sealed and divided renal arteries

Authors
Pietrow, PK; Weizer, AZ; L'Esperance, JO; Auge, BK; Silverstein, A; Cummings, T; Preminger, GM; Albala, DM
MLA Citation
Pietrow, PK, Weizer, AZ, L'Esperance, JO, Auge, BK, Silverstein, A, Cummings, T, Preminger, GM, and Albala, DM. "PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model." J Endourol 19.1 (January 2005): 107-110.
PMID
15735394
Source
pubmed
Published In
Journal of Endourology
Volume
19
Issue
1
Publish Date
2005
Start Page
107
End Page
110
DOI
10.1089/end.2005.19.107

Xanthogranuloma of the sciatic nerve: case report.

OBJECTIVE AND IMPORTANCE: Xanthogranulomas involving the central or peripheral nervous system are extraordinarily rare. None have been reported in the lower extremity. Here, we report and characterize the first case of xanthogranuloma of the sciatic nerve. CLINICAL PRESENTATION: A 58-year-old woman presented with poorly localized right back and groin pain. Magnetic resonance imaging studies revealed an enhancing lesion of the sciatic nerve in the right gluteal region. INTERVENTION: The sciatic nerve xanthogranuloma was resected without complication. CONCLUSION: Our report indicates that xanthogranuloma, although extremely rare, may occur throughout the nervous system. Our evaluation demonstrates that such lesions involving the peripheral nervous system have similar pathological characteristics to xanthogranulomas that more commonly occur in the skin.

Authors
Patil, PG; Cummings, TJ; Nunley, JA; Friedman, AH
MLA Citation
Patil, PG, Cummings, TJ, Nunley, JA, and Friedman, AH. "Xanthogranuloma of the sciatic nerve: case report." Neurosurgery 55.6 (December 2004): 1435-.
PMID
15574230
Source
pubmed
Published In
Neurosurgery
Volume
55
Issue
6
Publish Date
2004
Start Page
1435

Meningioma with eosinophilic granular inclusions.

Rare meningiomas have been described that contain eosinophilic inclusions that have a granular or granulofilamentous ultrastructure. We describe a 66-year-old woman who developed a planum sphenoidale meningioma. Histologically, the tumor was composed of meningothelial cells arranged in fascicles and whorls, typical of a well-differentiated meningioma. Many tumor cells contained round intracytoplasmic eosinophilic inclusions that were periodic acid Schiff-negative and red on Masson trichrome. The inclusions were immunopositive for vimentin, and were immunonegative for epithelial membrane antigen, smooth muscle actin, desmin and type IV collagen. Ultrastructural examination showed the inclusions were composed of round to oval, well-demarcated, non-membrane-bound, osmiophilic granular material. The inclusions within this tumor had histochemical, immunohistochemical and ultrastructural properties not described in other reported meningiomas with eosinophilic granular or granulofilamentous inclusions.

Authors
Alexander, RT; McLendon, RE; Cummings, TJ
MLA Citation
Alexander, RT, McLendon, RE, and Cummings, TJ. "Meningioma with eosinophilic granular inclusions." Clin Neuropathol 23.6 (November 2004): 292-297.
PMID
15584214
Source
pubmed
Published In
Clinical neuropathology
Volume
23
Issue
6
Publish Date
2004
Start Page
292
End Page
297

Extraosseous Ewings sarcoma (EES) of the central nervous system (CNS) - Case reports and molecular diagnosis

Authors
Gururangan, S; Bridge, JA; Cummings, TJ; Halperin, EC; Friedman, HS
MLA Citation
Gururangan, S, Bridge, JA, Cummings, TJ, Halperin, EC, and Friedman, HS. "Extraosseous Ewings sarcoma (EES) of the central nervous system (CNS) - Case reports and molecular diagnosis." October 2004.
Source
wos-lite
Published In
Neuro-Oncology
Volume
6
Issue
4
Publish Date
2004
Start Page
457
End Page
457

Extraskeletal myxoid chondrosarcoma of the jugular foramen.

OBJECTIVE: To report a case of an extraskeletal myxoid chondrosarcoma (EMC) arising from the jugular foramen. EMCs are tumors usually seen in the deep soft tissues of the extremities and are rarely seen within the intracranial cavity. The histological differential diagnosis includes chordoma, conventional chondrosarcoma and chordoid meningioma, among others. A distinguishing feature of EMC is their characteristic reciprocal translocation t(9;22)(q22;q12). MATERIAL: A 63-year-old man presented with progressive hearing loss and gait imbalance. Magnetic resonance imaging showed a heterogeneously enhancing 2.4 cm mass in the cerebellopontine angle. A right far lateral transcondylar skull base approach with gross total removal of the tumor was performed. Intraoperative findings showed that the mass appeared to arise from the glossopharyngeal nerve within the jugular foramen. METHOD: Histology, immunohistochemistry, and fluorescence in situ hybridization studies were performed. RESULTS: Histological and immunohistochemical studies were compatible with the diagnosis of EMC. Fluorescence in situ hybridization studies showed disruption of the EWS gene locus at 22q12 and added further support to the diagnosis. CONCLUSIONS: We report a rare case of EMC arising from the jugular foramen, and the diagnosis of EMC can be supported by confirmation of disruption of the EWS gene locus.

Authors
Cummings, TJ; Bridge, JA; Fukushima, T
MLA Citation
Cummings, TJ, Bridge, JA, and Fukushima, T. "Extraskeletal myxoid chondrosarcoma of the jugular foramen." Clin Neuropathol 23.5 (September 2004): 232-237.
PMID
15581026
Source
pubmed
Published In
Clinical neuropathology
Volume
23
Issue
5
Publish Date
2004
Start Page
232
End Page
237

Malignant peripheral nerve sheath tumor of the spine after radiation therapy for Hodgkin's lymphoma.

We report the development of a malignant peripheral nerve sheath tumor (MPNST) in 2 patients after irradiation for Hodgkin's lymphoma. Clinicians should be aware of this uncommon, but important fatal complication of radiation therapy. The first case is a 37-year-old man who was diagnosed with nodular sclerosing (NS) Hodgkin's lymphoma and underwent successful mantle radiation. He presented to our neurosurgery service with a left C6 radiculopathy 6 years later. The second case is a 30-year-old female diagnosed with NS Hodgkin's lymphoma. She did well with extensive radiotherapy until 5 years later when she developed severe right arm and chest pain secondary to recurrent lymphoma. After aggressive radio- and chemotherapy, she presented to the neurosurgery service with a right Horner's syndrome, right C6 radiculopathy, and weakness of her right triceps and wrist extensors. Both patients obtained magnetic resonance imaging revealing intradural extramedullary cervical nerve root associated mass lesions. Two years after radiation therapy for his Hodgkin's lymphoma, the first patient underwent a C6 laminectomy at an outside institution for resection of a benign neurofibroma. Four years later, he underwent a posterior C5-7 laminectomy with lateral mass plate fusion and partial excision of a recurrent mass diagnosed as a MPNST. The second patient underwent a C5-6 hemilaminectomy and partial resection of a tumor also pathologically consistent with MPNST. We present 2 case reports of patients who developed neurofibrosarcomatous tumors with malignant transformation after undergoing radiation therapy for Hodgkin's lymphoma. Despite prompt surgical resection, these tumors exhibited aggressive behavior. Numerous cases of soft tissue tumors have been described to arise in areas of prior radiation therapy; however, there have been rare reports of de novo MPNST after radiation therapy, especially in the setting of Hodgkin's lymphoma. Postirradiation MPNST should be considered in the differential diagnosis of a painful, enlarging mass in a previously irradiated area.

Authors
Adamson, DC; Cummings, TJ; Friedman, AH
MLA Citation
Adamson, DC, Cummings, TJ, and Friedman, AH. "Malignant peripheral nerve sheath tumor of the spine after radiation therapy for Hodgkin's lymphoma." Clin Neuropathol 23.5 (September 2004): 245-255.
PMID
15581029
Source
pubmed
Published In
Clinical neuropathology
Volume
23
Issue
5
Publish Date
2004
Start Page
245
End Page
255

Radial optic neurotomy in the porcine eye without retinal vein occlusion.

OBJECTIVE: To demonstrate the histopathologic changes in the porcine eye without retinal vein occlusion after radial optic neurotomy (RON). METHODS: A RON was performed in 14 normal eyes of 12 Yorkshire Cross pigs. One radial stab incision at the edge of the nasal optic nerve head was made using a 20-gauge microvitreoretinal blade (Visitec) while the intraocular pressure was elevated. Surgery was concluded when hemostasis was achieved. Weekly ophthalmoscopic examinations were performed. Group 1 eyes (4 eyes of 2 pigs) were enucleated at the end of surgery. Group 2 eyes (4 eyes of 4 pigs) were enucleated 1 week postoperatively, and group 3 eyes (4 eyes of 4 pigs) were enucleated 3 weeks postoperatively. In group 4 (2 eyes of 2 pigs), animals underwent vitrectomy and RON, and eyes were enucleated 3 weeks postoperatively. RESULTS: Ophthalmoscopic examination demonstrated engorged blood vessels at the RON site up to 3 weeks after surgery with minimal or no hemorrhage. Histological examination of the optic nerve demonstrated foci of hemorrhage, interstitial edema, reactive gliosis, and rare inflammatory cells. At 3 weeks, there was complete axonal nerve fiber loss distal to the neurotomy site. CONCLUSIONS: After RON, marked gliosis and complete axonal nerve fiber loss occur at the neurotomy site. Although bleeding was rare intraoperatively in this porcine model, hemorrhage and interstitial edema were present within the optic nerve at the neurotomy site histologically. Clinical Relevance Radial optic neurotomy remains a controversial method of treatment for central retinal vein occlusion. To our knowledge, this is the first study in the literature describing the histopathologic findings after RON.

Authors
Czajka, MP; Cummings, TJ; McCuen, BW; Toth, CA; Nguyen, H; Fekrat, S
MLA Citation
Czajka, MP, Cummings, TJ, McCuen, BW, Toth, CA, Nguyen, H, and Fekrat, S. "Radial optic neurotomy in the porcine eye without retinal vein occlusion." Arch Ophthalmol 122.8 (August 2004): 1185-1189.
PMID
15302660
Source
pubmed
Published In
Archives of Ophthalmology
Volume
122
Issue
8
Publish Date
2004
Start Page
1185
End Page
1189
DOI
10.1001/archopht.122.8.1185

Optic nerve compression in infantile malignant autosomal recessive osteopetrosis.

A 6-month-old infant was diagnosed with infantile malignant autosomal recessive osteopetrosis. An ophthalmologic examination revealed optic nerve pallor and computed tomography of the brain showed narrowing of the orbital fissure. Unrelated umbilical cord blood transplantation was performed. Four months later, the infant died of respiratory complications.

Authors
Cummings, TJ; Proia, AD
MLA Citation
Cummings, TJ, and Proia, AD. "Optic nerve compression in infantile malignant autosomal recessive osteopetrosis." J Pediatr Ophthalmol Strabismus 41.4 (July 2004): 241-244.
PMID
15305537
Source
pubmed
Published In
Journal of pediatric ophthalmology and strabismus
Volume
41
Issue
4
Publish Date
2004
Start Page
241
End Page
244

Effects of indocyanine green on the retina and retinal pigment epithelium in a porcine model of retinal hole.

PURPOSE: This study was designed to emulate human macular hole surgery and to test the effects of indocyanine green (ICG) on the retina and retinal pigment epithelium (RPE). METHODS: Yorkshire Cross pigs (n = 23) underwent vitrectomy, separation of the posterior cortical vitreous, and creation of a single retinal hole. In three study groups (n = 6, each group), air-fluid exchange was performed, following which balanced salt solution (BSS), 1.0% ICG, or 0.5% ICG was applied over the retinal hole. In one additional group (n = 5), 0.5% ICG was injected into the fluid-filled eye. At 4 weeks, the eyes were examined clinically, and fundus photographs were obtained before enucleation and light microscopic examination. RESULTS: Clinical evaluations documented a statistically significant difference between study groups (P = 0.036). There was a higher rate of moderate or severe RPE atrophy among animals where 1% or 0.5% ICG was applied in air-filled eyes (83% and 67%, respectively) compared with BSS controls (17%) and fluid-filled eyes receiving 0.5% ICG (40%). Histologic evaluation demonstrated a statistically significant difference between groups (P = 0.044), with extensive outer retinal degeneration observed in air-filled eyes receiving 1% or 0.5% ICG (66% and 60%, respectively) compared with BSS controls or fluid-filled eyes receiving 0.5% ICG (none of the eyes in either group). None of the study groups had any changes in the inner retina except at the retinal hole site. CONCLUSIONS: Retina exposed to ICG concentrations used in human vitreoretinal surgery had greater RPE atrophy and outer retinal degeneration than control eyes undergoing the same surgery without ICG. Eyes filled with infusion fluid during ICG injection had less damage to the RPE and outer retina than did air-filled eyes receiving ICG.

Authors
Czajka, MP; McCuen, BW; Cummings, TJ; Nguyen, H; Stinnett, S; Wong, F
MLA Citation
Czajka, MP, McCuen, BW, Cummings, TJ, Nguyen, H, Stinnett, S, and Wong, F. "Effects of indocyanine green on the retina and retinal pigment epithelium in a porcine model of retinal hole." Retina 24.2 (April 2004): 275-282.
PMID
15097890
Source
pubmed
Published In
Retina
Volume
24
Issue
2
Publish Date
2004
Start Page
275
End Page
282

A lethal association of congenital apnea with brainstem tegmental necrosis.

We present a female with premature birth, polyhydramnios, congenital apnea, cranial nerve palsies, orofacial and limb anomalies. Neuroimaging revealed calcifications along the vental margin of the caudal fourth ventricle. Neuropathologic findings at postmortem examination were consistent with brainstem tegmental necrosis and olivary hypoplasia, a rare lethal entity that should be considered in the differential diagnosis of congenital apnea.

Authors
Moya, MP; Delong, GR; Barboriak, D; Cummings, TJ
MLA Citation
Moya, MP, Delong, GR, Barboriak, D, and Cummings, TJ. "A lethal association of congenital apnea with brainstem tegmental necrosis." Pediatr Neurol 30.3 (March 2004): 219-221.
PMID
15033208
Source
pubmed
Published In
Pediatric Neurology
Volume
30
Issue
3
Publish Date
2004
Start Page
219
End Page
221
DOI
10.1016/j.pediatrneurol.2003.07.007

The pathology of extracranial scalp and skull masses in young children.

OBJECTIVE: Extracranial subcutaneous masses involving the scalp and/or skull in young children are uncommon lesions that get excised by the neurosurgeon. Although the most common reported lesion is the dermoid cyst, our experience suggests that the spectrum of pathology in these lesions can present diagnostic challenges to the pathologist. MATERIAL: We reviewed 30 consecutive extracranial masses from 29 patients between July 1998 and June 2003. METHOD: Hematoxylin and eosin-stained sections were reviewed in all cases, and immunohistochemistry was performed in select cases. RESULTS: Twenty-three were within the scalp, 5 involved the scalp and skull and 2 were within the limits of the inner and outer tables of the skull. There were 8 dermoid cysts, 2 epidermoid cysts, 6 post-traumatic lesions including 3 calcified cephalhematomas and 3 pseudocysts, 5 vascular lesions including 3 capillary hemangiomas, 1 venous angioma and 1 lymphangioma, 2 cases of cranial fasciitis and 1 case each of benign teratoma, deep granuloma annulare, benign fibrous histiocytoma, congenital melanocytic nevus, hamartoma with ectopic meningothelial elements, cutaneous hyalinised ectopic meningioma and a meningocele with a fibrohistiocytic reaction. No lesions have recurred or exhibited malignant features. CONCLUSIONS: Surgical pathologists and neuropathologists should be aware that the differential diagnosis of "lumps and bumps on babie's heads" is quite varied and can be histologically challenging.

Authors
Cummings, TJ; George, TM; Fuchs, HE; McLendon, RE
MLA Citation
Cummings, TJ, George, TM, Fuchs, HE, and McLendon, RE. "The pathology of extracranial scalp and skull masses in young children." Clin Neuropathol 23.1 (January 2004): 34-43.
PMID
14986932
Source
pubmed
Published In
Clinical neuropathology
Volume
23
Issue
1
Publish Date
2004
Start Page
34
End Page
43

Epithelioid hemangioma of the orbit

A 69-year-old African-American woman presented to the Duke University Eye Center with chief complaints of progressive swelling, occasional sharp pains, and a tender knot in the superomedial aspect of her right orbit for nine months. She denied fever and any recent history of illness or infection. External examination showed a slightly tender and palpable non-mobile mass in the right superior medial orbit and a 30-diopter right exotropia.

Authors
Cummings, TJ; Proia, AD; Woodward, J
MLA Citation
Cummings, TJ, Proia, AD, and Woodward, J. "Epithelioid hemangioma of the orbit." Clinical and Surgical Ophthalmology 22.8 (2004): 224-226.
Source
scival
Published In
Clinical and Surgical Ophthalmology
Volume
22
Issue
8
Publish Date
2004
Start Page
224
End Page
226

Optic nerve astrocytoma associated with angiogenesis and neovascular glaucoma

A 10-year-old boy with a history of neurofibromatosis type 1 presented with visual loss and proptosis in his left eye. Neuroimaging revealed a fusiform, enhancing mass of the left optic nerve extending through the optic canal and involving the intracranial portion of the nerve. Five months later, he experienced acute onset of severe pain and a dilated left pupil. Examination disclosed an increase in proptosis from 4 to 9 mm, neovascular glaucoma, and a central retinal vein occlusion. Repeat imaging showed a marked increase in the size of the mass. The left eye and the intraorbital portion of the optic nerve tumor were resected en bloc. Histologic examination showed a pilocytic astrocytoma of the optic nerve with a prominent angiogenic response, iris neovascularization, and angle closure. This case illustrates the rare occurrence of prominent angiogenic response and neovascular glaucoma complicating a pilocytic astrocytoma of the optic nerve.

Authors
Cummings, TJ; Chu, CT; Pollock, SC; Klintworth, GK
MLA Citation
Cummings, TJ, Chu, CT, Pollock, SC, and Klintworth, GK. "Optic nerve astrocytoma associated with angiogenesis and neovascular glaucoma." Clinical and Refractive Optometry 15.7-8 (2004): 208-215.
Source
scival
Published In
Clinical and Refractive Optometry
Volume
15
Issue
7-8
Publish Date
2004
Start Page
208
End Page
215

The immunohistochemical profile of the tethered filum terminale.

The embryopathy underlying tethering of the filum terminale is poorly understood. Knowledge of normal filum development is the foundation upon which to compare normal fila to fila from patients with tethered cord syndrome. Thirty-four fila from patients with tethered cord syndrome were immunostained with caudal neural tube developmental markers H4C4 (CD44), VIN-IS-53, AC4, FP3 and NOT1, and a panel of mature neuroglial, neural crest, epithelial and mesenchymal markers. H4C4 (CD44) and NOT1 exhibited significant alterations in immunoexpression in tethered fila compared to controls. The change in expression may be indicative of altered cell identity in the filum and constitute the predisposition to tethering.

Authors
George, TM; Bulsara, KR; Cummings, TJ
MLA Citation
George, TM, Bulsara, KR, and Cummings, TJ. "The immunohistochemical profile of the tethered filum terminale." Pediatr Neurosurg 39.5 (November 2003): 227-233.
PMID
14512685
Source
pubmed
Published In
Pediatric neurosurgery
Volume
39
Issue
5
Publish Date
2003
Start Page
227
End Page
233

The immunohistochemical profile of the myelomeningocele placode: is the placode normal?

One key to predicting optimal outcome of novel treatments, such as fetal surgery, for myelomeningocele is understanding the structure of the placode. We hypothesize that if the placode retains normal patterning and is simply unneurulated, then repair may be effective in preventing secondary injury. Serial sections of human myelomeningocele placodes were characterized using novel immunohistochemical caudal spinal cord markers (H4C4, AC4, NOT, VIN-IS-53, and FP3) and established structural markers (e.g. neurofilament, glial fibrillary acidic protein, or synaptophysin). The myelomeningocele placodes studied exhibited abnormal patterning along the dorsoventral and rostrocaudal axes indicative of a change in pattern determination and a paucity of maturing neurons. In addition, there was significant inflammatory infiltrate, gliosis and fibrosis consistent with secondary injury. Additionally, injury to the placode was also demonstrated. The combination of effects may be contributory to abnormal spinal cord function in myelomeningocele patients.

Authors
George, TM; Cummings, TJ
MLA Citation
George, TM, and Cummings, TJ. "The immunohistochemical profile of the myelomeningocele placode: is the placode normal?." Pediatr Neurosurg 39.5 (November 2003): 234-239.
PMID
14512686
Source
pubmed
Published In
Pediatric neurosurgery
Volume
39
Issue
5
Publish Date
2003
Start Page
234
End Page
239

Pathologic quiz case: acute-onset paraplegia in a 60-year-old woman. Spinal cord infarction secondary to fibrocartilaginous (intervertebral disk) embolism.

Authors
Alexander, RT; Cummings, TJ
MLA Citation
Alexander, RT, and Cummings, TJ. "Pathologic quiz case: acute-onset paraplegia in a 60-year-old woman. Spinal cord infarction secondary to fibrocartilaginous (intervertebral disk) embolism." Arch Pathol Lab Med 127.8 (August 2003): 1047-1048.
PMID
12873186
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
127
Issue
8
Publish Date
2003
Start Page
1047
End Page
1048
DOI
10.1043/1543-2165(2003)127<1047:PQCAPI>2.0.CO;2

Pathologic quiz case: a 54-year-old man with multiple pulmonary nodules.

Authors
Volmar, KE; Sporn, TA; Cummings, TJ
MLA Citation
Volmar, KE, Sporn, TA, and Cummings, TJ. "Pathologic quiz case: a 54-year-old man with multiple pulmonary nodules." Arch Pathol Lab Med 127.7 (July 2003): e319-e320.
PMID
12823071
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
127
Issue
7
Publish Date
2003
Start Page
e319
End Page
e320
DOI
10.1043/1543-2165(2003)1272.0.CO;2

Bone-related genes expressed in advanced malignancies induce invasion and metastasis in a genetically defined human cancer model.

We employed a genetically defined human cancer model to investigate the contributions of two genes up-regulated in several cancers to phenotypic changes associated with late stages of tumorigenesis. Specifically, tumor cells expressing two structurally unrelated bone-related genes, osteonectin and osteoactivin, acquired a highly invasive phenotype when implanted intracranially in immunocompromised mice. Mimicking a subset of gliomas, tumor cells invaded brain along blood vessels and developed altered vasculature at the brain-tumor interface, suggesting that production of those two proteins by tumor cells may create a complex relationship between invading tumor and vasculature co-opted during tumor invasion. Interestingly, the same tumor cells formed massive spontaneous metastases when implanted subcutaneously. This dramatic alteration in tumor phenotype indicates that cellular microenvironment plays an important role in defining the specific effects of those gene products in tumor behavior. In vitro examination of tumor cells expressing either osteonectin or osteoactivin revealed that there was no impact on cellular growth or death but increased invasiveness and expression of MMP-9 and MMP-3. Specific pharmacologic inhibitors of MMP-2/9 and MMP-3 blocked the increased in vitro invasion associated with osteoactivin expression, but only MMP-3 inhibition altered the invasive in vitro phenotype mediated by osteonectin. Results from this genetically defined model system are supported by similar findings obtained from several established tumor cell lines derived originally from human patients. In sum, these results reveal that the expression of a single bone-related gene can dramatically alter or modify tumor cell behavior and may confer differential growth characteristics in different microenvironments. Genetically defined human cancer models offer useful tools in functional genomics to define the roles of specific genes in late stages of carcinogenesis.

Authors
Rich, JN; Shi, Q; Hjelmeland, M; Cummings, TJ; Kuan, C-T; Bigner, DD; Counter, CM; Wang, X-F
MLA Citation
Rich, JN, Shi, Q, Hjelmeland, M, Cummings, TJ, Kuan, C-T, Bigner, DD, Counter, CM, and Wang, X-F. "Bone-related genes expressed in advanced malignancies induce invasion and metastasis in a genetically defined human cancer model." J Biol Chem 278.18 (May 2, 2003): 15951-15957.
PMID
12590137
Source
pubmed
Published In
The Journal of biological chemistry
Volume
278
Issue
18
Publish Date
2003
Start Page
15951
End Page
15957
DOI
10.1074/jbc.M211498200

Prognostic value of magnetic resonance imaging-guided stereotactic biopsy in the evaluation of recurrent malignant astrocytoma compared with a lesion due to radiation effect.

OBJECT: The prognostic value of differentiating between recurrent malignant glioma and a lesion due to radiation effect by performing stereotactic biopsy has not been assessed. Thus, this study was undertaken to determine such value. METHODS: Between 1995 and 2001, 114 patients underwent magnetic resonance (MR) imaging-guided stereotactic biopsy to differentiate lesions caused by a recurrence of malignant astrocytoma and by radiation effect. All patients had previously undergone tumor resection (World Health Organization Grade III or IV) followed by radiotherapy. Disease diagnosis based on biopsy and patient characteristics were assessed as predictors of survival according to results of a multivariate Cox regression analysis. The diagnosis determined with the aid of biopsy was compared with that established during a subsequent resection in 26 patients. Survival following stereotactic biopsy was markedly increased in patients suffering from radiation effect compared with those harboring recurrent malignant glioma (p < 0.0001). In patients with radiation effect on biopsy, an increasing patient age (p < 0.05), having had two compared with one prior resection (p < 0.05), and a decreasing time from radiotherapy to biopsy (p < 0.001) were factors associated with decreased survival. Nevertheless, in patients with biopsy-defined radiation effect at second progression or with an age younger than 50 years the survival rate remained higher than that in patients with recurrent tumor on biopsy (p < 0.01). A biopsy-based diagnosis of radiation effect obtained less than 5 months after radiotherapy was not associated with an increased rate of patient survival compared with a diagnosis of recurrent malignant glioma on biopsy (p = 0.286). Eighty-six percent of lesions initially determined to be due to radiation effect on biopsy fewer than 5 months after radiotherapy were characterized as recurrent glioma by a mean of 11 months later. In contrast, only 25% of lesions initially diagnosed as attributable to radiation effect on biopsy more than 5 months after radiotherapy were classified as recurrent glioma a mean of 12 months later (p < 0.05). CONCLUSIONS: With the aid of stereotactic biopsy the authors demonstrated prognostic significance in differentiating recurrent malignant astrocytoma from a lesion due to radiation effect in patients presenting more than 5 months after having undergone radiotherapy. In patients who presented earlier than 5 months after radiotherapy, radiation effect on biopsy was not associated with an improved rate of survival compared with that in patients harboring recurrent malignant astrocytoma.

Authors
McGirt, MJ; Bulsara, KR; Cummings, TJ; New, KC; Little, KM; Friedman, HS; Friedman, AH
MLA Citation
McGirt, MJ, Bulsara, KR, Cummings, TJ, New, KC, Little, KM, Friedman, HS, and Friedman, AH. "Prognostic value of magnetic resonance imaging-guided stereotactic biopsy in the evaluation of recurrent malignant astrocytoma compared with a lesion due to radiation effect." J Neurosurg 98.1 (January 2003): 14-20.
PMID
12546347
Source
pubmed
Published In
Journal of neurosurgery
Volume
98
Issue
1
Publish Date
2003
Start Page
14
End Page
20
DOI
10.3171/jns.2003.98.1.0014

Pathologic quiz case: Acute-onset paraplegia in a 60-year-old woman

Authors
Alexander, RT; Cummings, TJ
MLA Citation
Alexander, RT, and Cummings, TJ. "Pathologic quiz case: Acute-onset paraplegia in a 60-year-old woman." Archives of Pathology and Laboratory Medicine 127.8 (2003): 1047-1048.
Source
scival
Published In
Archives of Pathology and Laboratory Medicine
Volume
127
Issue
8
Publish Date
2003
Start Page
1047
End Page
1048

Optic nerve astrocytoma associated with aegiogenesis and neovascular glaucoma

A 10-year-old boy with a history of neurofitoromatosis type 1 presented with visual loss and proptosis in his left eye. Neuroimaging revealed a fusiform, enhancing mass of the left optic nerve extending through the optic canal and involving the intracranial portion of the nerve. Five months later, he experienced acute onset of severe pain and a dilated left pupil. Examination disclosed an increase in proptosis from 4 to 9 mm, neovascular glaucoma, and a central retinal vein occlusion. Repeat imaging showed a marked increase in the size of the mass. The left eye and the intraorbital portion of the optic nerve tumor were resected en bloc. Histologic examination showed a pilocytic astrocytoma of the optic nerve with a prominent angiogenic response, iris neovascularization, and angle closure. This case illustrates the rare occurrence of prominent angiogenic response and neovascular glaucoma complicating a pilocytic astrocytoma of the optic nerve.

Authors
Cummings, TJ; Chu, CT; Pollock, SC; Klintworth, GK
MLA Citation
Cummings, TJ, Chu, CT, Pollock, SC, and Klintworth, GK. "Optic nerve astrocytoma associated with aegiogenesis and neovascular glaucoma." Clinical and Surgical Ophthalmology 21.3 (2003): 104-107.
Source
scival
Published In
Clinical and Surgical Ophthalmology
Volume
21
Issue
3
Publish Date
2003
Start Page
104
End Page
107

The immunohistochemical profile of the normal conus medullaris and filum terminale

Background: The embryopathy underlying tethering of the filum terminale is poorly understood. Few studies have detailed the normal immunohistochemical profile of the distal spinal cord. Knowledge of normal filum development is the foundation upon which to compare tissues obtained from diseased fila in patients with tethered cord syndrome. Aims: Ten distal spinal cords containing morphologically normal conus medullaris and filum terminale were obtained at autopsy from patients with no clinical evidence of tethered cord syndrome. All were immunostained with caudal neural tube developmental markers H4C4, VIN-IS-53, AC4, FP3 and NOT1, and a panel of mature neuroglial, neural crest, epithelial and mesenchymal markers. Results: H4C4 marked ventral white matter and periventricular gray matter in the conus and showed rare reactivity in neuroglial tissue of the filum. VIN-IS-53 marked ependyma, cell bodies and dorsal white matter in the conus and strongly marked neuroglial tissue in the filum. AC4 marked neuronal cell bodies and white matter in the dorsal conus and strongly marked neuroglial tissue in the filum. FP3 and NOT1 marked neuronal cell bodies of the conus and were typically negative in the filum except for rare neuronal cell bodies. NOT1 also marked ependyma in the conus and filum. Glial fibrillary acidic protein, synaptophysin, neurofilament protein and epithelial membrane antigen showed expected reactivity in neuroglial elements of the filum and conus. No staining was seen in neuroglial tissue for CAM5.2, smooth muscle actin, myoglobin, desmin, HMB45 or HAM56. Conclusions: The immunoprofile of the normal conus medullaris and filum terminale was defined with a panel of developmental caudal neural tube markers and a panel of mature markers specific for neuroglial, epithelial and mesenchymal tissues. Copyright © 2003 S. Karger AG, Basel.

Authors
Cummings, TJ; George, TM
MLA Citation
Cummings, TJ, and George, TM. "The immunohistochemical profile of the normal conus medullaris and filum terminale." Neuroembryology 2.2 (2003): 43-49.
Source
scival
Published In
Neuroembryology
Volume
2
Issue
2
Publish Date
2003
Start Page
43
End Page
49
DOI
10.1159/000071020

Prognostic value of magnetic resonance imaging-guided stereotactic biopsy in the evaluation of recurrent malignant astrocytoma compared with a lesion due to radiation effect

Object. The prognostic value of differentiating between recurrent malignant glioma and a lesion due to radiation effect by performing stereotactic biopsy has not been assessed. Thus, this study was undertaken to determine such value. Methods. Between 1995 and 2001, 114 patients underwent magnetic resonance (MR) imaging-guided stereotactic biopsy to differentiate lesions caused by a recurrence of malignant astrocytoma and by radiation effect. All patients had previously undergone tumor resection (World Health Organization Grade III or IV) followed by radiotherapy. Disease diagnosis based on biopsy and patient characteristics were assessed as predictors of survival according to results of a multivariate Cox regression analysis. The diagnosis determined with the aid of biopsy was compared with that established during a subsequent resection in 26 patients. Survival following stereotactic biopsy was markedly increased in patients suffering from radiation effect compared with those harboring recurrent malignant glioma (p < 0.0001). In patients with radiation effect on biopsy, an increasing patient age (p < 0.05), having had two compared with one prior resection (p < 0.05), and a decreasing time from radiotherapy to biopsy (p < 0.001) were factors associated with decreased survival. Nevertheless, in patients with biopsy-defined radiation effect at second progression or with an age younger than 50 years the survival rate remained higher than that in patients with recurrent tumor on biopsy (p < 0.01). A biopsy-based diagnosis of radiation effect obtained less than 5 months after radiotherapy was not associated with an increased rate of patient survival compared with a diagnosis of recurrent malignant glioma on biopsy (p = 0.286). Eighty-six percent of lesions initially determined to be due to radiation effect on biopsy fewer than 5 months after radiotherapy were characterized as recurrent glioma by a mean of 11 months later. In contrast, only 25% of lesions initially diagnosed as attributable to radiation effect on biopsy more than 5 months after radiotherapy were classified as recurrent glioma a mean of 12 months later (p < 0.05). Conclusions. With the aid of stereotactic biopsy the authors demonstrated prognostic significance in differentiating recurrent malignant astrocytoma from a lesion due to radiation effect in patients presenting more than 5 months after having undergone radiotherapy. In patients who presented earlier than 5 months after radiotherapy, radiation effect on biopsy was not associated with an improved rate of survival compared with that in patients harboring recurrent malignant astrocytoma.

Authors
McGirt, MJ; Bulsara, KR; Cummings, TJ; New, KC; Little, KM; Friedman, HS; Friedman, AH
MLA Citation
McGirt, MJ, Bulsara, KR, Cummings, TJ, New, KC, Little, KM, Friedman, HS, and Friedman, AH. "Prognostic value of magnetic resonance imaging-guided stereotactic biopsy in the evaluation of recurrent malignant astrocytoma compared with a lesion due to radiation effect." Journal of Neurosurgery 98.1 SUPPL. (2003): 14-20.
Source
scival
Published In
Journal of Neurosurgery
Volume
98
Issue
1 SUPPL.
Publish Date
2003
Start Page
14
End Page
20

Pathologic quiz case: left eye proptosis, ptosis, and blindness. Hemangiopericytoma of the orbit.

Authors
Butnor, KJ; Cummings, TJ
MLA Citation
Butnor, KJ, and Cummings, TJ. "Pathologic quiz case: left eye proptosis, ptosis, and blindness. Hemangiopericytoma of the orbit." Arch Pathol Lab Med 126.12 (December 2002): 1555-1556.
PMID
12503588
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
126
Issue
12
Publish Date
2002
Start Page
1555
End Page
1556
DOI
10.1043/0003-9985(2002)126<1555:PQCLEP>2.0.CO;2

Pathologic quiz case - Left eye proptosis, ptosis, and blindness

Authors
Butnor, KJ; Cummings, TJ
MLA Citation
Butnor, KJ, and Cummings, TJ. "Pathologic quiz case - Left eye proptosis, ptosis, and blindness." ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE 126.12 (December 2002): 1555-1556.
Source
wos-lite
Published In
Archives of Pathology and Laboratory Medicine
Volume
126
Issue
12
Publish Date
2002
Start Page
1555
End Page
1556

Biphasic malignant meningioma: a comparative genomic hybridization study.

To ascertain if a carcinoma-like component within a fibroblastic meningioma represented a metastatic carcinoma to a meningioma or malignant progression, we employed traditional immunohistochemical methods as well as comparative genomic hybridization (CGH) which compares chromosomal alterations. Vimentin and epithelial membrane antigen were strongly immunoreactive in both the fibroblastic and carcinoma-like components. The CGH profile in both components had similar chromosomal alterations, including losses of 1p, 14, 16p13-->p10 and 22. However, the CGH profiles from the fibroblastic component showed losses of 4p, 10q23-->q24 and 18, along with gains of 1q, 6q25-->qter and 13q32-->qter. The profile of the carcinoma-like component showed losses of chromosome 4, in addition to gains of 3p12-->q13.11, 5q14.3-->q23.2, 6pter-->p23, and 13q14.2-->qter. CGH analysis of a biphasic malignant meningioma confirmed that the disparate histologic components were genetically related and likely derivative from a common precursor, demonstrating genetic instability and clonal expansion. Furthermore, CGH showed that the histologically appearing low-grade fibroblastic component had not solely the characteristic alterations of a benign meningioma but had already progressed to an atypical meningioma.

Authors
Heimberger, AB; Wiltshire, RN; Bronec, R; McLendon, RE; Cummings, TJ
MLA Citation
Heimberger, AB, Wiltshire, RN, Bronec, R, McLendon, RE, and Cummings, TJ. "Biphasic malignant meningioma: a comparative genomic hybridization study." Clin Neuropathol 21.6 (November 2002): 258-264.
PMID
12489674
Source
pubmed
Published In
Clinical neuropathology
Volume
21
Issue
6
Publish Date
2002
Start Page
258
End Page
264

Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics.

PURPOSE: To determine if water diffusivity within lymphomas and high-grade astrocytomas correlates with cellularity. MATERIALS AND METHODS: Echo-planar diffusion-weighted magnetic resonance (MR) images obtained in 11 patients with brain lymphomas (19 lesions) and in 17 patients with astrocytomas (19 lesions) were retrospectively reviewed. Regions of interest were drawn on apparent diffusion coefficient (ADC) maps in enhancing tumor. ADC values were normalized by dividing ADC values of tumors by those of normal-appearing regions and expressing the quotient as a ratio. Histologic samples from 11 patients with astrocytomas (11 lesions) and seven patients with lymphoma (seven lesions) were reviewed. Cellularity was measured by calculating the percentage of nuclear area and the percentage of cytoplasmic area and expressing the results as the nuclear-to-cytoplasmic (N/C) ratio. The ADC and N/C ratios of both tumor types were compared by using a two-tailed t test. RESULTS: Mean ADC ratio of lymphomas was 1.15 (SD, 0.33; standard error of the mean [SEM], 0.10), and that of high-grade astrocytomas was 1.68 (SD, 0.48; SEM, 0.11) (P <.01). Mean N/C ratio of lymphoma was 1.45 (SD, 0.94; SEM, 0.36), and that of high-grade astrocytomas was 0.24 (SD, 0.18; SEM, 0.05) (P <.01). CONCLUSION: Measurements of water diffusivity and cellularity suggest that higher cellularity contributes to more restricted diffusion.

Authors
Guo, AC; Cummings, TJ; Dash, RC; Provenzale, JM
MLA Citation
Guo, AC, Cummings, TJ, Dash, RC, and Provenzale, JM. "Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics." Radiology 224.1 (July 2002): 177-183.
PMID
12091680
Source
pubmed
Published In
Radiology
Volume
224
Issue
1
Publish Date
2002
Start Page
177
End Page
183
DOI
10.1148/radiol.2241010637

Peroneal nerve tumor.

Authors
Kline, DG; Gruen, JP; Cummings, TJ
MLA Citation
Kline, DG, Gruen, JP, and Cummings, TJ. "Peroneal nerve tumor." J Neurosurg 97.1 (July 2002): 238-239. (Letter)
PMID
12134926
Source
pubmed
Published In
Journal of neurosurgery
Volume
97
Issue
1
Publish Date
2002
Start Page
238
End Page
239

Comparative genomic hybridization of a biphasic malignant meningioma.

Authors
Cummings, TJ; Wiltshire, RN; McLendon, RE; Heimberger, AB
MLA Citation
Cummings, TJ, Wiltshire, RN, McLendon, RE, and Heimberger, AB. "Comparative genomic hybridization of a biphasic malignant meningioma." JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY 61.5 (May 2002): 480-480.
Source
wos-lite
Published In
Journal of Neuropathology and Experimental Neurology
Volume
61
Issue
5
Publish Date
2002
Start Page
480
End Page
480

TaqMan junction probes and the reverse transcriptase polymerase chain reaction: detection of alveolar rhabdomyosarcoma, synovial sarcoma, and desmoplastic small round cell tumor.

The reverse transcriptase polymerase chain reaction (RT-PCR) provides a technique to diagnose a group of sarcomas and small round cell tumors that contain specific chromosomal translocations and chimeric gene fusion products. We adapted real-time qualitative RT-PCR to utilize dual-labeled, fluorogenic, TaqMan probes, which hybridize to targets that overlap the junction of the chimeric gene fusions in alveolar rhabdomyosarcoma (ARMS), synovial sarcoma (SS), and desmoplastic small round cell tumor (DSRCT). Assays were confirmed on cell lines and tissue samples; appropriate negative amplification assays were obtained when each tumor-specific probe and primer set was used on different neoplasms and cell lines that were not expected to harbor the specific translocations and chimeric gene fusions. Although our cases are few, we speculate that as more molecular variants of ARMS, SS, and DSRCT are discovered, clinical correlations based on precise molecular features will be required and fusion site specificity will be assured by the use of junction-based TaqMan probes.

Authors
Cummings, TJ; Brown, NM; Stenzel, TT
MLA Citation
Cummings, TJ, Brown, NM, and Stenzel, TT. "TaqMan junction probes and the reverse transcriptase polymerase chain reaction: detection of alveolar rhabdomyosarcoma, synovial sarcoma, and desmoplastic small round cell tumor." Ann Clin Lab Sci 32.3 (2002): 219-224.
PMID
12175083
Source
pubmed
Published In
Annals of Clinical and Laboratory Science
Volume
32
Issue
3
Publish Date
2002
Start Page
219
End Page
224

Left eye proptosis, ptosis, and blindness

Authors
Butnor, KJ; Cummings, TJ
MLA Citation
Butnor, KJ, and Cummings, TJ. "Left eye proptosis, ptosis, and blindness." Archives of Pathology and Laboratory Medicine 126.12 (2002): 1555-1556.
Source
scival
Published In
Archives of Pathology and Laboratory Medicine
Volume
126
Issue
12
Publish Date
2002
Start Page
1555
End Page
1556

Peroneal nerve tumor [1] (multiple letters)

Authors
Kline, DG; Gruen, JP; Cummings, TJ; Heilbrun, M; Heilbrun, MP
MLA Citation
Kline, DG, Gruen, JP, Cummings, TJ, Heilbrun, M, and Heilbrun, MP. "Peroneal nerve tumor [1] (multiple letters)." Journal of Neurosurgery 97.1 (2002): 238-240.
Source
scival
Published In
Journal of Neurosurgery
Volume
97
Issue
1
Publish Date
2002
Start Page
238
End Page
240

Dementia with Lewy bodies and Alzheimer's disease.

To investigate similarities and differences between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), we undertook a demographic analysis of 277 patients from the Kathleen Price Bryan Brain Bank with an antemortem diagnosis of probable AD. Patients with additional, possibly confounding clinical and pathologic diagnoses such as infarcts, hematomas, neoplasms, and other neurodegenerative disorders, were excluded from the analysis. Neuropathologically, AD alone was present in 192 subjects (69%), and DLB was found in 85 subjects (31%). All of the DLB cases had neuropathologic evidence of AD sufficient to meet CERAD criteria for a diagnosis of definite AD plus nigral Lewy bodies. Gender, apolipoprotein E (APOE) genotype, brain weight, age at death, duration of disease and Braak stage were compared between the two groups. Statistical analyses were performed using Fisher's exact test for comparisons of categorical data and Student's t-test for comparison of means for continuous outcomes. The proportion of males and females was balanced in the combined AD and DLB populations. There was a highly statistically significant increased frequency of APOE 3/4 in males with DLB (P = 0.007). We found higher brain weights in males with DLB versus males with AD (P = 0.012). AD was more frequent in females and DLB was more frequent in males (P = 0.019). Our findings with respect to age at death, duration of disease and Braak stage within diagnostic groups confirm previously reported findings. These data suggest that Lewy bodies are more common in males affected with dementia, especially those with the APOE 3/4 genotype.

Authors
Rosenberg, CK; Cummings, TJ; Saunders, AM; Widico, C; McIntyre, LM; Hulette, CM
MLA Citation
Rosenberg, CK, Cummings, TJ, Saunders, AM, Widico, C, McIntyre, LM, and Hulette, CM. "Dementia with Lewy bodies and Alzheimer's disease." Acta Neuropathol 102.6 (December 2001): 621-626.
PMID
11761723
Source
pubmed
Published In
Acta Neuropathologica
Volume
102
Issue
6
Publish Date
2001
Start Page
621
End Page
626

Endodermal cyst of the oculomotor nerve.

Endodermal cysts are rare congenital intracranial lesions. Although histologically benign, they can become symptomatic as a result of mass effect and cause neurological deficits. We report a 30-year-old woman who presented with paresis of her right oculomotor nerve. Magnetic resonance imaging showed a 13 x 8-mm cystic lesion originating from the right oculomotor nerve at its exit from the mesencephalon. She underwent craniotomy, biopsy, slit resection, and drainage of the cyst. To our knowledge, endodermal cysts have not been previously described in relation to the oculomotor nerve.

Authors
Morgan, MA; Enterline, DS; Fukushima, T; McLendon, RE; Cummings, TJ
MLA Citation
Morgan, MA, Enterline, DS, Fukushima, T, McLendon, RE, and Cummings, TJ. "Endodermal cyst of the oculomotor nerve." Neuroradiology 43.12 (December 2001): 1063-1066.
PMID
11792045
Source
pubmed
Published In
Neuroradiology
Volume
43
Issue
12
Publish Date
2001
Start Page
1063
End Page
1066

Recovery and expression of messenger RNA from postmortem human brain tissue.

The Bryan Alzheimer's Disease Research Center Rapid Autopsy Program at Duke University Medical Center obtains postmortem human brain tissue for experimental investigations. We evaluated 19 brains for RNA integrity and mRNA gene expression. Nine were from patients diagnosed with Alzheimer's disease, and ten were from nondemented controls. In all cases, the following variables were recorded: postmortem procurement delay (range, 1 hour and 10 minutes to 14 hours), pH of cerebrospinal fluid, premortem fever or sepsis, provision of supplemental oxygen in the agonal period, and temporal relation to time of death (either sudden death or protracted illness). Total RNA was extracted, quantified, and evaluated by agarose gel electrophoresis and quantitative gene expression analysis of 18S rRNA and edg-1 using TaqMan technology. All samples appeared to yield intact RNA without significant degradation, and expression of the edg-1 gene was detected by the real time reverse transcriptase polymerase chain reaction in all cases. We conclude that intact RNA can be obtained from postmortem human brain tissue, even in patients with severe premortem illnesses and delayed postmortem tissue procurement intervals. However, we caution that the successful expression of certain genes from postmortem brain tissue may require enhanced procurement efforts to maximize RNA integrity.

Authors
Cummings, TJ; Strum, JC; Yoon, LW; Szymanski, MH; Hulette, CM
MLA Citation
Cummings, TJ, Strum, JC, Yoon, LW, Szymanski, MH, and Hulette, CM. "Recovery and expression of messenger RNA from postmortem human brain tissue." Mod Pathol 14.11 (November 2001): 1157-1161.
PMID
11706078
Source
pubmed
Published In
Modern Pathology
Volume
14
Issue
11
Publish Date
2001
Start Page
1157
End Page
1161
DOI
10.1038/modpathol.3880451

CD34 and dural fibroblasts: the relationship to solitary fibrous tumor and meningioma.

Intracranial solitary fibrous tumors (SFTs) are typically dural-based, CD34-positive neoplasms of uncertain histogenesis. We examined ten cases of meninges obtained at autopsy from patients with no history of neurological illness, head trauma, or neurosurgical intervention, and ten cases of typical meningiomas with attached dural margins not involved by tumor. All cases were immunostained with CD34. CD34 reactivity was noted in the long, thin delicate processes of dural fibroblasts preferentially located in the meningeal portion of the dura rather than the periosteal portion. No CD34 reactivity was identified in the arachnoid or pia mater, except in some endothelial cells. One supratentorial dural-based fibrous nodule and one SFT within the confines of the fourth ventricle showed strong and diffuse reactivity to CD34, bcl-2, and vimentin, and were negative for epithelial membrane antigen (EMA), S-100 protein, glial fibrillary acidic protein, smooth muscle actin, and desmin. We also describe a meningothelial meningioma within which a well circumscribed SFT-like nodule was embedded. The SFT-like nodule was strongly CD34 positive and EMA negative, and the meningioma was strongly EMA positive and CD34 negative. Fibroblasts of the dural border cell layer are attached to the underlying arachnoid, and their inclusion with arachnoidal stromal elements and pial-based tela choroidea during formation of choroid plexus interstitium may account for intraventricular SFTs. Our results suggest that SFTs and dural-based fibrous nodules derive from CD34-positive dural-based fibroblasts, and that CD34 reactivity in meningiomas may result from inclusion of dural fibroblasts within the neoplasm.

Authors
Cummings, TJ; Burchette, JL; McLendon, RE
MLA Citation
Cummings, TJ, Burchette, JL, and McLendon, RE. "CD34 and dural fibroblasts: the relationship to solitary fibrous tumor and meningioma." Acta Neuropathol 102.4 (October 2001): 349-354.
PMID
11603810
Source
pubmed
Published In
Acta Neuropathologica
Volume
102
Issue
4
Publish Date
2001
Start Page
349
End Page
354

March 2000: A 16 year old female with a cerebellar mass.

The March COM: A 16 year old female presented with headaches and cerebellar dysfunction. MR images showed a mass lesion of the right cerebellar hemisphere with mass effect on the medulla. The mass exhibited a striated pattern of alternating isointense and hypointense zones on T1-weighted images that did not contrast enhance. The lesion was hyperintense on T2-weighted images, and also showed a striated appearance. A suboccipital craniotomy and resection of the lesion was performed. Microscopically, the specimen consisted of widened folia and a disorganized cerebellar architectonic pattern in which the internal granular cell layer was occupied by a population of large dysmorphic nerve cell bodies. Patient's diagnosed with Lhermitte-Duclos disease must be adequately evaluated for Cowden's syndrome.

Authors
Cummings, TJ; Ebert, RH; Provenzale, J; McLendon, RE
MLA Citation
Cummings, TJ, Ebert, RH, Provenzale, J, and McLendon, RE. "March 2000: A 16 year old female with a cerebellar mass." Brain Pathol 11.3 (July 2001): 391-393.
PMID
11414481
Source
pubmed
Published In
Brain Pathology
Volume
11
Issue
3
Publish Date
2001
Start Page
391
End Page
393

Ham56-immunoreactive macrophages in untreated infiltrating gliomas.

CONTEXT: Classic diagnostic neuropathologic teachings have cautioned against making the diagnosis of neoplasia in the presence of a macrophage population. The knowledge of macrophage distribution should prove useful when confronted with an infiltrating glioma containing macrophages. OBJECTIVE: To identify macrophages in untreated, infiltrating gliomas using the monoclonal antibody HAM56, and to confirm their presence in an untreated glioblastoma multiforme (GBM) with the serial analysis of gene expression (SAGE) method. METHODS: We evaluated the presence of macrophages in 16 cases of untreated, supratentorial infiltrating gliomas with the macrophage monoclonal antibody HAM56. We performed SAGE for one case of GBM and for normal brain tissue. RESULTS: In World Health Organization (WHO) grade II well-differentiated astrocytoma and oligodendroglioma, HAM56 reactivity was noted only in endothelial cells, and unequivocal macrophages were not identified. In WHO grade III anaplastic astrocytoma and anaplastic oligodendroglioma, rare HAM56-positive macrophages were noted in solid areas of tumor. In WHO grade IV GBM, HAM56-positive macrophages were identified in areas of solid tumor (mean labeling index, 8.6%). In all cases of GBM, nonquantitated HAM56-positive macrophages were identified in foci of pseudopalisading cells abutting necrosis and in foci of microvascular proliferations. In none of the cases were granulomas or microglial nodules found, and there was no prior history of surgical intervention, radiation therapy, chemotherapy, or head trauma in these cases. By SAGE, the macrophage-related proteins osteopontin and macrophage-capping protein were overexpressed 12-fold and eightfold, respectively, in one untreated GBM compared with normal brain tissue. In this case, numerous HAM56-positive macrophages (labeling index, 24.5%) were present in the solid portion of tumor, and abundant nonquantified macrophages were identified in foci of pseudopalisading cells abutting necrosis and in foci of microvascular proliferations. CONCLUSIONS: This study confirms the utility of the monoclonal antibody HAM56 in identifying macrophages within untreated infiltrating gliomas. The overexpression of macrophage-related proteins in one case of GBM as detected by SAGE signifies that macrophages may be present in untreated GBMs.

Authors
Cummings, TJ; Hulette, CM; Bigner, SH; Riggins, GJ; McLendon, RE
MLA Citation
Cummings, TJ, Hulette, CM, Bigner, SH, Riggins, GJ, and McLendon, RE. "Ham56-immunoreactive macrophages in untreated infiltrating gliomas." Arch Pathol Lab Med 125.5 (May 2001): 637-641.
PMID
11300934
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
125
Issue
5
Publish Date
2001
Start Page
637
End Page
641
DOI
10.1043/0003-9985(2001)125<0637:HIMIUI>2.0.CO;2

Fine-needle aspiration diagnosis of medulloblastoma metastatic to the pelvis.

A 25-yr-old male presented with a cerebellar mass, underwent a suboccipital craniotomy, and was diagnosed with medulloblastoma. Six months later he developed a large mass in the right iliac crest. Fine-needle aspiration biopsy (FNAB) confirmed the diagnosis of metastatic medulloblastoma. The diagnosis of metastatic medulloblastoma is usually suspected clinically or radiographically, and is uncommonly confirmed by cytologic evaluation. Here we report on a rare case of FNAB used to diagnose metastatic medulloblastoma.

Authors
New, KC; Bulsara, KR; Dodd, LG; Cummings, TJ
MLA Citation
New, KC, Bulsara, KR, Dodd, LG, and Cummings, TJ. "Fine-needle aspiration diagnosis of medulloblastoma metastatic to the pelvis." Diagn Cytopathol 24.5 (May 2001): 361-363.
PMID
11335970
Source
pubmed
Published In
Diagnostic Cytopathology
Volume
24
Issue
5
Publish Date
2001
Start Page
361
End Page
363

Pathology of the normal versus the tethered filum terminale.

Authors
Cummings, TJ; Bulsara, KR; McLendon, RE; Fuchs, HE; George, TM
MLA Citation
Cummings, TJ, Bulsara, KR, McLendon, RE, Fuchs, HE, and George, TM. "Pathology of the normal versus the tethered filum terminale." May 2001.
Source
wos-lite
Published In
Journal of Neuropathology and Experimental Neurology
Volume
60
Issue
5
Publish Date
2001
Start Page
553
End Page
553

Pathologic quiz case: pituitary mass in a 48-year-old woman.

Authors
Cummings, TJ; Bentley, RC; McLendon, RE
MLA Citation
Cummings, TJ, Bentley, RC, and McLendon, RE. "Pathologic quiz case: pituitary mass in a 48-year-old woman." Arch Pathol Lab Med 125.2 (February 2001): 299-300.
PMID
11175658
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
125
Issue
2
Publish Date
2001
Start Page
299
End Page
300
DOI
10.1043/0003-9985(2001)125<0299:PQCPMI>2.0.CO;2

Pathologic quiz case - Pituitary mass in a 48-year-old woman - Pathologic diagnosis: Granular cell tumor of the infundibulum

Authors
Cummings, TJ; Bentley, RC; McLendon, RE
MLA Citation
Cummings, TJ, Bentley, RC, and McLendon, RE. "Pathologic quiz case - Pituitary mass in a 48-year-old woman - Pathologic diagnosis: Granular cell tumor of the infundibulum." ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE 125.2 (February 2001): 299-300.
Source
wos-lite
Published In
Archives of Pathology and Laboratory Medicine
Volume
125
Issue
2
Publish Date
2001
Start Page
299
End Page
300

CD34 positivity in pleural fibroblasts

Authors
Butnor, KJ; Cummings, TJ; Burchette, JL; Sporn, TA; Hammar, SP; Roggli, VL
MLA Citation
Butnor, KJ, Cummings, TJ, Burchette, JL, Sporn, TA, Hammar, SP, and Roggli, VL. "CD34 positivity in pleural fibroblasts." MODERN PATHOLOGY 14.1 (January 2001): 217A-217A.
Source
wos-lite
Published In
Modern Pathology
Volume
14
Issue
1
Publish Date
2001
Start Page
217A
End Page
217A

Pathology of the filum terminale in the tethered spinal cord syndrome

Authors
Cummings, TJ; Fuchs, HE; George, TM
MLA Citation
Cummings, TJ, Fuchs, HE, and George, TM. "Pathology of the filum terminale in the tethered spinal cord syndrome." January 2001.
Source
wos-lite
Published In
Modern Pathology
Volume
14
Issue
1
Publish Date
2001
Start Page
6P
End Page
6P

Pathology of the filum terminale in the tethered spinal cord syndrome

Authors
Cummings, TJ; Fuchs, HE; George, TM
MLA Citation
Cummings, TJ, Fuchs, HE, and George, TM. "Pathology of the filum terminale in the tethered spinal cord syndrome." January 2001.
Source
wos-lite
Published In
Laboratory Investigation
Volume
81
Issue
1
Publish Date
2001
Start Page
6P
End Page
6P

CD34 positivity in pleural fibroblasts

Authors
Butnor, KJ; Cummings, TJ; Burchette, JL; Sporn, TA; Hammar, SP; Roggli, VL
MLA Citation
Butnor, KJ, Cummings, TJ, Burchette, JL, Sporn, TA, Hammar, SP, and Roggli, VL. "CD34 positivity in pleural fibroblasts." LABORATORY INVESTIGATION 81.1 (January 2001): 217A-217A.
Source
wos-lite
Published In
Laboratory Investigation
Volume
81
Issue
1
Publish Date
2001
Start Page
217A
End Page
217A

Histologic evaluation of fetal brains following maternal pneumoperitoneum

Background: The purpose of this study was to determine if maternal pneumoperitoneum with carbon dioxide (CO2) produces evidence of central nervous system (CNS) injury in preterm fetal guinea pigs. Methods: Thirty pregnant guinea pigs at gestational day (GD) 45 were assigned at random to one of three treatment groups: anesthesia only, CO2 pneumoperitoneum (5 mmHg), or laparotomy. Dams were killed 3 or 5 days postprocedure and fetal brains (83 total) harvested and fixed for subsequent histopathologic evaluation. For comparative purposes, histologic features of fetal guinea pig brain injury were defined from examination of fetal brains harvested from an additional dam that underwent laparotomy with 20 min of uterine arterial occlusion. Results: Carbon dioxide pneumoperitoneum did not increase maternal/fetal morbidity. No evidence of brain injury was found in fetuses from any of the treatment groups. Conclusion: Carbon dioxide pneumoperitoneum at 5 mmHg for 40 min in the pregnant guinea pig does not produce evidence of fetal brain injury.

Authors
Garcia-Oria, M; Ali, A; Reynolds, JD; Clary, E; Gandsas, A; Cummings, T; McMahon, RL; Bruch, S; Fina, M; Ko, A; Eubanks, S
MLA Citation
Garcia-Oria, M, Ali, A, Reynolds, JD, Clary, E, Gandsas, A, Cummings, T, McMahon, RL, Bruch, S, Fina, M, Ko, A, and Eubanks, S. "Histologic evaluation of fetal brains following maternal pneumoperitoneum." Surgical Endoscopy 15.11 (2001): 1294-1298.
PMID
11727136
Source
scival
Published In
Surgical Endoscopy
Volume
15
Issue
11
Publish Date
2001
Start Page
1294
End Page
1298
DOI
10.1007/s004640080040

Human chorionic gonadotropin beta subunit protein immunoreactivity in pituitary adenomas: Pathologic features

Authors
Cummings, TJ; McLendon, RE; Villavicencio, AT; Friedman, AH; Burchette, JL; Bentley, RC
MLA Citation
Cummings, TJ, McLendon, RE, Villavicencio, AT, Friedman, AH, Burchette, JL, and Bentley, RC. "Human chorionic gonadotropin beta subunit protein immunoreactivity in pituitary adenomas: Pathologic features." BRAIN PATHOLOGY 10.4 (September 2000): 746-747.
Source
wos-lite
Published In
Brain Pathology
Volume
10
Issue
4
Publish Date
2000
Start Page
746
End Page
747

Castleman's disease confined to the leptomeninges.

We report a rare case of the plasma cell variant of Castleman's disease confined to the leptomeninges in a 42-year-old female. Flow cytometry demonstrated a minor monoclonal kappa light chain population, and conventional Southern blotting confirmed clonal rearrangement of the J(H) immunoglobulin heavy-chain gene. Polymerase chain reaction for Epstein-Barr virus and Kaposi's sarcoma-associated herpes virus was negative. The patient is disease-free five years after surgical resection. To our knowledge, clonal gene rearrangement has not been previously reported in the plasma cell variant of localized intracranial Castleman's disease.

Authors
Cummings, TJ; Gong, JZ; Friedman, AH; McLendon, RE
MLA Citation
Cummings, TJ, Gong, JZ, Friedman, AH, and McLendon, RE. "Castleman's disease confined to the leptomeninges." Ann Clin Lab Sci 30.3 (July 2000): 278-282. (Review)
PMID
10945568
Source
pubmed
Published In
Annals of Clinical and Laboratory Science
Volume
30
Issue
3
Publish Date
2000
Start Page
278
End Page
282

Fine-needle aspiration diagnosis of psammomatous melanotic schwannoma.

A 51-yr-old male presented with an 8-mo history of lower back pain. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) studies showed a 3.5 X 3.0 cm sacral mass within the spinal canal in the region of the left S2 nerve root. A fine-needle aspirate biopsy (FNAB) was performed under CT guidance. The cytologic findings included a spindle-cell population with a fibrillary background arranged in a vaguely streaming pattern, wavy nuclei with mild atypia, wispy cytoplasm, rare intranuclear inclusions, and dilated vascular spaces. Some cells contained a nonrefractile granular brown pigment consistent with melanin. Also identified were calcified concentric laminations typical of psammoma bodies. Immunohistochemically, the neoplastic cells were strongly immunoreactive for S-100 protein and HMB-45. A diagnosis of psammomatous melanotic schwannoma was rendered. No stigmata of Carney's complex were identified on physical examination. The patient has declined the recommendation of surgical excision of the mass. We herein describe a case unequivocally diagnosed as psammomatous melanotic schwannoma by FNAB.

Authors
Cummings, TJ; Liu, K; Jordan, LK; Dodd, LG
MLA Citation
Cummings, TJ, Liu, K, Jordan, LK, and Dodd, LG. "Fine-needle aspiration diagnosis of psammomatous melanotic schwannoma." Diagn Cytopathol 23.1 (July 2000): 55-58.
PMID
10907935
Source
pubmed
Published In
Diagnostic Cytopathology
Volume
23
Issue
1
Publish Date
2000
Start Page
55
End Page
58

Pineal epidermoid cysts.

Authors
Cummings, TJ; McLendon, RE
MLA Citation
Cummings, TJ, and McLendon, RE. "Pineal epidermoid cysts." J Neurosurg 92.5 (May 2000): 909-910. (Letter)
PMID
10794322
Source
pubmed
Published In
Journal of neurosurgery
Volume
92
Issue
5
Publish Date
2000
Start Page
909
End Page
910

Gliomas of the optic nerve: histological, immunohistochemical (MIB-1 and p53), and MRI analysis.

Gliomas of the optic nerve, although typically of pilocytic (WHO grade I) histology, can present within the spectrum of astrocytic neoplasia including glioblastoma (WHO grade IV). In certain cases, histologic features alone make the distinction between pilocytic and diffuse astrocytomas difficult. We reviewed 22 cases of optic nerve gliomas, 19 of which were pilocytic astrocytomas (PA), and 3 of which were diffuse, non-pilocytic astrocytomas. The cases were evaluated for their clinical course, radiographic appearance, histologic grade, and proliferation indices as detected by MIB-1 (Ki-67) and p53 antibodies. Of the 19 PA, 14 showed no tumor growth by magnetic resonance imaging, and had Ki-67 and p53 labeling indices (LI) of < 1%. The other 5 PA exhibited aggressive behavior manifest by marked diffuse infiltrative tumor growth causing death in 2 patients, 1 of whom was diagnosed with neurofibromatosis type 1 (immunoperoxidase and radiographs not available), and marked local growth with an average time to growth of 39.3 months, a Ki-67 LI of 2-3%, and a p53 LI of < 1% in three others. Three of the five aggressive PA histologically demonstrated a finely reticulated pattern, a pattern that appears as an exaggeration or expansion of the normal neuroglia of the optic nerve, and may simulate a diffuse low-grade astrocytoma. Two demonstrated the coarsely reticulated pattern, with the biphasic and microcystic pattern typical of PA. Three diffuse astrocytomas (2 anaplastic astrocytomas and 1 glioblastoma) originated clinically and radiographically from the optic nerve, and revealed a Ki-67 LI of 2-12%, a p53 LI of 2-8%, and an average time to growth of 8 months. We conclude that the majority of PA of the optic nerve are non-aggressive, stabilize radiographically, and have Ki-67 and p53 LI < 1%. However, a subpopulation of PA has a propensity for aggressive behavior, and are identified by a Ki-67 LI of 2-3% and a p53 LI of < 1%. Diffuse astrocytomas have both Ki-67 and p53 LI > 2%. Thus, in cases of aggressive optic nerve tumors in which the histologic review of biopsy material cannot confidently confirm the diagnosis of pilocytic or diffuse fibrillary glioma, a p53 LI of > 1% appears to favor the diagnosis of diffuse astrocytoma.

Authors
Cummings, TJ; Provenzale, JM; Hunter, SB; Friedman, AH; Klintworth, GK; Bigner, SH; McLendon, RE
MLA Citation
Cummings, TJ, Provenzale, JM, Hunter, SB, Friedman, AH, Klintworth, GK, Bigner, SH, and McLendon, RE. "Gliomas of the optic nerve: histological, immunohistochemical (MIB-1 and p53), and MRI analysis." Acta Neuropathol 99.5 (May 2000): 563-570.
PMID
10805102
Source
pubmed
Published In
Acta Neuropathologica
Volume
99
Issue
5
Publish Date
2000
Start Page
563
End Page
570

HAM56 immunoreactivity in infiltrating glial neoplasms.

Authors
Cummings, TJ; Hulette, CM; Bigner, S; Lal, A; Riggins, GJ; Burchette, JL; McLendon, RE
MLA Citation
Cummings, TJ, Hulette, CM, Bigner, S, Lal, A, Riggins, GJ, Burchette, JL, and McLendon, RE. "HAM56 immunoreactivity in infiltrating glial neoplasms." JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY 59.5 (May 2000): 437-437.
Source
wos-lite
Published In
Journal of Neuropathology and Experimental Neurology
Volume
59
Issue
5
Publish Date
2000
Start Page
437
End Page
437

Ubiquitin immunochemistry as a diagnostic aid for community pathologists evaluating patients who have dementia.

Alzheimer's disease is the most common cause of dementia It is associated with genetic risk factors and at least three autosomal dominant mutations. Community pathologists are frequently asked by families to evaluate autopsy material for Alzheimer's disease. Neuropathologic diagnosis is based on technically difficult silver impregnation stains that may not be readily available to community-based pathologists. Because immunohistochemical techniques are more widely accessible, we evaluated the practical utility of using a single immunohistochemical stain for diagnosing Alzheimer's disease. The ubiquitin antigen was selected because of its presence in morphologically distinct deposits characteristic of several neurodegenerative diseases. Paraffin blocks were obtained from the Bryan Alzheimer's Disease Research Center Brain Bank, a repository of approximately 900 brains. Tissues from 16 individuals who exhibited the entire range of Alzheimer's-type neuropathology were selected. Ubiquitin immunostains, evaluated blindly and independently by four pathologists ranging from first-year resident trainee to experienced neuropathologist, reliably stained both neuritic plaques and neurofibrillary tangles essential for diagnosing and staging Alzheimer's disease. Nondemented controls with early Alzheimer's-type changes were easily distinguished from cases of definitive Alzheimer's disease. The stains also highlighted characteristic inclusions of Parkinson's disease or Lewy body dementia Ubiquitin immunohistochemistry is a reliable, reproducible, and readily available diagnostic aid for distinguishing Alzheimer's disease from other causes of dementia.

Authors
Chu, CT; Caruso, JL; Cummings, TJ; Ervin, J; Rosenberg, C; Hulette, CM
MLA Citation
Chu, CT, Caruso, JL, Cummings, TJ, Ervin, J, Rosenberg, C, and Hulette, CM. "Ubiquitin immunochemistry as a diagnostic aid for community pathologists evaluating patients who have dementia." Mod Pathol 13.4 (April 2000): 420-426.
PMID
10786809
Source
pubmed
Published In
Modern Pathology
Volume
13
Issue
4
Publish Date
2000
Start Page
420
End Page
426
DOI
10.1038/modpathol.3880072

The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms.

Patients with a history of closed head trauma and subarachnoid hemorrhage are uncommonly diagnosed with an intracranial saccular aneurysm. This study presents a group of patients in whom a pre-existing aneurysm was discovered during work-up for traumatic subarachnoid hemorrhage. Without an accurate pre-trauma clinical history, it is difficult to define the relationship between trauma and the rupture of a pre-existing intracranial saccular aneurysm. We retrospectively reviewed 130 patients who presented to Detroit Receiving Hospital between 1993 and 1997 with a diagnosis of subarachnoid hemorrhage (SAH). Of these 130 patients, 70 were spontaneous, and 60 had a history of trauma. Mechanisms of trauma include motor vehicle accident, assault, or fall from a height. Of the 60 patients with subarachnoid hemorrhage and a history of trauma, 51 (86%) did not undergo conventional four-vessel angiography, and had no further neurological sequelae. Nine patients (14%) had a suspicious quantity of blood within the basal cisterns or Sylvian fissure and had a four-vessel angiogram. Five patients (8%) were diagnosed with a saccular intracranial aneurysm, and all underwent surgical clipping of the aneurysm. We conclude that the majority of patients (92%), with post-traumatic SAH do not harbor intracranial aneurysms. However, during initial evaluation, a high level of suspicion must be entertained when post-traumatic subarachnoid hemorrhage is encountered in the basal cisterns or Sylvian fissure, as 8% of our population were diagnosed with aneurysms.

Authors
Cummings, TJ; Johnson, RR; Diaz, FG; Michael, DB
MLA Citation
Cummings, TJ, Johnson, RR, Diaz, FG, and Michael, DB. "The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms." Neurol Res 22.2 (March 2000): 165-170.
PMID
10763504
Source
pubmed
Published In
Neurological Research
Volume
22
Issue
2
Publish Date
2000
Start Page
165
End Page
170

Expression of the intermediate filament peripherin in extraskeletal myxoid chondrosarcoma.

The embryologic histogenesis of cartilage is not well characterized. While cranial cartilage is believed to be derived from pluripotential precursor cells of the neural crest, chondrocytes found elsewhere in the body are thought to be derived from mesoderm. As such, soft tissue tumors with cartilaginous differentiation may be related to neural crest or mesoderm. Peripherin is an intermediate filament encoded on chromosome 12, involved in growth and development of the peripheral nervous system. Peripherin is apparently expressed exclusively in cells derived from the neural crest and neural tube. A group of six soft tissue tumor types was selected because they are either of controversial differentiation or cytogenetically related to chromosome 12. A total of 41 cases was evaluated with antibodies against the intermediate filament peripherin. A panel of neural and neuroendocrine differentiation markers was used in selected cases. Three of five extraskeletal myxoid chondrosarcomas showed strong cytoplasmic reactivity with anti-peripherin. No peripherin expression was noted in any of eleven epithelioid sarcomas, eight liposarcomas, seven conventional chondrosarcomas, four neurothekeomas, three alveolar soft part sarcomas, or three clear cell sarcomas. The finding of peripherin expression in some extraskeletal myxoid chondrosarcomas may suggest the ability of some tumors to demonstrate both neural and chondroid differentiation.

Authors
Cummings, TJ; Shea, CR; Reed, JA; Burchette, JL; Prieto, VG
MLA Citation
Cummings, TJ, Shea, CR, Reed, JA, Burchette, JL, and Prieto, VG. "Expression of the intermediate filament peripherin in extraskeletal myxoid chondrosarcoma." J Cutan Pathol 27.3 (March 2000): 141-146.
PMID
10728817
Source
pubmed
Published In
Journal of Cutaneous Pathology
Volume
27
Issue
3
Publish Date
2000
Start Page
141
End Page
146

Parasitic lesion of the insula suggesting cerebral sparganosis: case report.

Cerebral sparganosis, a parasitic disease, rarely produces a chronic active inflammatory response in the brain. Clinically and radiographically the process may mimic a neoplasm. We report a 30-year-old man who underwent surgical exploration for a mass in the insular cortex. Histology revealed a densely fibrotic mass heavily infiltrated with plasma cells and lymphocytes, in which were embedded parasitic forms consistent with sparganosis. We describe the MRI appearances and pathologic features. Intracranial mass lesions secondary to sparganosis must be considered in patients with a history of travel to endemic areas, especially Asia.

Authors
Cummings, TJ; Madden, JF; Gray, L; Friedman, AH; McLendon, RE
MLA Citation
Cummings, TJ, Madden, JF, Gray, L, Friedman, AH, and McLendon, RE. "Parasitic lesion of the insula suggesting cerebral sparganosis: case report." Neuroradiology 42.3 (March 2000): 206-208.
PMID
10772144
Source
pubmed
Published In
Neuroradiology
Volume
42
Issue
3
Publish Date
2000
Start Page
206
End Page
208

Pineal epidermoid cysts [9] (multiple letters)

Authors
Cummings, TJ; McLendon, RE; Spallone, A
MLA Citation
Cummings, TJ, McLendon, RE, and Spallone, A. "Pineal epidermoid cysts [9] (multiple letters)." Journal of Neurosurgery 92.5 (2000): 909-910.
Source
scival
Published In
Journal of Neurosurgery
Volume
92
Issue
5
Publish Date
2000
Start Page
909
End Page
910

Optic nerve astrocytoma associated with angiogenesis and neovascular glaucoma

A 10-year-old boy with a history of neurofibromatosis type 1 presented with visual loss and proptosis in his left eye. Neuroimaging revealed a fusiform, enhancing mass of the left optic nerve extending through the optic canal and involving the intracranial portion of the nerve. Five months later, he experienced acute onset of severe pain and a dilated left pupil. Examination disclosed an increase in proptosis from 4 to 9 mm, neovascular glaucoma, and a central retinal vein occlusion. Repeat imaging showed a marked increase in the size of the mass. The left eye and the intraorbital portion of the optic nerve tumor were resected en bloc. Histologic examination showed a pilocytic astrocytoma of the optic nerve with a prominent angiogenic response, iris neovascularization, and angle closure. This ease illustrates the rare occurrence of prominent angiogenic response and neovascular glaucoma complicating a pilocytic astrocytoma of the optic nerve.

Authors
Cummings, TJ; Chu, CT; Pollock, SC; Klintworth, GK
MLA Citation
Cummings, TJ, Chu, CT, Pollock, SC, and Klintworth, GK. "Optic nerve astrocytoma associated with angiogenesis and neovascular glaucoma." Ophthalmic Practice 18.5 (2000): 227-230.
Source
scival
Published In
Ophthalmic Practice
Volume
18
Issue
5
Publish Date
2000
Start Page
227
End Page
230

Meningioma of the fourth ventricle.

Meningiomas are primary meningeal based tumors of the central nervous system that rarely are located strictly within the fourth ventricle. We report a 72-year-old man operated upon for such a tumor. The pre-operative magnetic resonance images revealed a well circumscribed mass in the fourth ventricle that exhibited a low signal on T1-weighted magnetic resonance images and homogenously enhanced with gadolinium. By light microscopy the tumor was composed of tightly packed spindle cells separated by collagen. Immunohistochemistry showed the tumor cells to be positive for vimentin and epithelial membrane antigen, and negative for glial fibrillary acidic protein. Electron microscopy revealed typical findings of meningioma, including interdigitating cell processes, desmosomes, and intermediate filaments. Although rare, fibroblastic meningioma must be included in the differential diagnosis of a fourth ventricular spindle cell tumor in elderly patients.

Authors
Cummings, TJ; Bentley, RC; Gray, L; Check, WE; Lanier, TE; McLendon, RE
MLA Citation
Cummings, TJ, Bentley, RC, Gray, L, Check, WE, Lanier, TE, and McLendon, RE. "Meningioma of the fourth ventricle." Clin Neuropathol 18.5 (September 1999): 265-269.
PMID
10505436
Source
pubmed
Published In
Clinical neuropathology
Volume
18
Issue
5
Publish Date
1999
Start Page
265
End Page
269

Gliomatosis cerebri: cytologic and autopsy findings in a case involving the entire neuraxis.

We describe the case of a 7-year-old girl who was clinically diagnosed as having a pontine glioma based on magnetic resonance imaging studies. Neoplastic cells were identified upon cytologic examination of cerebrospinal fluid. Autopsy studies revealed an anaplastic astrocytoma (WHO grade III) diffusely infiltrating the cerebral hemispheres, brain stem, cerebellum, leptomeninges, and spinal cord to the level of the conus medullaris. The Ki-67 labeling index focally approached 30%. Although many of the neoplastic cells displayed elongated twisted nuclei reminiscent of microglia, these cells stained intensely for glial fibrillary acidic protein, supporting an astrocytic origin. Unusual features of this case of gliomatosis cerebri include involvement of the entire central neuraxis, correlation with pre-mortem lumbar puncture cytology, and a markedly elevated Ki-67 labeling index.

Authors
Cummings, TJ; Hulette, CM; Longee, DC; Bottom, KS; McLendon, RE; Chu, CT
MLA Citation
Cummings, TJ, Hulette, CM, Longee, DC, Bottom, KS, McLendon, RE, and Chu, CT. "Gliomatosis cerebri: cytologic and autopsy findings in a case involving the entire neuraxis." Clin Neuropathol 18.4 (July 1999): 190-197.
PMID
10442461
Source
pubmed
Published In
Clinical neuropathology
Volume
18
Issue
4
Publish Date
1999
Start Page
190
End Page
197

Long term recurrent juvenile pilocytic astrocytomas of the cerebellum: Histologic and pathologic studies.

Authors
Cummings, TJ; Chu, CT; McLendon, RE
MLA Citation
Cummings, TJ, Chu, CT, and McLendon, RE. "Long term recurrent juvenile pilocytic astrocytomas of the cerebellum: Histologic and pathologic studies." JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY 58.5 (May 1999): 538-538.
Source
wos-lite
Published In
Journal of Neuropathology and Experimental Neurology
Volume
58
Issue
5
Publish Date
1999
Start Page
538
End Page
538
DOI
10.1097/00005072-199905000-00126

December 1998--16 year old female with headaches, lethargy and a sellar/suprasellar mass.

A 16 year female with a history of developmental delay and shunted hydrocephalus presented with two months of progressive headaches, lethargy and visual disturbances. An MRI of the brain revealed a sellar and suprasellar cystic mass which was absent on a previous MRI six years earlier. The pre-operative clinical diagnosis was pituitary adenoma vs. craniopharyngioma. Histologically, the fibrous wall of the ciliated epithelial-lined cyst was thickened by non-caseating granulomatous inflammation, hemorrhage, hemosiderin, and cholesterol clefts, consistent with cyst rupture. Rathke's cleft cysts are uncommon symptomatic lesions in young people, and must be distinguished from craniopharyngioma.

Authors
Cummings, TJ; Chu, CT; Hulette, CM
MLA Citation
Cummings, TJ, Chu, CT, and Hulette, CM. "December 1998--16 year old female with headaches, lethargy and a sellar/suprasellar mass." Brain Pathol 9.2 (April 1999): 425-426.
PMID
10219756
Source
pubmed
Published In
Brain Pathology
Volume
9
Issue
2
Publish Date
1999
Start Page
425
End Page
426

Gliomas of the optic nerve in children and adults.

Authors
Cummings, TJ; Provenzale, J; Hunter, S; Friedman, HS; Klintworth, G; Bigner, SH; McLendon, RE
MLA Citation
Cummings, TJ, Provenzale, J, Hunter, S, Friedman, HS, Klintworth, G, Bigner, SH, and McLendon, RE. "Gliomas of the optic nerve in children and adults." LABORATORY INVESTIGATION 79.1 (January 1999): 170A-170A.
Source
wos-lite
Published In
Laboratory Investigation
Volume
79
Issue
1
Publish Date
1999
Start Page
170A
End Page
170A

Case of the month: December 1998 - 16 year old female with headaches, lethargy and a sellar/suprasellar mass

A 16 year female with a history of developmental delay and shunted hydrocephalus presented with two months of progressive headaches, lethargy and visual disturbances. An MRI of the brain revealed a sellar and suprasellar cystic mass which was absent on a previous MRI six years earlier. The pre-operative clinical diagnosis was pituitary adenoma vs. craniopharyngioma. Histologically, the fibrous wall of the ciliated epithelial-lined cyst was thickened by non-caseating granulomatous inflammation, hemorrhage, hemosiderin, and cholesterol clefts, consistent with cyst rupture. Rathke's cleft cysts are uncommon symptomatic lesions in young people, and must be distinguished from craniopharyngioma.

Authors
Cummings, TJ; Chu, CT; Hulette, CM
MLA Citation
Cummings, TJ, Chu, CT, and Hulette, CM. "Case of the month: December 1998 - 16 year old female with headaches, lethargy and a sellar/suprasellar mass." Brain Pathology 9.2 (1999): 425-426.
Source
scival
Published In
Brain Pathology
Volume
9
Issue
2
Publish Date
1999
Start Page
425
End Page
426

Serotonin depletion exacerbates changes in striatal gene expression following quinolinic acid injection.

Controversy exists as to whether serotonin (5-HT) plays a neuroprotective role during brain injury. We sought to determine if prior 5-HT depletion alters gene expression patterns normally associated with NMDA receptor-mediated excitotoxicity of the rodent striatum. Adult male Sprague-Dawley rats were treated systemically with saline or p-chlorophenylalanine (pCPA, 350 mg/kg) to block 5-HT synthesis. After 3 days, these rats received unilateral injection (1 microliter) of quinolinic acid (QA, 40 micrograms in 0.1 M phosphate buffered saline, pH 7.4) or saline vehicle directly into the anterior striatum. All rats were sacrificed 6 or 48 h later. Striatal tissues containing the saline or QA injection site were subjected to Northern analysis of preprotachykinin (PPT), preproenkephalin (PPE), and zif/268 mRNAs, as well as HPLC-EC detection of monoamines. At the time of the intrastriatal injection, 5-HT levels were depleted greater than 95% by pCPA as compared to saline controls. At 48 h post-QA injection, PPT and PPE mRNAs were markedly reduced within the striatal lesion site of saline/QA and pCPA/QA groups with respect to their contralateral uninjected control sides. In the pCPA/QA group, striatal PPE and PPT mRNA levels were further reduced as compared to the saline/QA group with PPE mRNA reductions reaching statistical significance at 95% (ANOVA with Scheffe F-test). Exacerbation of the excitotoxic lesion in the 5-HT depleted rat was further exemplified by a larger increase in zif/268 mRNA measured at 6 h post-intrastriatal injection in the pCPA/QA group as compared to saline/QA animals (P < 0.05 by ANOVA with Scheffe F-test). These results suggest that 5-HT depletion may adversely affect neuronal survival following intrastriatal QA exposure and lend support to the hypothesis that increasing 5-HT levels during NMDA receptor-mediated excitotoxicity may spare neurons destined to degenerate.

Authors
Cummings, TJ; Walker, PD
MLA Citation
Cummings, TJ, and Walker, PD. "Serotonin depletion exacerbates changes in striatal gene expression following quinolinic acid injection." Brain Res 743.1-2 (December 16, 1996): 240-248.
PMID
9017251
Source
pubmed
Published In
Brain Research
Volume
743
Issue
1-2
Publish Date
1996
Start Page
240
End Page
248

Positron emission tomography in pediatric epilepsy.

PET is an additional tool in the armamentarium to provide improved care to children and infants with epilepsy. It provides important lateralizing information noninvasively, thus avoiding the need for depth or subdural electrodes in most instances. It can be invaluable when CT and MR imaging do not show a structural lesion. When it corresponds to an EEG focus of epileptogenicity, intraoperative electrocorticography may be used to delineate further the extent of surgical resection, often with impressive reduction in the seizure frequency postoperatively. As PET technology continues to improve, the clinical role of PET in the future will undoubtedly continue to grow.

Authors
Cummings, TJ; Chugani, DC; Chugani, HT
MLA Citation
Cummings, TJ, Chugani, DC, and Chugani, HT. "Positron emission tomography in pediatric epilepsy." Neurosurg Clin N Am 6.3 (July 1995): 465-472. (Review)
PMID
7670320
Source
pubmed
Published In
Neurosurgery Clinics of North America
Volume
6
Issue
3
Publish Date
1995
Start Page
465
End Page
472
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