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Volume 10, Issue 33 (6-2003)
Gliomas comprise about 50% of all primary central nervous system tumors that have defied treatment. Despite of improvement in treatment with surgery, radiotherapy and chemotherapy, the prognosis for these patients remains poor. Efforts to improve the treatment of malignant glioma have included Targeted Radiotherapy with [125I]-Iododeoxyuridine. 125IUdR, a thymidine analogue, is preferentially incorporated into the DNA of tumor cells, and the Auger electrons emitter [125I] is highly toxic to dividing cells. We have achieved comparative study of Targeted Radiotherapy and external beam therapy in treatment of glioma. Clonogenic assays formed basis of experiments to the human glioma cell line “A172” cultured as monolayers in the exponential and the plateau phase. In external beam radiation, the survival curves were exhibited a distinct shoulder, in comparison with, lack of shoulder (absence of repair) in Targeted Radiotherapy. In the treatment of cells in the plateau, the effectiveness of 125IUdR was attenuated by the presence of non-cycling cells. These finding suggest that Targeted Radiotherapy may be a useful method for treatment of glioma, in case we overcome non-cyling malignant cells.
Volume 11, Issue 41 (9-2004)
Paraganglioma are tumors that arise within the sympathetic and parasympathetic nervous system. About 10% of paraganglioma spread to distant sites. Malignant potential has been difficult to be determined by histologic characteristic and it is defined after a metastatic lesion or direct invasion found in a site with no residual embryonic paraganglionic tissue. In this case report, a 51-year-old man is presented who had a neck mass from 15 years ago. After resection of the mass, diagnosis was paraganglioma. After 6 months, the patient was involved by tumor recurrence and she was then reoperated, but this time due to lymph node involvement, malignant paraganglioma was diagnosed.
Volume 12, Issue 46 (9-2005)
The present case report concerns a 64-year-old female who referred with an enlargement mass of right side of neck(submandibular angle) since 4 months ago. Mass resection specimen grossly revealed firm red-brown well-circumscribe mass. Cut sections showed nonhomogeneous tissue with multiple areas of hemorrhage associated with two regional lymph nodes. Microscopic examination mostly exhibited zell ballen pattern with pleomorphic oval to polyhedral tumoral cells which contained eosinophilic granular cytoplasm and hyperchromic nuclei surrounded by sustentacular cells. In subcapsular area of lymph node, a focus of metastatic tumoral cells was also seen. Ultimately, histopathologic diagnosis revealed a very rare malignant paraganglioma of carotid body.
Volume 12, Issue 47 (12-2005)
Background & Objective: Parapharyngeal and infratemporal masses are rare head and neck tumors that constitute about 0.5% of all of them. To assess the distribution of infratemporal and parapharyngeal masses, this study was carried out in ENT department of Hazrat Rasoul Hospital as a sample of Iranian population.
Method: In this retrospective study, we evaluated parapharyngeal and infratemporal tumors in Hazrat Rasoul-e-Akram Hospital in Tehran, from Jan. 1991 until Jan. 2001.
Results: The sampled population was 39 patients suffering from these masses. The mean age of the patients was 44.9 years. The most frequent complaint was asymptomatic neck mass(69.2%).
Conclusion: The findings reported masses of these areas in descending order of frequency: salivary gland tumors(51.2%-esp. PMA: Pleomorphic Adenoma), paraganglioma (15.3%), schwanoma (7.7%), angiofobroma and lymphoma. All patients had been evaluated by imaging techniques, the most common of which was contrast-enhanced CT-scan. All patients except one case of NHL(Non-Hodgkin Lymphoma) were candidates to be operated on and with the exception of 4 cases, surgery via transcervical approach(with or without a combined approach) was done on them.
Volume 14, Issue 56 (11-2007)
Background & Aim: In vitro experiments and in vivo studies have revealed that radiosensitizers in radiation therapy may serve as powerful tools in the treatment of glioma cancers. Many cell lines, under some specific conditions will aggregate and grow to form multicellular structures called spheroid. Thses spheroids resemble in vivo tumor models in several aspects. Therefore studying growth characteristics and behavior of spheroids is beneficial in understanding the behavior of tumors under various experimental conditions. The aim of the current study was to determine the role of Iudr(Iododeoxyuridine) in sensitizing glioma cell line spheroids to radiation. Material and Methods: This study is an experimental research and T-test was used to compare the results. In this study we compared the DNA induced damages in U87MG cell line using alkaline comet assay method. Experiments were performed with two different sizes of spheroids(100µm and 300 µm). Results: Our results showed the effect of radiation on both diameters of spheres in the presence and absence of Iudr. Accordiology radiation in the presence of Iudr increased the tail moment and thus increased cellular damage. Iudr, in saturation concentration increases the cells radiosensitivity. Specifically in 300µm spheroids, in the presence of Iudr, cell damage was increased to 50%. Conclusion: Comparison of tail moments in spheroids with 100 and 300µm diameter showed that cell damages in larger spheroids(300µm) are lesser than smaller ones(100µm). It may be because of existence of G0 cells and cells with longer cycles, in which Iudr is incorporated to a lesser extent into them. Also, our results showed that minimum presence of Iudr increased the cells radiosensitivity. Therefore inorder to increase the efficacy of this modality of treatmnt we can increase the incubation time of Iudr, increasing the cell population in the cell cycle. In addition cells with longer cycles have more time to incorporate Iudr, or we can use agents that inhibit repairing.
Volume 15, Issue 0 (9-2008)
Introduction: Typical laryngeal carcinoid tumor, only 14 cases of which have been reported so far, is one of the rarest neuroendocrine tumors of the larynx. In all these cases supraglottic area was involved. Wide local excision is the treatment of choice.
Case Report: This article represents a 68-year-old man who presented with progressive hoarseness since 6 months ago. Indirect laryngoscopy showed an exophytic mass in the right supraglottic area. Direct laryngoscopy and biopsy were performed. Pathologic findings were compatible with a typical carcinoid tumor.
Conclusion: Owing to different biological behaviors and special treatment modality, accurate diagnosis of neuroendocrine neoplasms of the larynx is very important. When the surgeon is suspicious about the presence of these tumors, special immunohistochemical staining is essential to confirm the diagnosis.
Volume 30, Issue 6 (9-2023)
Methods: Between 2019 and 2022, patients with brain tumors were evaluated. To select the samples, 33 patients with intra-axial brain tumors were initially selected. Then, the decisions of two neurosurgeons were collected regarding the possibility of gross total resection of tumors in these cases. As a result, 4 patients were excluded from the study, and 29 patients were included. In the next step, tumor resection was performed using IOUS. According to the pathology results, 10 patients with pathologies other than glioma were excluded, and 19 patients with glioma lesions were evaluated.
The patient was admitted with a brain tumor, and initial imaging was done. During surgery, the ultrasound probe with a sterile cover entered the surgical field before opening the dura. The exact location of the tumor was determined over the dura, and so the dura was opened. With the ultrasound guide, the location of the lesion was determined, and the resection of the lesion began. Then, ultrasound was performed intermittently to determine the tumor area, and surgery continued until the complete resection of the lesion. Within 72 hours after the surgery, an MRI was performed to evaluate the extent of resection.
In order to measure the tumor volume, MRI images with the same cut distance were evaluated. Therefore, the tumor area in all MRI imaging slices was added together and multiplied by the slice distance. Then, the amount of resection was calculated by comparing the volume of the tumor before and after surgery.
Results: 19 patients were selected to participate in the study. Three patients died after surgery and during hospitalization and were therefore not included in the follow-up, but only in the pre-surgical examinations.
The characteristics of the patients are listed in table 1. In this study, there were 7 women and 12 men, whose average age was 46.5 years (average 40 years for women and 50 years for men). Most of the patients were middle-aged adults. Regarding the alertness and functional status of the patients, the average GCS was 13, and the median GCS of the samples was 14. The minimum GCS was 9, corresponding to a 58-year-old man with recurrent glioblastoma. Also, the median KPS of the patients was 80, the minimum of which was 10 and related to the same patient with glioblastoma recurrence.
Regarding the location of the lesions, most of the lesions were observed in the frontal lobe and mostly on the left side. In 32% of patients (6 out of 19 patients), the tumor was located in the eloquent area, and the lesion had an ill margin in 17 out of 19 patients.
3 patients died after surgery and they were excluded from the analysis. In the remaining 16 patients, the average length of surgery was 3 hours, with a minimum of 1.5 hours and a maximum of 5 hours. The average intraoperative bleeding was 350 cc. Also, in examining the consciousness, the average GCS was 10.4 in one hour after surgery, 12.3 in 6 hours after surgery, and 12.8 in 24 hours after surgery. The average length of hospitalization in 16 patients with glioma who survived was 9.3 days, with a minimum hospitalization time of 3 days and a maximum of 38 days.
In 16 patients of this study, the size and amount of tumor resection were calculated according to the imaging done before and after the surgery. The mean size of the tumor in pre-surgical imaging was 30.44 cc. The smallest tumor was 3.5 cc in a 47-year-old woman with complaints of headache and convulsions, whose lesion was located in the right parietal, with glioblastoma pathology. There were no lesions left in imaging after surgery. Also, the largest tumor was 74 cc in a 52-year-old man with a complaint of anxiety. In imaging, a butterfly-type glioma was observed with frontal involvement on both sides (predominantly on the right side). In the post-surgery examination, only 56% of the tumor was resected, which happened due to the proximity of the lesion to the lateral ventricle and preventing the opening of the ventricle.
In the post-surgery imaging, the mean tumor size was 4 cc. In evaluating the extent of resection, an average of 90.5% of the tumor was resected. The largest residual tumor of 32 cc was related to the patient with a butterfly tumor, which was mentioned earlier.
Out of 16 patients examined, 11 patients were extubated in the operating room. The reason for non-extubation in 5 other patients was low GCS.
Based on the extent of resection, the amount of resection was divided into three categories: gross total resection (GTR) with a tumor removal rate of more than 95%, subtotal resection (STR) with a tumor removal rate between 80 and 95%, and partial resection (PR) with a tumor removal rate of less than 80%. According to this classification, there was only one patient with partial resection in the study.
In the comparison between the amount of resection and the complications after surgery, it was observed that resection of GTR is related to the amount of dysphagia experienced by the patient after surgery. It was also observed that the rate of extubation in women is significantly higher than in men. All 6 women in the study were extubated in the operating room, whereas only 5 out of 10 men were extubated during surgery. The study did not find any correlation between complications and the amount of tumor resection or bleeding, nor hospitalization of patients. However, more comprehensive studies are needed for a more detailed investigation.
Conclusion: Ultrasound during surgery can be used as a modality in brain tumor surgery because it has efficient results, and its use is easy and cheap. Although ultrasound cannot be considered as a substitute for other modalities during surgery to monitor the patient, its use can be beneficial for the patient.
Among the important advantages of using ultrasound during surgery that were observed in the patients of this study, we can mention the possibility of detecting the ventricles in the periphery of the tumor and preventing entry into the ventricle during surgery, which prevents the occurrence of significant complications such as ventriculitis. One of the reasons why complete resection was not performed in some patients was the long interval between preoperative imaging and surgery, which caused some tumor foci to be missed during surgery.
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