Table.1 Summary of the cases (Case 1 15). Tenttentorial,sphe:sphenoid,conv:convexity,ventventricle, parasag parasagittal, meningo : meningotheriomatou

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1 Table.1 Summary of the cases (Case 1 15). Tenttentorial,sphe:sphenoid,conv:convexity,ventventricle, parasag parasagittal, meningo : meningotheriomatous, transit:transitional.

2 Table.2 Results of MIB-1 LI and DNA index. Fig. 1 flow chart of FCM and formula for DNA inde

Fig. 2 left : Case3 (Group A) preoperative computerized tomography (CT) scanning with contrast medium revealing a mass lesion in the right convexity infiltrating into frontal lobe as homogeneous

3 Fig. 2 left : Case3 (Group A) preoperative computerized tomography (CT) scanning with contrast medium revealing a mass lesion in the right convexity infiltrating into frontal lobe as homogeneous enhancement. right : Case3 (Group A) postoperative magnetic resonance imaging (MRI) with contrast medium revealing total removal of the tumor. Fig. 3 left : Photomicrographs revealing anaplastic meningioma, (Case3) showing pleomorphism, the mitosis, and the necrosis. (H &E stain X 100) right : MIB-1 staining index is high value 14%. ^ Fig. 4 Flow cytometry showing aneuploidy pattern and DNA index is ^ Fig.5 left : and right : Case3 (Group A) preoperative MRI scanning with contrast medium revealing recurrent mass lesion in the right convexity infiltrating into frontal lobe as multiple homogenous enhancement

Fig. 6 left : Case4 ( Group B) preoperative CT with contrast medium revealing mass lesion originated from right trigone as homogeneous enhancement.

4 Fig. 6 left : Case4 ( Group B) preoperative CT with contrast medium revealing mass lesion originated from right trigone as homogeneous enhancement. right : total removal of the tumor, leaving slight edema (Simpson 2). Fig. 7 left : Photomicrographs revealing meningotheliomatous meningioma (Case4) (H&E stain X 100). right:mib-1 staining index is less than 1%. *Fig. 9 MIB-1 staining index is relative high value 10%. ^Fig. 8 Case4 (Group B) preoperative CT scanning with contrast medium revealing recurrent mass lesion along right trigone as homogenous enhancement.

*Fig. 10 left : Casel5 (Group C)preoperative CT scanning with contrast medium revealing a mass lesion in the left temporal convexity as homogeneous enhancement with perifocal edema and mass effect.

5 *Fig. 10 left : Casel5 (Group C)preoperative CT scanning with contrast medium revealing a mass lesion in the left temporal convexity as homogeneous enhancement with perifocal edema and mass effect. right : total removal of the tumor. *Fig. 11 Photomaicrographs revealing meningotheliomatous meningioma (Case15), MIB-1 staining index is less than 1%. 4 Fig12 Case15 (Group C) preoperative CT scanning with contrast medium revealing recurrent left temporal mass as slight enhanced cystic cavity wall. ^Fig. 13 MIB-1 staining index is increasing 8%. 43

1 ) Akutsu H, Sugita K, Sonobe M, et al : Parasagittal meningioma en plaque with extracranial extension presenting diffusemassive hyperostosis of the skull. Surg Neurol.

7 1 ) Akutsu H, Sugita K, Sonobe M, et al : Parasagittal meningioma en plaque with extracranial extension presenting diffusemassive hyperostosis of the skull. Surg Neurol. 61 : , ) Bigner DD, McLendon RE, Bruner JM : Russell and Rubinstein's Pathology of Tumors of the Nervous Arnold : System, 6th ed, Vol 2. London, Edward 4) Bouvier C, Liprandi A, Colin C : Lack of alkaline phosphatase activity predicts meningioma recurrence : Am 1-1 Clin Pathol : 252-8,2005 5) Kalala JP, Maes L, Vandenbrecke C, et al The htert protein as a marker for malignancy in meningiomas : Oncol Rep : 273-7, ) Roggendort W, Schuster T, Peiffer j: potential immunohistochemistry. : J Neurooncol. 34, , 21) Takeuchi H, Kubota T, Kabuto M, et at 9 ) Kolles H, Niedermayer I, Schmitt C, et : Triple Prediction of recurrence in histologically benign approach for diagnosis and grading of meningiomas: Histology, morphometry or Ki-67/Feulgen staings, and meningiomas : Proliferating cell nuclear antigen and Ki-67 immunohistochemica study. Surg Neurol 48 : cytgogenetics. Acta Neurochir(Wien) , , ) Lamszus K : Meningioma pathology, genetics, and biology : J Neuropahol Exp Neurol 63 : , ) Louis DN, Scheithauer BW, Budka H, et al : 23) Trop SH, Lindboe CF, Gronberg BH, et al ; Meningeal Tumors. Pathology and Genetics of Tumors Prognostic significance of Ki-67/MIB-1 of the Nervous System (World Health Organization proliferation index in meningiomas : Clin Classification of Tumors). Lyon, IARC, 2000, Neuropathol. 24 : , ) Maes L, Lippens E, Kalala JP, et al : The 24) Tyagi A, Chakrabarty A, Franks A; MIB-1 htert-protein and Ki-67 labelling index in recurrent proliferation index in meningiomas : does it predict and non-recurrent meningiomas : Cell Prolif. : 3-12, recurrence?a clinicopathological study. : Br J ) Maier H, Wanschitz J, Sedivy R, et al :Proliferation and DNA fragmentation in meningioma subtypes. Neuropathol Appl Neurobiol 77 : , 1992 Neurosurg. 18 : , ) Moller ML, Braendstrup 0 : No prediction of recurrence of menigiomas by PCNA and Ki ) Chen 0, Demirhan B, Altinors N : Correlation between histological grade and MIB-1 and p53 immunoreactivity in meningiomas. : Clin Neuropathol : ,2005 of meningiomas determined with the monoclonal antibody Ki-67. Acta Neuropathol(Berl) 73 : , 1987.

8 Immunohistological and flow cytometric studies on proliferating activities in recurrent meningioma Hideyuki Oshige, Harubumi Kasai, Takashi Ryu, Keiichi Azuma, Qiang Li, Takashi Yamahara, Yoshihiro Numa, Keiji Kawamoto Department of Neurosurgery, Kansai Medical University Summary In 184 cases harboring meningiomas that we performed the surgical resection between 1993 and 1998, 36 cases were recurrent. In these recurrent cases, we investigated 15 cases that were removed totally (Simpson I or II )with first operation. We classified those 15 cases into three groups on the basis of WHO brain tumor's histological classification of Group A was included atypical or anaplastic meningiomas from onset to recurrence. Group B was included the cases changing from benign type to atypical or anaplastic meningiomas. Group C was included the cases showing histologically benign type in the recurrence. About those three groups, we studied MIB-1 LI by immunohistology, DNA index with FCM. In the group A (histologically, malignant to malignant), MIB-1 LI was initially high value, but recurrently high value. DNA index had the same tendency. In the group B( histologically, benign to malignant), MIB-1 LI showed initially low value, but recurrentlly into high value. DNA-index has the same tendency except case 4. Only DNA index of case 4 was initiallyl. 08 slight high and malignant. In the group C (histologically, benign to benign), MIB-1 LI was initially low, but recurrently medium or high. DNA-index has two tendencies. One is initially low, but recurrently low, and the other is initially low, but recurrently slight high. DNA-histogram in the group A and B revealed aneuploidy pattern. In the group C, it revealed all diploid pattern. In the result of that, MIB-1 LI and DNA index were correlated each other. But in the group B and C, it was hard to predict the malignant change except case 4. For the purpose of the effective prediction, we will need more studies including other predictive factors and accumulation of the cases. In recurrent meningiomas, there were some cases having high proliferative rate in spite of histologically benign. We concluded not only histological malignancy but also proliferative rate were very important, when we predict it's recurrence. Key Words Recurrence, meningioma, immunohistochemistry, flow cytometry, MIB-1

日本職業・災害医学会会誌第51巻第5号

日本職業・災害医学会会誌第51巻第5号太田ら同時多発性高血圧性脳葉出血の 1 手術例図 1 搬入時 CT 上段単純 CT 下段造影 CT 図 2 術後の脳血管撮影検査では明らかな出血源は認めない 379 Reprint request: MULTIPLE SIMULTANEOUS HYPERTENSIVE LOBAR HEMORRHAGE Hirotsugu OHTA M.D. 1) and Akira YOKOTA M.D.