Spinal metastasis from renal cell carcinoma, 31 years following nephrectomy--case report

Most renal cell carcinomas recur or metastasize within 2 years. We present a 62-year-old lady with metastatic renal cell carcinoma in the spine, 31 years following nephrectomy of the primary tumor. This is the longest interval between diagnosis of primary renal cell carcinoma and metastasis reported in the literature.

Assessment and management of the head-injured patient

Head injury is one of the most important causes of serious morbidity and mortality in young adults. Each year in Britain, there are approximately 5000 deaths from serious head injuries. Appropriate multidisciplinary assessment and management of systemic and intracranial pathology can significantly improve the outcome.

Carcinomatous meningitis: antibody-guided therapy with I-131 HMFG1

Seven patients with carcinomatous meningitis were administered intrathecal I-131 labelled monoclonal antibody HMFG1. Clinical responses were seen in two patients, with a long term survivor at 32 months. Aseptic meningitis occurred in 4/7 patients, but more serious toxicity was observed in the form of seizures (2/7 patients) and myelosuppression (3/7 patients). Partial obliteration of the subarachnoid space was identified as a potential problem in patients with advanced disease.

Monoclonal antibody and F(ab')2 fragment delivery to tumor in patients with glioma: comparison of intracarotid and intravenous administration

Non-i.v. delivery of radiolabeled monoclonal antibodies (MAbs) has been shown to increase tumor uptake and decrease dose to normal tissues. In this study, we have examined the potential advantage of intracarotid (i.c.) versus i.v. administration for the delivery of an intact MAb and a F(ab')2 fragment to tumor in patients with gliomas. Three patients received 10-50 mg of 81C6 IgG2b, a MAb reactive with the glioma-associated extracellular matrix antigen tenascin, and three received 5-20 mg of the F(ab')2 fragment of Mel-14, which is reactive with gliomas and melanomas. Paired-injection protocols, in which one-half of the MAb was labeled with 131I and administered by i.c. injection, and one-half was labeled with 125I and simultaneously administered by i.v. injection, were used. For both 81C6 IgG2b and Mel-14 (Fab')2, no differences in blood clearance half-times or urinary excretion rates of radioiodine were observed between i.c.- and i.v.-administered activity. Analysis of biopsy samples revealed i.c.:i.v. uptake ratios of 1.02 +/- 0.04, 0.95 +/- 0.03, and 1.03 +/- 0.05 for the accumulation of 81C6 IgG2b in temporalis muscle, normal brain, and glioma, respectively. Similarly, the i.c.:i.v. uptake ratios for Mel-14 F(ab')2 in these tissues were 0.98 +/- 0.04 (SD), 1.00 +/- 0.05, and 1.04 +/- 0.05. When the differences in percentage of injected dose/g uptake after i.c. and i.v. administration were compared, no statistically significant advantage for i.c. delivery was seen (P = 0.22-0.61). These data indicate that i.c. administration of MAb 81C6 IgG2b and Mel-14 F(ab')2 fragments offers no delivery advantage to offset the small but finite risk involved in cannulation and injection of the internal carotid artery.

Cerebral distribution of immunoconjugate after treatment for neoplastic meningitis using an intrathecal radiolabeled monoclonal antibody

A detailed autopsy and autoradiographic study was performed after the death of a patient undergoing intrathecal, antibody-guided irradiation for carcinomatous meningitis. The results demonstrated tumor cells infiltrating the surface meninges and a severe astrocytic reaction associated with oedema in the periventricular and brain stem subpial white matter. This was not seen in cortical or other gray matter structures. Autoradiographic examination correlated well, demonstrating isotope within the oedematous areas of the white matter in addition to the expected concentration in the leptomeningeal layers. These findings are discussed in the context of antibody binding to tumor tissue and the possible benefits conferred in the treatment of infiltrating tumor cells.

Spontaneous atlantoaxial subluxation: an unusual presenting manifestation of Reiter's syndrome

A male Sikh presented with spontaneous neck pain. Plain cervical radiography showed gross atlantoaxial subluxation (AAS). Computed tomography showed soft tissue anterior to a subluxed odontoid peg. A diagnosis of atlantoaxial tuberculosis was considered. Confirmation of this would have required a trans-oral anterior cervical biopsy. Despite the paucity of other rheumatic symptoms a diagnosis of Reiter's syndrome with spondylitis was made, and the only surgical procedure required was posterior fusion of C1 and C2, with resultant spinal stability and pain relief. This is the first report of Reiter's syndrome presenting with AAS.

Epidermoid and cholesterol cysts in the apex of the petrous bone

Cystic lesions in the petrous apex are nearly always either epidermoid cysts, with a soft but solid content, or cholesterol cysts, containing brown fluid. They may be symptomless, produce progressive cranial nerve palsies or, occasionally, reach the CSF pathways thus leading either to meningitis or a CSF leak. Thirteen cases and four unverified cases have been encountered amongst a series of more than 500 cerebellopontine angle tumours. Their clinical features, radiological diagnosis and difficulties of surgical approach are discussed.