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Background: The purpose of this study was to evaluate whether breast carcinoma biomarkers vary among separate tumor foci of multifocal/multicentric (MF/MC) breast carcinomas and whether this variation correlates with morphological features and tumor grade., Design: We reviewed the biomarker profiles of MF/MC invasive breast carcinomas diagnosed between January 2001 and June 2010 at our institution. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal receptor protein (HER2) results were classified as positive or negative., Results: Out of the 51 patients included in the study, 6 cases had 2 tumor foci with different morphologies, 7 cases had 2 foci with similar morphology but different grades, and 38 cases had 2 tumor foci with similar morphologies and grades. Out of the 38 patients who had MF/MC tumors with the same morphology and grade, only 1 patient had a difference in ER and PR status between foci. Out of the 7 patients who had morphologically similar tumors with different grades, 4 had similar results in both tumor foci, 3 had different results for ER and PR, and another had differing results for HER2 between the foci. All 6 patients who had MF/MC foci with different morphologies exhibited similar ER, PR, and HER2 results between the foci., Conclusion: Regardless of the similarity in tumor morphology or grade, a small number of cases included foci that exhibited different tumor marker expression, which might affect the treatment strategy. Therefore, our results suggest that the evaluation of tumor markers in different foci should be considered in MF/MC tumors for accurate treatment strategies.

The purpose of this study is to evaluate the roles of resection extent and adjuvant radiation in the treatment of craniopharyngiomas. We reviewed the records of 122 patients ages 11-52 years who received primary treatment for craniopharyngioma between 1980 and 2009 at the University of California, San Francisco (UCSF). Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were development of panhypopituitarism, diabetes insipidus (DI), and visual field defects. Of 122 patients, 30 (24%) were treated with gross total resection (GTR) without radiation therapy (RT), 3 (3%) with GTR + RT, 41 (33.6%) with subtotal resection (STR) without RT, and 48 (39.3%) with STR + RT. Median age at diagnosis was 30 years, with 46 patients 18 years or younger. Median follow-up for all patients was 56.4 months (interquartile range 18.9-144.2 months) and 47 months (interquartile range 12.3-121.8 months) for the 60 patients without progression. Fifty six patients progressed, 10 have died, 6 without progression. Median PFS was 61.1 months for all patients. PFS rate at 2 years was 61.5% (95% CI: 52.1-70.9). OS rate at 10 years was 91.1% (95% CI 84.3-97.9). There was no significant difference in PFS and OS between patients treated with GTR vs. STR + XRT (PFS; p = 0.544, OS; p = 0.735), but STR alone resulted in significantly shortened PFS compared to STR + RT or GTR (p < 0.001 for both). STR was associated with significantly shortened OS compared to STR + RT (p = 0.050) and trended to shorter OS compared to GTR (p = 0.066). GTR was associated with significantly greater risk of developing DI (56.3 vs. 13.3% with STR + XRT, p < 0.001) and panhypopituitarism (54.8 vs. 26.7% with STR + XRT, p = 0.014). In conclusion, for patients with craniopharyngioma, STR + RT may provide superior clinical outcome, achieving better disease control than STR and limiting side effects associated with aggressive surgical resection.

Anaplastic meningiomas that resemble sarcomas often reveal clues to their meningothelial differentiation or develop in a plausible setting that confirms their meningothelial origin. Malignant mesenchymal neoplasms without obvious evidence of meningothelial differentiation or origin are more likely to be true primary or metastatic sarcomas. Because of their clinical and biological differences, it is important to distinguish anaplastic meningioma from a sarcoma. We present a 67-year-old woman with multiple meningiomas, who developed a high-grade spindle cell tumor 6 months after the resection of a World Health Organization grade I meningioma. It was not clear whether this tumor represented a malignant transformation of meningioma or a primary sarcoma. Malignant transformation of a meningioma is exceptional within this short period and a coexisting sarcoma and meningioma are equally uncommon. Even though these malignant neoplasms are rare in general, they appear to be more prevalent in patients with multiple meningiomas including those with neurofibromatosis type 2.

Objective: To determine whether the order of intraocular pressure (IOP) measurement between right and left eyes affects IOP measurement., Methods: A total of 105 healthy volunteers from the eye clinics and staff at Washington University were randomized into 2 groups. Group 1 underwent 3 sets of 2 IOP measurements per eye, starting with the right eye (right eye twice, left eye twice, right eye twice). Group 2 underwent similar measurements starting with the left eye. After 2 weeks the order of IOP measurements were reversed between groups. A mixed-model repeated-measures analysis of variance analyzed the association of IOP measurement with the order measured (1) between first and second eyes, (2) between first and second visits, (3) between right and left eyes, and (4) with ocular squeezing., Results: Intraocular pressure measured higher in first eyes compared with fellow eyes regardless of whether right or left eyes were measured first (P = .002). Intraocular pressure measurements decreased between the first and second visits (P < .001). No difference was found in IOP measurements between right and left eyes (P = .41). Moderate and severe ocular squeezing were associated with higher IOP measurements (P < .001) and occurred more during earlier than later IOP measurements within a set (P < .001) and between sets (P < .001 to P = .03)., Conclusions: Intraocular pressure measured in the first eye, whether right or left, is higher than IOP measured in the fellow eye; this may be partially because of ocular squeezing. Measurements of IOP decrease between first and second visits. Multiple IOP measurements at multiple visits are necessary to accurately diagnose and treat patients with glaucoma and ocular hypertension.

Today, one of the most popular and controversial topics in medicine is undoubtedly the rapidly developing field of stem cell research. Some of the controversy in this field arises from lack of uniform terminology and different interpretation of concepts such as brain tumor stem cells. In addition, lack of reliable and universal markers that can identify stem cells and define precursor cells in a particular differentiation pathway further confounds the interpretation of results in many studies. Stem cells are undoubtedly critical in normal cellular development as well as tumor biology and better characterization of these cells is likely to have profound influence on the classification schemes of tumors. In this manuscript, we present the generally accepted definitions of key concepts in stem cell biology and review some of the related molecular pathways. In addition, we put forth our position on how progress in this field should be affecting the future classification schemes of central nervous system neoplasia. We strongly believe that the ever increasing knowledge in the field of neural and brain tumor stem cells should be influential in the subsequent attempts to classify brain tumors.

Background: To assess the intra-examiner repeatability and agreement of corneal pachymetry maps measured by time-domain (Visante OCT) and Fourier-domain optical coherence tomography (RTVue OCT)., Methods: This observational cross-sectional study enrolled 72 eyes from 72 volunteers. Only one eye of each patient was chosen randomly to receive repeated scanning with both devices by the same examiner, in order to test the intra-observer repeatability. The first scan by each device from all enrolled eyes was used to analyze the difference and agreement between the two devices. The agreement between the two devices was analyzed by the Bland-Altman method. Intra-observer repeatability of each OCT device was analyzed by intra-class correlation (ICC)., Results: The mean corneal thickness of the central 2 mm zone was 524.3 ± 35.7 µm and 525.4 ± 35.3 µm by the Visante OCT and the RTVue OCT respectively (p = 0.089). The intra-observer repeatability of the RTVue OCT (ICC = 0.994) was superior to that of the Visante OCT (ICC = 0.989) in the central 2 mm zone. However, the intra-observer repeatability of the RTVue OCT in the pericentral 2 to 5 mm zone was not superior to that of the Visante OCT. Both OCT devices had similar repeatability in the pericentral 2 to 5 mm zone [ICC of the Visante OCT = 0.991; 95% confidence interval (CI) 0.986-0.995), ICC of the RTVue OCT = 0.991; 95% CI 0.985-0.994))., Conclusions: The difference in CCT measurement by the Visante OCT and the RTVue OCT is probably too small to influence clinical decision making for refractive surgery and glaucoma management. The RTVue OCT demonstrated better intra-observer repeatability in the central 2 mm zone, which probably was related to its rapid image acquisition capability.

Background and Objective: To evaluate the safety and efficacy of residents performing glaucoma valve surgery at a metropolitan county hospital., Patients and Methods: A retrospective analysis was performed of consecutive resident-performed Ahmed valve (New World Medical, Inc., Rancho Cucamonga, CA) glaucoma surgeries from 1993 to 2005. Data of 50 eyes of 48 patients were evaluated for intraocular pressure (IOP) and best-corrected visual acuity., Results: The mean follow-up period was 34.7 +/- 30.5 months, with an IOP decrease from 30.8 +/- 11.3 mm Hg preoperatively to 15.3 +/- 11.6 mm Hg at last visit. Success, defined by a postoperative IOP of greater than 5 mm Hg and at most 21 mm Hg or less or a decreased postoperative IOP of at least 25% if the preoperative IOP was already 21 mm Hg or less, occurred in 78% of eyes. Best-corrected visual acuity decreased in 58% of eyes. Four eyes (8%) required subsequent penetrating glaucoma procedures., Conclusion: This retrospective study suggests that placement of an Ahmed valve can be a safe and effective procedure in the hands of residents under appropriate attending physician supervision., (Copyright 2010, SLACK Incorporated.)

Background and Objective: Anterior segment optical coherence tomography (AS-OCT) is an alternative method for the assessment of angle width. The purpose of this study is to assess the accuracy of AS-OCT for detecting occludable angles and compare the results of high- and low-resolution images with gonioscopy., Patients and Methods: Visante AS-OCT (Carl Zeiss Meditec, Dublin, CA) images of 303 eyes (155 patients) presenting between February 1 and July 15, 2007, were retrospectively analyzed. Angle recess area (ARA) and angle opening distances (AOD) at 250, 500, and 750 microm were measured and correlated with the corresponding gonioscopic measurements., Results: AS-OCT parameters showed a nonlinear relationship with gonioscopy, ARA having the highest correlation. Correlations between high- and low-resolution images were modest. Cut-off values were 0.180 mm2 (70.3% sensitivity, 87.4% specificity) for ARA and 0.264 mm (71.8% sensitivity, 84.8% specificity) for AOD at 500 microm., Conclusion: AS-OCT appears to be a promising screening tool for narrow angles.

Objective: To determine the proportions of glaucoma subtypes and risk factors for glaucoma in a large Japanese American clinic population., Methods: Medical records of patients of Japanese descent who visited 2 private ophthalmology clinics within the last 10 years were retrospectively reviewed. Glaucoma was diagnosed based on optic nerve findings and presence of visual field defects. Main outcome measures were distribution of glaucoma subtypes, characteristics of different glaucoma subtypes, and comparative results with Japanese American patients without glaucoma., Results: Of 1732 patients, 112 had glaucoma (6.4%). Of these, 17% had high-tension glaucoma (HTG) and 70% had normal-tension glaucoma (NTG). There were 2 patients with primary angle-closure, 3 with mixed-mechanism, and 10 with secondary glaucoma. The presence of glaucoma was positively correlated with age, refractive error, visual acuity in logarithm of the minimum angle of resolution, and intraocular pressure, while there was a negative correlation between central corneal thickness and glaucoma. Controlling for age, intraocular pressure and visual acuity remained significantly correlated with glaucoma., Conclusions: In this large Japanese American clinic population, the proportion of patients with glaucoma who had NTG was 4-fold higher than those with HTG. A prospective population-based study may be warranted to further define the spectrum of glaucoma and the reason for the high proportion of NTG in this population.