These cells were then incubated at a ratio of 40 : 1

with 51Cr-labelled B16 or B16FasL cells for 4 hr at 37°. For minimal and maximal lysis, cells were LY2606368 ic50 incubated with medium or 5% Triton-X-100, respectively. Lytic activity was measured by 51Cr release with the formula: % lysis = [(sample − min)/(max − min)] × 100. B6 mice were injected i.p. with 0·5 mg of PC61 or GL113 antibodies 4 days and 1 day before s.c. injection of 0·5 × 106 B16-FasL cells. Twenty-four hours later, the skin area including the tumour cells was dissected, snap-frozen in liquid nitrogen and RNA was extracted using TRIzol reagent (Invitrogen, Carlsbad, CA). Total RNA was reverse transcribed using Superscript III (Invitrogen), and subsequently cDNA was amplified in triplicate Selleck LBH589 by real-time PCR using 1 × Platinum SYBR Green qPCR SuperMix (Invitrogen) with primers for glyceraldehyde 3-phosphate dehydrogenase (GAPDH), CXCL1/KC or CXCL2/MIP-2. Messenger mRNA levels were normalized relative to GAPDH mRNA expression. The average C(t) values were taken from three mice per group and data are presented as gene expression in PC61-treated mice relative to control GL113-treated mice. Primer pairs were as follows: GAPDH, 5′-TGACCTTGCCCACAGCCTTG-3′ (sense) and 5′-GAACGGGAAGCTTGTCATCA-3′ (anti-sense): CXCL1/KC, 5′-CTCAAGAATGGTCGCGAGGCT-3′ (sense) and 5′-GCACAGTGGTTGACACTTAGTGGTCTC-3′ (anti-sense); CXCL2/MIP-2 5′-CCACTCTCAAGGGCGGTCAAA-3′ (sense) and 5′-TACGATCCAGGCTTC-CCGGGT-3′

(anti-sense). We previously found that B16FasL cells are rejected more efficiently by C57BL/6 (B6) mice when Treg cells are partially depleted by in vivo administration of CD25-specific mAbs.9 Furthermore, this effect is attributable to the ability of Treg cells to suppress innate immune responses.9 To characterize the Flavopiridol (Alvocidib) nature of the innate response inhibited by Treg cells, we injected mice partially depleted of Treg cells and control mice with B16FasL cells and assessed the response to this whole cell challenge at early time-points thereafter. We first performed histological analyses to study the cellular

infiltrate at the non-palpable B16FasL inoculation site. B6 mice treated with depleting CD25-specific mAbs (PC61) or non-depleting control mAbs (GL113) were injected s.c. with 105 live B16FasL, then 4, 24 and 96 hr after tumour injection mice were killed and the injected skin was removed for histology. Tissue was embedded in paraffin and 5-μm sections were cut at 300-μm intervals throughout the skin. Sections were stained with H&E to locate the midsection of the tumour inoculation site (Fig. 1a–d). A large amount of cell death was observed at each inoculation site, as indicated by the lack of cellular cohesion and the presence of fragmented nuclei (Fig. 1b,d). Analyses at these early time-points revealed the presence of an inflammatory infiltrate evident within 24 hr of tumour cell inoculation and which was significantly larger in the PC61-treated group (Fig. 1c,d) compared with the GL113-treated group (Fig.

By comparison, of the chronic kidney disease (CKD) population without diabetes, an estimated 24% have an eGFR<60 mL/min per 1.73 m2 in the absence of albuminuria. The proportion of the diabetes

population with normoalbuminuric CKD, however, increases with older age and is affected by the proportion of patients receiving treatment with ACE inhibitors and angiotensin receptor blockers (ARB).[6, 7] Thus, as the demographics and the management of the diabetes population in Australia change, so will the distribution of markers of kidney damage in this population. Longitudinal surveillance of the diabetes population Cell Cycle inhibitor in the United States has shown evidence of such trends. find more Comparing NHANES survey data for 1988–1994 to data for 2005–2010, albuminuria prevalence in the diabetes population declined from 36% to 30% over this period, whereas the prevalence of eGFR<60 mL/min per 1.73 m2 increased from 16% in 1988–1994 to 19% in 2005–2010.[8] These observations are indicative of competing trends that will have important

implications for the future burden of DKD in the Australian population: (i) the ageing of the diabetes population due to increasing incidence of late onset T2DM and improved survival among the diabetes population, increasing the prevalence of low eGFR, and (ii) the impact of either increased use of ACE inhibitors and ARB on albuminuria prevalence. The distribution of markers of CKD in the population with diabetes has important implications for approaches to screening and disease prevention, and therefore an understanding of temporal trends in the prevalence of albuminuria and low eGFR is necessary to guide

approaches to detection and management of DKD. Of the approximately 250 000 Australians with DKD, 913 commenced treatment for ESKD with a primary diagnosis of diabetic nephropathy in 2012. These figures correspond to an annual incidence of treated DM-ESKD among Australian adults 25 years and older with diabetes (diagnosed and undiagnosed) of approximately 1 case per thousand. Over the past two decades, DKD has rapidly emerged as the single leading cause of ESKD among patients commencing kidney replacement therapy (KRT) in Australia (Fig. 1). Of all incident KRT patients in 2012, 38% had a primary diagnosis of DM-ESKD, compared with 13% in 1991. Indeed most of the overall increase in the annual number of patients commencing KRT, from 979 new patients in 1991 to 2379 patients in 2012, is due to the more than 600% increase in the number of incident patients with DM-ESKD over this period. This growth in DM-ESKD incidence cannot be explained by demographic factors: after adjusting for age, sex and race, the incidence of KRT due to DM-ESKD still increased by 7% per annum.

Background: SWN is a feature of tubulo-interstitial pathology and in my experience is more common than glomerulonephritis. Without awareness of the clinical features, its presence may go undetected,

as there may be no evidence (abnormal eGFR or urine dipstick) of chronic kidney disease (CKD). Methods: Review clinical records of 50 patients identified as SWN, whose symptoms were described at ANZSN 2013, to identify eGFR (MDRD), dipstick urinalysis and 24 hour protein excretion. Collate scanning reports, blood pressure measurement and treatments, along with other relevant signs. Results: 6 men and 44 women, mean age 46.8 years (range 25–92). 68% of patients with appropriate data would not have been classified with CKD according to eGFR criteria. 1 had CKD 1, 20% had CKD 2, 9% had CKD 3. Haematuria was noted in 23%, proteinuria >0.15 g/24 h find more was present in 2 patients, glycosuria in 3 patients and urine pH of selleck chemicals 7 or over in 62%. Anti-hypertensives were required in 16%. The mean blood pressure of the untreated group was 118/74. In 22 patients eGFR improved by a median of 7 mL/min/1.73 m2 (range 1–37), over a median follow up of 15 months (range 1–107). In 9 patients, eGFR deteriorated by a median of 10 mL/min/1.73 m2 (range 2–35), over

a median follow up period of 14 months (range 3–89). Urinary tract infections were documented in 60%. Small or scarred kidneys were seen in 29%. Conclusions: SWN is a significant public health threat, which with recognition and correction, may offer insights into common clinical problems. 212 THE INITIAL SIX MONTHS OF AN AUSTRALIAN RENAL GENETICS CLINIC SERVICE A MALLETT1,2, C PATEL3, J MCGAUGHRAN3, H HEALY1,2 1Department DNA ligase of Renal Medicine, Royal Brisbane and Women’s Hospital, Queensland; 2CKD.QLD and School of Medicine, University of Queensland, Queensland; 3Genetics Health Queensland, Royal Brisbane and Women’s Hospital, Queensland, Australia Aim: To describe the initial experience of a new Australian Conjoint Renal Genetics (CRG) and Inheritable Kidney Disease (IKD) Clinic program. Background: Rapid expansion

in the understanding of genetic forms of kidney disease provides opportunities to consider clinical service redesign. This is required to enable optimal translation of this knowledge into a paradigm of personalised healthcare. Methods: A clinical audit has been undertaken of the first six months (1.7.13 to 31.12.13) of the CRG-IKD Clinic program at RBWH, Queensland. Results: 71 patients from 64 families were encountered in 101 clinic appointments (96% attendance) across 23 clinic dates. Referral was most commonly from a General Practitioner (44.9%) or Nephrologist (39.1%). A renal diagnosis had been made at time of referral in 76.9% of cases. Patients were most commonly female (59.2%), with a mean age of 44years and an early stage of kidney disease (CKD Stage 1: 35.7%, CKD Stage 2: 28.6%). 12.5% and 5.

Each unique parameterization of the model specifies one ‘virtual NOD mouse’, and each virtual mouse is validated by extensive comparisons of simulated responses against published data (see below). This approach focuses on finding BGJ398 purchase biologically feasible parameterizations that reproduce critical behaviours, rather than on exact characterization of numerous difficult-to-measure parameters. In support

of our approach focusing on behavioural validation and prediction, a recent analysis of 17 other systems biology models, some with more than 200 parameters, suggests that attention to predictive accuracy, rather than parametric precision, is critical and can provide scientific value in areas where biological relationships are characterized incompletely [3]. Other models of type 1 diabetes have provided valuable insight into disease pathogenesis or health care optimization (e.g. [4–9]). As this model was designed to support drug development, it differs from existing models in the following areas. First, our model includes multiple contributors to the pathogenic process in order to support physiologically based representation of a diverse

GSK1120212 cell line set of therapeutic strategies. Second, we model multiple disease stages, tracking autoimmune pathogenesis from initiation through diabetes onset in order to investigate relative efficacy associated with interventions applied at different disease stages. It should be noted that the focus of our model (and most corresponding NOD mouse research) is on disease prevention or remission, not disease management. Finally, our model represents the physiologically based interactions leading to destruction of β cells, differentiating it from Archimedes, another large-scale diabetes model which Wilson disease protein includes detailed representation of metabolic responses, health care and complications, but in which disease results from a mathematical combination of epidemiological factors [8]. This paper is a biology-focused description of the Type 1 Diabetes PhysioLab platform intended

to introduce the model at a level of detail appropriate for understanding its research applications. Due to its size, a full mathematical description of the entire platform is not reasonable within the body of text. However, to illustrate our modelling approach, the equations, assumptions and data sources for a key module, islet CD8+ T lymphocytes, are summarized in Appendix S1, along with textual explanations. Further, the full model is available freely online as a downloadable file, including all equations, parameters, references, documentation, simulated intervention experiments reproducing published protocols and their associated simulation results (Appendix S2). We applied a top-down, outcomes-focused approach in developing the Type 1 Diabetes PhysioLab platform.

These findings suggest encouraging possibilities for targeting angiogenesis (for instance with anti-VEGF) Rapamycin as a therapeutic strategy in pilocytic astrocytoma. “
“Adult-onset GM2 gangliosidosis is very rare and only three autopsy cases have been reported up to now. We report herein an autopsy case of adult-onset GM2 gangliosidosis. The patient developed slowly progressive motor neuron disease-like symptoms after longstanding mood disorder and cognitive dysfunction. He developed

gait disturbance and weakness of lower limbs at age 52 years. Because of progressive muscle weakness and atrophy, he became bed-ridden at age 65. At age of 68, he died. His neurological findings presented slight cognitive disturbance, slight manic state, severe muscle weakness, atrophy of four limbs and no extrapyramidal signs and symptoms, and cerebellar ataxia. Neuropathologically, mild neuronal loss and abundant lipid deposits were noted in the neuronal LY2606368 cytoplasm throughout the nervous system, including peripheral autonomic neurons. The most outstanding findings were marked neuronal loss and distended neurons in the anterior horn of the spinal cord, which supports

his clinical symptomatology of lower motor neuron disease in this case. The presence of lipofuscin, zebra bodies and membranous cytoplasmic bodies (MCB) and the increase of GM2 ganglioside

by biochemistry led to diagnosis of GM2 gangliosidosis. “
“S. Sharma, R. Bandopadhyay, T. Lashley, A. E. M. Renton, A. E. Kingsbury, R. Kumaran, C. Kallis, C. Vilariño-Güell, S. S. O’Sullivan, A. J. Lees, T. Revesz, Elongation factor 2 kinase N. W. Wood and J. L. Holton (2011) Neuropathology and Applied Neurobiology37, 777–790 LRRK2 expression in idiopathic and G2019S positive Parkinson’s disease subjects: a morphological and quantitative study Aims: Mutations in the gene encoding leucine-rich repeat kinase-2 (LRRK2) have been established as a common genetic cause of Parkinson’s disease (PD). The distribution of LRRK2 mRNA and protein in the human brain has previously been described, although it has not been reported in PD cases with the common LRRK2 G2019S mutation. Methods: To further elucidate the role of LRRK2 in PD, we determined the localization of LRRK2 mRNA and protein in post-mortem brain tissue from control, idiopathic PD (IPD) and G2019S positive PD cases. Results: Widespread neuronal expression of LRRK2 mRNA and protein was recorded and no difference was observed in the morphological localization of LRRK2 mRNA or protein between control, IPD and G2019S positive PD cases.

By contrast, no differences in the percentage of CD8+ T cells stained with antibodies directed

to IFN-γ, IL-4 and IL-13 were observed. Because CD8α+ DCs have been implicated as the main DC subset for cross-presentation and cross-priming of CD8+ T cells,21–23 we investigated whether treatment of allergic mice with OVA-pulsed DCHISs also resulted in the accumulation of CD8α+ DCs in the lungs. Figure 4(a,b) www.selleckchem.com/screening/selective-library.html shows that i.t. injection of both OVA-pulsed control DCs and OVA-pulsed DCHISs resulted in a higher proportion of CD8α+ cells in the population of CD11c+ cells. However, the proportion of lung CD8α+ cells was significantly higher (P < 0·05) for mice treated with OVA-pulsed DCHISs versus OVA-pulsed control DCs. Moreover, we found that CD11c+ cells isolated from the lungs of mice treated with DCHISs released higher levels of LTB4 compared with CD11c+ cells isolated from the lungs of mice treated with control DCs (Fig. 4c). Because LTB4 displays a potent chemotactic effect on CD8

T cells,24 this result could explain the infiltration of the lungs by CD8+ T cells found in mice treated with DCHISs. We finally investigated whether administration selleck chemicals llc of OVA-pulsed DCs to allergic mice resulted in changes in serum levels of specific IgE antibodies or the percentages of eosinophils found in the BAL. In these experiments, OVA-pulsed DCs were injected 3 days after challenge of mice with aerosolized OVA, and BAL and serum samples 4��8C were obtained 2 weeks later. Figure 5(a,b) shows that administration of OVA-pulsed DCHISs resulted in: (i) a significant increase in serum levels of specific IgE antibodies directed to OVA, and (ii) an increase of eosinophils percentages of eosinophils in BAL compared with mice treated with OVA-pulsed control DCs. Asthma is a complex respiratory disease characterized by persistent airway inflammation and AHR.25 Eosinophils, Th2 cells and mast cells play a critical role in asthma.26,27 These cells

are recruited in the lung and upon activation they release a number of cytokines and chemokines inducing airway inflammation. In contrast to the well-defined role of Th2 cells in the induction of IgE production, eosinophilia and AHR, the role of CD8+ T cells is less well established.28,29 A number of reports, however, have shown that CD8+ T cells are essential for the development of AHR and allergic inflammation.30 An increased number of CD8+ T cells were observed in the blood and in the BAL of asthmatic patients, while animal models of airway inflammation have revealed substantial CD8+ T-cell infiltration of the bronchial mucosa after allergic sensitization.

4B). Mice immunized with GFP+ CD8α+ cDCs from non-protected mice had equivalent bacterial titers as non-transferred animals upon challenge infection. In fact, only GFP+ CD8α+ cDCs from mice immunized with the protective dose of secA2−Lm were

able to induce substantial levels of immunity. Since the number of bacteria per infected cell is the same between the two conditions of immunization, it suggested that other signals distinct from those given by cytosolic bacteria are allowing CD8α+ cDCs from protected animals to be optimally conditioned to induce CD8+ T-cell protective memory. Protected mice were immunized with ten-fold more bacteria than non-protected click here animals, likely leading to a stronger inflammatory environment at the time of DC maturation. To provide support for this hypothesis, we measured the early inflammatory environment (5 h) under Seliciclib price the two conditions of immunization (Fig. 5). As proposed, we readily detected a strong inflammatory response

that included cytokines and chemokines involved in DC maturation in mice that received 107secA2−Lm. Animals injected with the lower numbers of bacteria were comparable to non-immunized control groups and exhibited low levels of inflammation. We next sought to determine whether this finding held true for animals immunized with other well-established Tangeritin protective Lm immunizations, e.g. wt Lm or the attenuated mutant actA−Lm25 (Supporting Information Fig. 5) and monitored several inflammatory mediators (IL-1β, CCL2, IL-12p70 and TNF-α) over a 48 h kinetics. In all groups that received protective immunization (e.g. 107secA2 Lm−, 106actA−Lm

and 3000 wt Lm), inflammation reached levels that were never measured in mice immunized with the non-protective dose of secA2−Lm. In the case of wt Lm immunization, however, such levels of inflammation were only observed at later time points (24–48 h), a result in agreement with former studies 26, which also correlates with the low initial inocula and the growth kinetics of wt Lm in vivo 16. Therefore, collectively these data favor the idea that during a protective immunization, CD8α+ cDCs receive stronger extracellular inflammatory signals than during non-protective immunization, which likely contribute to their optimal maturation in vivo. To further support to our interpretation that both cytosolically delivered and extracellular signals are conditioning CD8α+ cDC optimal programming, we compared the maturation profiles of infected and non-infected CD8α+ cDCs from mice immunized with the two doses of secA2−Lm.

Tetraspanins can potentially contribute to both adhesion-dependent and adhesion-independent DC migration. Tetraspanins are best characterized by their ability to molecularly interact with integrins — adhesion molecules important in regulating cell migration in many diverse cell types [2]. Tetraspanins regulate integrin function, as frequently observed in the impaired adhesion and migration of tetraspanin-deficient cells of various lineages [27, 29-31]. Similarly, we demonstrate that adhesion to fibronectin is impaired in CD37−/− DCs under low shear flow (Fig. 6A) implicating a role for CD37 in regulating

outside-in signaling of α4β1 and/or α5β1 integrins in DCs. Tetraspanins are also known to interact with the cytoskeleton AZD2281 via molecular interactions with ezrin/radixin/moesin proteins [37], and cross-linking tetraspanins at the cell surface can drive cytoskeletal rearrangement [38]. In buy R788 this study we observed impaired CD37−/− DC function in two processes known to require cytoskeletal rearrangement: integrin outside-in signaling, investigated by measuring adhesion under flow (Fig. 6A), as well as

cell spreading to form membrane protrusions (Fig. 6C–G). An effect of CD37 ablation on cytoskeletal rearrangement is also consistent with a recent report that the absence of another tetraspanin, CD81, results in inhibited integrin-dependent in vitro DC chemotaxis [28] and the formation of membrane protrusions, driven by

a dysregulation of Rac-1 activation. While the Cell press in vivo immunological effects of impaired migration of CD81−/− DCs were not studied [28], in the present paper it is clear that CD37 ablation profoundly affects in vivo DC migration which is the likely cellular mechanism that underlies the poor cellular immunity induced in CD37−/− mice. The next challenge is to unravel the molecular interactions of CD37 in DCs. C57BL/6 (WT), C57BL/6.CD37−/− (CD37−/−) [10], CD11cYFP, CD37−/−.CD11cYFP, and OT-I Ly5.1 mice were bred in house, or obtained from the Walter and Eliza Hall Institute (Melbourne, Australia). Mice were housed under SPF conditions within the Burnet Institute animal facility (Austin Campus), the AMREP Animal Services, or the Nijmegen Medical Centre and used between 8 and 12 weeks of age. In vivo multiphoton imaging was performed on 8–10-week-old female CD37−/−.CD11cYFP mice with CD11cYFP mice used as controls. The corresponding campus animal ethics committees at Austin Hospital, AMREP Animal Services, Monash Medical Centre, or Nijmegen Medical Centre approved all animal experiments. Mice were challenged subcutaneously with 1–5 × 106 cells from either RMA (C57BL/6 — T-cell lymphoma) or RMA-Muc1 as described previously [39].

Gorbachev, unpublished observations). Anti-CD25 mAb treatment of mice receiving check details WT DC increased hapten-specific CD8+ T-cell activation, while blockade of CD4+CD25+ T-cell activity did not affect hapten-specific CD8+ T-cell activation in recipients of lpr DC. Finally, CD4+CD25+ T cells suppressed the activation of hapten-specific CD8+ T cells cultured with WT but not lpr DC, indicating that negative regulation of effector CD8+ T-cell activation was mediated through effects on Fas-expressing DC but not on Fas-expressing CD8+ T cells. Together these results indicate

that CD4+CD25+ T cells regulate the priming functions of hapten-presenting DC in CHS through Fas–FasL interactions. The ability of regulatory CD4+CD25+ RGFP966 datasheet T cells to express FasL and kill Fas-expressing target cells has been previously reported 19, 26, 27. This report is the first, to our knowledge, demonstrating the ability of these regulatory cells to restrict DC priming

functions in CD8+ T-cell-mediated immune responses through a Fas–FasL-dependent mechanism. Furthermore, CD4+CD25+ T cells suppress CD8+ T-cell-mediated CHS responses in a non-specific manner. CD4+CD25+ regulatory T cells activated by hapten sensitization restricted the ability of LC activated by subsequent sensitization with a non-related hapten to activate CD8+ T cells specific to the latter hapten. These results are consistent with studies demonstrating non-antigen-specific suppression of T-cell-mediated autoimmune gastritis and viral responses by CD4+CD25+ regulatory T cells 28, 29. The current report further supports the hypothesis that previously activated CD4+CD25+ regulatory T cells can exert non-specific suppressor functions 28. Collectively, these studies reveal the restriction of cutaneous DC priming functions in the skin-draining LN through Fas–FasL interactions as a mechanism employed by CD4+CD25+ T cells to regulate

effector CD8+ T-cell development and expansion during cutaneous immune responses. The findings may be also applicable to the understanding of immunoregulation of other T-cell-mediated immune responses. WT and lpr female mice on the C57BL/6 background were purchased from The Jackson Laboratory Neratinib solubility dmso (Bar Harbor, ME). All animal experiments were performed according to the National Institutes of Health Guides for the Care and Use of Laboratory Animals and all protocols were approved by the Institutional Animal Care Use Committee (IACUC) of The Cleveland Clinic. DNFB and FITC were purchased from Sigma (Sigma Chemical, St. Louis, MO). mAb for the capture and detection of IFN-γ in ELISPOT assays, PE-labeled and biotin-labeled hamster isotype control Ab, anti-CD11c, anti-Fas and anti-FasL mAb MFL3, and streptavidin-APC, streptavidin-PE and streptavidin-FITC were purchased from BD Bioscience (San Diego, CA). AlexaFluor 647-labeled mAb RMUL.

08 (2.98-3.18)) and MSAc cerebella (expression NVP-AUY922 ic50 change: 2.44 (2.14-2.88)). In the latter there was CysC overexpression in Pukinje

cells, Bergmann glia and dentate nucleus neurons. No cathepsin increase was detected in MSA cerebella. High mRNA levels of CST3 and cathepsins B and L1 were observed in SCA3 and CI brains. CysC changes are differentially present in the parkinsonian and cerebellar forms of MSA and may play an important role in the pathogenesis of this neurodegenerative condition. “
“Medulloblastoma is the most common paediatric malignant brain tumour. To identify altered genetic events in a comprehensive manner, we recently performed exome sequencing of a series of medulloblastomas [1]. This study identified mutations in genes involved in chromatin modification in 20% of patients examined, including the myeloid/lymphoid or mixed lineage leukaemia (MLL) family genes MLL2 and MLL3, which were not previously known to be associated with medulloblastoma [1]. The majority of those alterations were nonsense or frameshift mutations, indicating that MLL2 and MLL3 are new medulloblastoma tumour suppressor genes [1]. Subsequent exome sequencing studies further validated MLL2 pathway mutations as medulloblastoma

driver events [2-4]. In this report, we present detailed histopathological characteristics of three cases with MLL2/3 gene mutations. The male patient discussed in case 1 initially presented as a 5-year-old with a profound frontal headache associated with nausea and vomiting, following receipt of an immunization booster. Five days later the headache HA-1077 in vitro returned, and he was noted to have a gait imbalance; a magnetic resonance AG-014699 ic50 imaging scan showed a fourth ventricular mass (Figure 1A). Histopathological analysis revealed a medulloblastoma. Therapy consisted of craniospinal irradiation with a posterior fossa boost and chemotherapy consisting of a bone marrow transplant protocol

of vincristine, amifostine, cisplatin and cyclophosphamide. He is now 5 years post therapy without evidence of disease. Case 2 is of a male patient who presented as an 11-year-old who began to experience decreased appetite and headaches that awoke him, associated with nausea and vomiting. A computed tomography scan showed marked hydrocephalus with a 4-cm mass in the posterior fossa. Histopathological analysis identified a medulloblastoma. Post-operatively, he underwent craniospinal radiation therapy and chemotherapy with vincristine, cisplatin and cyclophosphamide supplemented with hyperalimentation via gastric tube placement. Now at 6 years post diagnosis, he is doing well at recent follow-up. Case 3 is a female patient who presented as a 7-year-old with a 3-week history of headache associated with morning nausea and vomiting, dizziness and recent onset of double vision. Radiographic studies revealed an enhancing mass lesion in the fourth ventricle. Axial and sagittal gadolinium-enhanced images demonstrated diffuse leptomeningeal spread of disease.