Case Of Glioblastoma Multiforme Research Articles

Photodynamic therapy for glioblastoma: A preliminary approach for practical application of light propagation models.

Photodynamic therapy (PDT) is a promising treatment modality to be added in the management of glioblastoma multiforme (GBM). Light distribution modeling is required for planning and optimizing PDT. Several models have been developed to predict the light propagation inside biological tissues. In the present study, two analytical methods of light propagation emitted from a cylindrical fiber source were evaluated: a discrete and a continuous method. The two analytical approaches were compared according to their fluence rate results. Several cylindrical diffuse lengths were evaluated, and the relative deviation in the fluence rates was estimated. Moreover, a sensitivity analysis was conducted to compute the variance of each analytical model. The discrete method provided fluence rate estimations closer to the Monte-Carlo simulations than the continuous method. The sensitivity study results did not reveal significant differences between the variance of the two analytical models. Although the discrete model provides relevant light distribution, the heterogeneity of GBM tissues was not considered. With the improvement in parallel computing that drastically decreased the computing time, replacing the analytical model by a Monte-Carlo GPU-accelerated code appeared relevant to the GBM case. Nonetheless, the analytical modeling may still function in the optimization algorithms, which might be used in the Photodynamic treatment planning system. Lasers Surg. Med. 50:523-534, 2018. © 2017 Wiley Periodicals, Inc.

Variegated Colors of Pediatric Glioblastoma Multiforme: What to Expect?

Malignant gliomas account for 35-45% of primary brain tumors; among these glioblastoma multiforme (GBM) is the most common adult brain tumor constituting approximately 85%. Its incidence is quite less in the pediatric population and treatment of these patients is particularly challenging. Exposure to ionizing radiation is the only environmental factor found to have any significant association with GBM. Several genetic alterations associated with GBM in adults have been well documented such as epidermal growth factor receptor amplification, overexpression of mouse double minute 2 homolog also known as E3 ubiquitin-protein ligase, Phosphatase and tensin homolog gene mutation, loss of heterozygosity of chromosome 10p and isocitrate dehydrogenase-1 mutation. However, data on genetic mutations in pediatric GBM is still lacking. Exophytic brain stem gliomas are rare tumors and are usually associated with a poor prognosis. The most effective treatment in achieving long-term survival in such patients, is surgical excision of the tumor and then chemoradiotherapy followed by adjuvant chemotherapy by temozolomide. This schedule is the standard treatment for GBM patients. In view of the rarity of pediatric GBM, we report here a case of pontine GBM in a 5-year-old girl.

Single-stimulus dual-drug sensitive nanoplatform for enhanced photoactivated therapy

In the frame of accelerator-based BNCT, the 9Be(d,n)10B reaction was investigated as a possible source of epithermal neutrons. In order to determine the configuration in terms of bombarding energy, target thickness and Beam Shaping Assembly (BSA) design that results in the best possible beam quality, a systematic optimization study was carried out. From this study, the optimal configuration resulted in tumor doses ≥40 Gy-Eq, with a maximum value of 51 Gy-Eq at a depth of about 2.7 cm, in a 60 min treatment.The optimal configuration was considered for the treatment planning assessment of a real Glioblastoma Multiforme case. From this, the resulted dose performances were comparable to those obtained with an optimized 7Li(p,n)-based neutron source, under identical conditions and subjected to the same clinical protocol.

Abstract 4580: Improved quality of life and tumor regression in a patient with stage IV non-small cell lung cancer with brain metastasis 10 months after daily treatment with single agent mifepristone

Abstract The FDA granted an IND for a 40 patient study entitled “A phase II study of treatment with oral mifepristone as salvage therapy in patients with advanced or metastatic non-small cell lung cancer who have failed 2 or more previous chemotherapy or immunotherapy regimens”. Presented herein is a description of the effect of treating Case 1 who is a 68 year old male who presented with stage IV non-small cell lung cancer with brain metastasis causing seizures following 10 months of treatment with single agent oral mifepristone (Korlym from Corcept Inc) 300mg qd. He had shown tumor progression despite treatment with carboplatin, docetaxel, premetrexed, and gemcitabine. He was not considered a candidate for nivolumab or pembrolizumab because his tumor was negative for the programmed cell death factor ligand 1 (PD-L-1) marker. His preclinical performance status was ECOG 1. After 2 months of daily 300mg mifepristone treatment he showed a considerable improvement in energy and stamina and less shortness of breath. There have been no new lung or brain lesions. In fact, there has been shrinkage of the lung lesions and no growth of the brain lesion and no more seizures. His ECOG was “0” after 10 months of single agent mifepristone treatment. The mechanism of action is believed to be by suppressing intracytoplasmic production of an immunomodulatory protein known as the progesterone induced blocking factor (PIBF). One of the functions of PIBF is to stabilize perforin granules in natural killer cells thus inhibiting their cytotoxic activity. This protein seems to be unique to rapidly growing cells, e.g., trophoblast cells or cancer cells. Thus, in general, in low dosages, as used in this patient, the drug is very well tolerated. PIBF does not seem to be needed for cells growing at normal speed. In humans, mifepristone has been found to either cause complete tumor regression, or more commonly, stabilization of the cancer with improved quality of life. Previously, mifepristone allowed long-term complete remission from a terminal small cell lung cancer with associated hyponaotremia. The case reported here is believed the first involving palliative benefit of treating advanced non-small cell lung cancer with mifepristone. Stabilization of the brain metastasis in this report supports evidence from a previous case of advanced glioblastoma multiforme with a clear though transient response to mifepristone, that the drug can cross the blood-brain barrier, and thus be effective for brain lesions. This is the first case treated with 300mg daily mifepristone (200mg used previously). Similar to the lower dosage, this patient reported no adverse side effects. Mifepristone was also found to improve longevity and body conditioning scores in a placebo controlled study of spontaneous murine lung cancer. Citation Format: Jerome H. Check, Diane Check, Mahmoud Aly, Patricia Lofberg, Rachael Cohen, Dwight McKee. Improved quality of life and tumor regression in a patient with stage IV non-small cell lung cancer with brain metastasis 10 months after daily treatment with single agent mifepristone [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4580. doi:10.1158/1538-7445.AM2017-4580

Glioblastoma multiforme in a patient with common variable immunodeficiency and multiple malignancies – a case report

ABSTRACTA case of glioblastoma multiforme in female patient suffering from common variable immune deficiency syndrome is presented. The patient with history of previously treated due to breast carcinoma and ovarian cancer. The patient underwent craniotomy twice followed by radiotherapy and chemotherapy with temozolomide and finally died after 11 months.

A rare case of glioblastoma multiforme with bone metastasis

Glioblastoma multiforme (GBM) is the most aggressive form of primary brain tumor. The median survival time is 14 months. Extracranial metastases from GBM are even rare, with a reported frequency of only 0.44%. A rare case of GBM with bone metastases is presented in this paper. This is the first such case reported at Gujarat Cancer Research Institute, which is a radiotherapy center with maximum cancer patient load in India.

胸膜に血行性転移をきたした膠芽腫の1例

62歳, 男性. 右側頭葉膠芽腫にて開頭腫瘍摘出術施行. 肉眼的全摘出後にテモゾロミドを併用した放射線化学療法を追加した. 以後はテモゾロミド単独の維持化学療法を行った. 術後17カ月で摘出腔内側に再発を認め, その後, 大量胸水にて緊急入院となった. 胸部CTにて胸膜に多発する腫瘤を認め, 生検による病理診断の結果, 膠芽腫の胸膜への血行性転移と判明した.

Giant pediatric glioblastoma multiforme causing primary calvarial erosion and sutural diastasis presenting with enlarged head

Authors report a rare case of supratentorial glioblastoma multiforme in a 13-year-old boy, who had headache, vomiting and left sided hemiparesis for last 6 months. On evaluation by primary physician he was labeled as hydrocephalus in view of enlarged head with papilledema on fundoscopic evaluation and no imaging was carried out. On current admission, magnetic resonance imaging brain revealed a large heterogeneous mass lesion involving right frontoparietal region associated with massive perilesional edema causing significant mass effect. He underwent right fronto-temporal craniotomy and intraoperatively erosion of parietal bone was observed, unassociated with any extradural deposit of tumor. After surgery, he noticed improvement in headache along with hemiparesis. Primary calvarial erosion in glioblastoma is extremely rare, and there is paucity of literature as evident from the few case reports reported previously and all occurred in elderly, so current case is the first pediatric case having primary calvarial erosion. Management of such case and pertinent literature is briefly discussed.

A case of glioblastoma masquerading as an affective disorder.

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.To the Editor: Brain tumors can produce psychiatric symptoms, particularly if malignant and fast growing. Among gliomas, growth rate seems to be particularly relevant for the occurrence of mental disturbance, with symptoms in up to 80% of glioblastomas and only 25%-35% of lower-grade astrocytomas. We report a case of glioblastoma multiforme, a very fast-growing brain tumor, initially presenting as acute mania.

Cerebellar giant cell glioblastoma multiforme in an adult

ABSTRACTCerebellar glioblastoma multiforme (GBM) is a rare tumor that accounts for only 1% of all cases of GBM and its giant cell variant is even much rarely encountered in adults. A case of cerebellar giant cell GBM managed at our institution reporting its clinical presentation, radiological and histological findings, and treatment instituted is described. In conjunction, a literature review, including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options, and the behavior of such malignant tumor is presented. It is very important for the neurosurgeon to make the differential diagnosis between the cerebellar GBM, and other diseases such as metastasis, anaplastic astrocytomas, and cerebellar infarct because their treatment modalities, prognosis, and outcome are different.

MULTIFOCAL GLIOBLASTOMA MULTIFORME PRECEDED BY A GEMISTOCYTIC ASTROCYTOMA AND DYSREGULATED IMMUNE RESPONSE

Glioblastoma multiforme (GBM) is known to be the most common malignant form of astroglial brain tumors. The etiology, cellular and molecular pathogenic mechanisms remain unclear to a great extent. Recent research indicates the role of the immune system in malignant glioma and especially in triggering the mechanisms of local resistance and systemic immune suppression. There is accumulating evidence that the concept of the CNS as an immune-privileged organ is no longer valid. Recent advances demonstrate that it is an immunologically active site, with complex immune responses mostly based on innate immune processes. Multifocal gliomas with varying histopathological appearance are extremely rare. We report the only case of GBM preceded by a gemistocytic astrocytoma with a very short survival time of just 3 months after the onset of complaints. Interestingly, a normal CD4/CD8 ratio but prominent change in the regulatory T cell lineage was recorded. The elevation of the suppressor CD8+CD11b+ cells and the reduction of cytotoxic CD8+CD11b- cells indicate the prevalence of a suppressor phenotype which provides an explanation for the occurrence of the second malignant tumor, the rapid tumor progression and fatal outcome.

Fatal glioblastoma after Gamma Knife radiosurgery for arteriovenous malformation in a child

We describe a fatal case of glioblastoma multiforme that was induced by Gamma Knife radiosurgery (GKS; Elekta AB, Stockholm, Sweden) for an arteriovenous malformation (AVM). A 4-year-old girl presented with repeated convulsions. Imaging studies revealed an AVM located in the right thalamus. One year after initial symptoms, GKS was performed to obliterate the nidus. The maximum and marginal radiation doses were 32 and 16Gy, respectively. Seventy months after GKS, the patient represented with severe headache. MRI showed a poorly demarcated tumor with heterogeneous gadolinium enhancement in the right thalamus and adjacent to the white matter of the temporal lobe. After a generalised convulsion, the patient deteriorated into a deep coma. CT scans showed severe brain swelling with intratumoral hemorrhage. An emergency craniotomy was performed, and the hematoma was removed. During this surgery, a tumor mass, which was found adjacent to the hematoma, was resected. Microscopic examination revealed glioblastoma multiforme. Despite intensive treatment, the patient died 1month after surgery. A GKS-induced secondary tumor is a rare but serious complication. It is important to be aware of the adverse effects of GKS, including secondary neoplasms, before its clinical application, especially in young patients.

Infratentorial Glioblastoma Multiforme in a Young Patient

Glioblastoma multiforme (GBM) is the most common primary supratentorial tumor of the brain. Infratentorial type GBM is very rare especially in young patients. In this report we present a case of primary infratentorial GBM in a young patient which was treated surgically with concomitant chemoradiotherapy.

Glioblastoma Multiforme of Optic Nerve in Adults with Hyper intense Diffuse Weighted Imaging

We present a case of glioblastomamultiforme of the optic nerve with Hyper intense Diffusion Weighted Imaging(DWI) in a 56 year old man without Neurofibromatosis1 who presented with generalized tonic clonic seizures and loss of vision in right eye. Presence of hyperintenseDWI imaging of optic nerve makes this case unique.Further details about diagnostic methods available with major emphasis on Magnetic Resonance Imaging in adults is been done.

9Be(d,n)10B-based neutron sources for BNCT

In the frame of accelerator-based BNCT, the (9)Be(d,n)(10)B reaction was investigated as a possible source of epithermal neutrons. In order to determine the configuration in terms of bombarding energy, target thickness and Beam Shaping Assembly (BSA) design that results in the best possible beam quality, a systematic optimization study was carried out. From this study, the optimal configuration resulted in tumor doses ≥40Gy-Eq, with a maximum value of 51Gy-Eq at a depth of about 2.7cm, in a 60min treatment. The optimal configuration was considered for the treatment planning assessment of a real Glioblastoma Multiforme case. From this, the resulted dose performances were comparable to those obtained with an optimized (7)Li(p,n)-based neutron source, under identical conditions and subjected to the same clinical protocol.

Plastic reshaping of cortical language areas evaluated by navigated transcranial magnetic stimulation in a surgical case of glioblastoma multiforme

Navigated repetitive transcranial magnetic stimulation (nrTMS) Q2 24 is a novel technology that, unlike the other non-invasive methods 25 used to map language, applies a methodology (“virtual lesions”) 26 that is identical to that of the gold standard direct electrical stimu27 lation (DES) during awake surgery [1]. 28 The induction of brain plasticity due to pathological conditions 29 is an established observation and has been studied extensively 30 in stroke [2]. In brain tumor surgery, a small number of reports 31 have demonstrated that brain plasticity can occur in slow-growing 32 lesions and may enable the resection of tumors that were pre33 viously deemed inoperable due to their infiltration of areas that 34 carry essential language or motor function [3]. This article reports 35 for the first time a subacute reshaping of the language network 36 within 7 months after surgery for a left fronto-opercular glioblas37 toma detected by nrTMS. 38

An Extremely Rare Case of Glioblastoma Multiforme of the Spinal Cord

Being the most common glial cell tumor of the adult brain, primary glioblastoma multiforme is an extremely rare but excessively devastating condition of the spinal cord. It presents with indistinctive magnetic resonance imaging findings, so the diagnosis is very complicated to make. A low-grade glioma may undergo a malignant transformation into glioblastoma multiforme in a very short period, critically impairing treatment possibilities and prognosis, so a correct and timely diagnosis is crucial. We report a case of intramedullary glioblastoma multiforme in a young man and describe the diagnostic difficulties and devastating progression of the entity.

Abstract 714: Single cell phenotypic heterogeneity as a prognostic factor in glioblastoma.

Abstract Background – Glioblastoma Multiforme (GBM) is a highly aggressive and heterogeneous disease in which survival of patients is measured only in months. Pathologic features associated with patient outcome are still incompletely understood. Until recently, phenotypic features of single cells have not been investigated due to technological limitations. However, with the advent of high-content slide scanning coupled with cognitive and scriptable algorithms, researchers are now positioned to identify and quantify single cell features that may provide unique insight on tumor behavior. In this project we sought to identify variations in cellular phenotypes which correlate with time of post diagnostic survival in patients with GBM. Methods – A total of 157 GBM patients were selected for study on the basis of short (SS) (median K-M survival = 6 months; N=81) or long (LS) (median K-M survival = 33 months, N=76) survival times. Median age was 56 years and all patients underwent current standard of care therapy for GBM (surgery, radiation and temozolomide). Among the 157 cases, 11 were excluded due to poor sample quality (final n=146). For each case, the diagnostic H&E slide was digitally scanned using the ScanScope XT (Aperio, Vista, CA, USA) with a 200x/0.8NA objective lens. Definiens TissueStudio v3.0 (Munich, Germany) was used to identify viable tumor regions. Individual cells were segmented in areas of viable tumor and twenty separate features extracted from each tumor cell (subcellular compartmentalization, nucleus to cytoplasm area ratio, nuclear size and shape, etc). In total, the 20 features were extracted in thousands of single cells for each GBM case. Output was evaluated by Matlab (The MathWorks, Inc,, Natick, MA) using a heatmap approach by first normalizing the scales of each feature to a range of 0-1, and assigning a color from green (0) to red (1) (5 classes) for each cell or compartment (x) and each feature (y). Results – This study was completed in a series of three stages including training followed by two replication sets. In the training set (N=50), four of the evaluated features associated with the size and shape of the cancer cell nuclei (i.e. width [μm], circularity, ellipticity and hematoxylin intensity), were found to distinguish the SS group (15/25) from the LS group (6/25) based on supervised classification. A similar pattern was observed in replication set 1 (15/24 and 8/28, respectively) and replication set 2 (15/23 and 8/21, respectively). Overall, 66% of cases were correctly classified with respect to survival time on the basis of these cellular features (p=0.0001). Conclusions – Quantitative image analysis may be useful in the identification of novel prognostic features in GBM with potential for gaining new biological insights on the behavior of these tumors. Citation Format: Mark C. Lloyd, Melissa H. Madden, L. Burton Nabors, Reid C. Thompson, Jeffrey J. Olson, Steven L. Carroll, James Browning, Tamir Epstein, Robert A. Gatenby, Kathleen M. Egan. Single cell phenotypic heterogeneity as a prognostic factor in glioblastoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 714. doi:10.1158/1538-7445.AM2013-714

Unusual Massive Spinal Metastases from a Recurrent Intracranial Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor and is the most common primary malignancy of the central nervous system (CNS). It is also locally aggressive, invasive, and resistant to therapy. Extracranial seeding of GBM is very rare, but cerebrospinal fluid (CSF) seeding is observed in approximately 15–25 % of supratentorial GBM cases [1–3]. Spinal seeding of GBM metastasis is frequently observed in autopsy series, whilst symptomatic spinal metastases from primary GBM are rarely reported [3–5]. Here, we report the clinical features, radiographic findings, and management of a unique supratentorial GBM case presented with paraplegia secondary to massive spinal metastases.

Multimodal MR imaging findings of a congenital glioblastoma multiforme

Dear Editor: We wish to report a case of congenital glioblastoma multiforme which is a rare high-grade glial tumor, with diffusionweighted magnetic resonance images and MR spectroscopy. Published reports are mostly based on clinical, genetical, and pathological behavior of the tumor; reports of radiological appearance are relatively uncommon. The imaging in those reports most commonly involved antenatal diagnoses by ultrasound; we did not recognize any report of MRI with diffusion and spectroscopy so far. An 8-month-old female infant from North Iraq presenting with an enlarging head was admitted to our hospital. The parents stated that they were told that the head circumference was larger than normal limits at birth. No further investigation was made at that time. On her routine follow-up onthe second month,aheadCTwasperformedbecauseoftheenlargedhead which revealeda supratentorialmass.The parents didnot seek any treatment at that time. Six months later, the baby was seen at our hospital, with the complaint of increasing enlargement of the head circumference. On physical examination, the patient was fine, with normal reflexes and normal responses to the stimuli, except for the macrocephaly. An MRI of the brain revealed a huge mass in the right frontal and parietal lobes which contained multiple small and large cystic areas and solid components that were isointense to gray matter on both T1-weighted- (Fig. 1a) and T2-weighted images. The