Case Of Astrocytoma Research Articles

Immunohistochemical characterisation and histopathology of astrocytic neoplasms at a tertiary Nigerian hospital.

To describe histological features and pattern of expression of selected markers including epithelial growth factor receptor (EGFR), mutant p53 and mutant isocitrate dehydrogenase-1 (IDH-1R132H) among astrocytic neoplasms at the University College Hospital, Ibadan, Nigeria. A retrospective cross-sectional study involving histologically diagnosed Central Nervous System (CNS) neoplasms between January 2004 and December 2015. Haematoxylin and Eosin Slides of 81 cases of astrocytomas were retrieved, re-cut and reviewed. Ethical clearance was obtained from the ethical board of the hospital. Immunohistochemistry using the Biotin-Streptavidin system was performed with IDH-1 R132H, p53 and EGFR mouse monoclonal antibodies (MOABs) specific against all the cases of astrocytomas under review. All cases were graded and classified using the World Health Organisation (WHO) Classification of Central Nervous System tumours (2016). Membranous and cytoplasmic staining of EGFR and IDH-1R132H mouse monoclonal antibodies, respectively, were regarded as positive while nuclear staining of p53 mouse monoclonal antibody was regarded as positive. The data obtained were analysed with the level of statistical significance set at P<.05. Males constituted a majority of cases, 50 (61.7%). Male-Female ratio was 1.6:1. Mean age was 30.6years. Tumours were of a higher WHO grade with increasing age, albeit glioblastoma cases tended to present at younger ages. The higher WHO grades were more likely to be located supratentorially. Glioblastomas accounted for most of the diagnosis 39 (48.1%), followed by pilocytic astrocytomas at 23 (28.4%). There was a low positive cytoplasmic expression of IDH-1 with only three (3.7%) being positive, eight (9.9%) showed a positive nuclear expression for mutant p53 while 17 (21%) showed membranous positivity for EGFR expression. There are similar epidemiological trends between our cohort of patients and as described in most instances worldwide. Optimal stratification for astrocytomas can be achieved using a combination of IDH-1/EGFR immunohistochemistry.

The impact and causes of negative cortical mapping in primary motor area tumours

Introduction: Intraoperative neurophysiological monitoring is the golden standard for lesions located in eloquent areas of the brain. On the one hand, positive mapping offers a view of the relationship between the anatomo-functional cortical organisation of the patient and the lesion, facilitating the choice of the cerebrotomy entry point and the resection until the functional borders are found. On the other hand, negative mapping does not offer certainty that the absence of the motor response, from the operative field, is the real feedback or is the result of the false-negative response. In such a situation, a differentiation between those two must be done.&#x0D; Materials and methods: We evaluated the results of direct cortical stimulation of lesion located in or near the primary motor area, which were diagnosticated with contrast-enhancement head MRI and admitted to the Third Department of Neurosurgery, "Prof. Dr N. Oblu” Emergency Clinical Hospital, Iasi, Romania, between January 2014 and July 2018. Special attention was given especially to the negative mapping cases, regarding the histological type, imagistic localisation, symptoms and neurological outcome immediate postoperative, at 6 months and one-year follow-up.&#x0D; Results: From all 66 patients meeting the inclusion and exclusion criteria in 9,09% (6 cases) we did not obtain any motor response after direct cortical stimulation. The imagistic localisations of those cases were: 3 – Rolandic, 2 – pre-Rolandic and one retro-Rolandic. Tumors histological types were: glioblastoma, anaplastic astrocytoma, oligoastrocytoma and oligodendroglioma each one case and two cases of fibrillary astrocytoma. The intensity range was between 6 – 18mA, the mode – 12mA and the median – 10mA. Postoperatively the neurological condition of 3 patients worsened (4,54% from all the cases), while 3 had a favourable evolution with symptom remission. At 6monts and one-year follow-up in one case (1,51%), we observed no improvement in contrast with the other two, where dysfunction remission was highlighted.&#x0D; Conclusion: The possible technical, surgical and anesthesiologic causes of false-negative motor response must be eliminated to be able to differentiate from the real absence of the functional area from the operative field. In the first scenario, the resection may be associated with permanent postoperative neurologic deficit and major life quality alteration while in the second one the patient presents no motor dysfunction after surgery and the resection may be extensive with multiple oncological benefits.

Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

BACKGROUNDPrimary intramedullary spinal tumors cause significant morbidity and death. Intraoperative ultrasound as an adjunct for localization and monitoring the extent of resection has not been systematically evaluated in these patients; the effectiveness of intraoperative contrast-enhanced ultrasound (CEUS) remains almost completely unexplored.OBSERVATIONSA retrospective case series of patients at a single institution who had consented to the off-label use of intraoperative CEUS was identified. Seven patients with a mean age of 52.8 ± 15.8 years underwent resection of intramedullary tumors assisted by CEUS performed by a single attending neurosurgeon. Histopathological evaluation revealed 3 cases of hemangioblastoma, 1 case of pilocytic astrocytoma, 2 cases of ependymoma, and 1 case of subependymoma. Contrast enhancement correlated with gadolinium enhancement on preoperative magnetic resonance imaging. Intraoperative CEUS facilitated precise lesion localization and myelotomy planning. Dynamic CEUS studies were useful in demonstrating the blood supply to lesions with a dominant vascular pedicle. Regardless of contrast uptake, the differential enhancement between spinal cord tissue and neoplasm assisted in determining interface boundaries.LESSONSIntraoperative CEUS constitutes a useful adjunct for the intraoperative delineation of contrast-enhancing intramedullary tumors and in vivo confirmation of gross-total resection. Systematic investigation is needed to establish the role of CEUS for resection of intramedullary spinal tumors of various pathologies.

Prognostic relevance of adding MRI data to WHO 2016 and cIMPACT-NOW updates for diffuse astrocytic tumors in adults. Working toward the extended use of MRI data in integrated glioma diagnosis.

Assess the contribution of preoperative MRI data in improving grading of adult astrocytomas reclassified according to the WHO 2016 and cIMPACT‐NOW update 3. Retrospective unicentric cohort study of 679 adult patients treated for newly diagnosed diffuse astrocytic and oligodendroglial tumors (January 2006–December 2016). We first systematically compared radiological (contrast enhancement present [CE+] vs. absent [CE−]) and histopathological findings (microvascular proliferation present [MPV+] vs. absent [MPV−]) to validate whether this comparing step of neoangiogenesis represents an efficient method to appreciate the representativity of the tumoral sampling. We focused on 629 cases of astrocytomas for radio‐histological integrated analyses. In 598 cases (95.1%), neoangiogenesis evaluated by MRI or histology (CE+/MPV+ or CE−/MPV−) was identical. For the CE+/MPV− and CE−/MPV+ groups (23 cases), the radio‐histological face‐to‐face evaluation allowed us to assess that for 13 cases (56.5%) the reason for this discrepancy was an undersampled tumor. We analyzed the group of CE+/MPV− (n = 8) and CE−/MPV+ (n = 2) in verified image‐guided tumoral samples. Finally, we identified three new prognostic subgroups for molecular glioblastomas: (1) “non‐representative sampling” (n = 9), (2) “Non neoangiogenic glioblastoma at the time of diagnosis, without contrast enhancement and microvascular proliferation” (n = 8), and (3) “contrast enhancing glioblastoma but without microvascular proliferation in a representative sample” (n = 4). Neoangiogenesis processes should be assessed to improve the prognosis accuracy of the current integrated diagnosis. We suggest adding imaging analyses during the neuropathological analysis of astrocytomas in adults.

Genetic signature and treatment of pediatric high-grade glioma.

Pediatric high-grade glioma (HGG) is a type of malignancy that carries a poor prognosis. The genetic analysis of HGGs has previously identified useful mutations, the targeting of which has improved prognosis. Thus, further research into the more common mutations, such as H3 histone variants (HIST1H3B and H3F3A) and BRAF V600E, may be useful in identifying tumors with different prognoses, as the mutations are considered to drive two distinct oncogenic programs. The present study performed a retrospective analysis of pediatric HGGs. In total, 42 cases of HGG, including 32 cases (76.1%) of anaplastic astrocytoma and 10 cases (23.8%) of glioblastoma multiforme (GBM), were assessed. The median age of the patients was 7 years (range, 0-32 years). Mutations on histone H3, in particular the K27M and G34R mutations in the distinct variants HIST1H3B and H3F3A, in addition to the presence of the BRAF V600E mutation, were analyzed in 24 patients. The H3F3A K27M mutation was identified in 7 patients (29.1%), while the HIST1H3B K27M mutation was only observed in 1 patient with GBM. In addition, 5 patients harbored a BRAF V600E mutation (21%), while the H3F3A G34R mutation was not recorded in any of the patients. The overall survival of the wild-type patients at 20 months was 68% [confidence interval (CI): 38-85%] compared with 28% (CI: 0.4-60%) in patients with the H3F3A K27M mutation. These results suggested that patients with the H3F3A K27M mutation had a worse prognosis compared with wild-type patients (P=0.0045). Moreover, 3/5 patients with the BRAF V600E mutation had HGGs that were derived from a previous low-grade glioma (LGG; P=0.001). In conclusion, these results suggested that histone H3 mutations may help predict the outcome in patients with HGG. In addition, the BRAF V600E mutation was found to be associated with an increased risk of anaplastic progression. The novel data of the present study may help better define the clinical and radiological characteristics of glioma.

Human epidermal growth factor receptor 2 neu and E-cadherin expression in primary astrocytic brain tumors as prognostic biomarkers

Background The primary brain tumors including astrocytic tumors, ranging from circumscribed into diffuse and glioblastoma (GBM), which is considered as a highly malignant neoplasm of the central nervous system. They share common molecular and biological abnormalities. This study was aiming to illustrate the role of c-erbB-2 protein [human epidermal growth factor receptor 2 (HER2 neu)] and E-cadherin expression in varied groups of astrocytic tumors. Patients and methods The material of this work consisted of 50 cases with histopathological diagnosis of astrocytoma and GBM. The patients were classified histopathologically into four grades based on the WHO 2007 criteria: pilocytic astrocytoma (G1), diffuse astrocytoma (G2), anaplastic astrocytoma (G3), and GBMs (G4). C-erbB-2 protein and E-cadherin expressions were estimated semiquantitatively on immunohistochemically tissue sections stained with antibodies against c-erbB-2 protein and E-cadherin. Results Checking HER2 scores, 29 (58%) cases were HER2 neu positive. Comparing the percentage of all cases of astrocytic tumors, it was found that the most obvious positive staining was observed predominantly in anaplastic astrocytoma and GBM cases. Regarding E-cadherin, 19/50 (38%) cases were E-cadherin positive with variable expressions moderate to strong immunostaining, but was typically higher in low-grade astrocytoma than in higher grades. Conclusions Taken together from our and other data, HER2 overexpression may be considered a poor prognostic marker in patients with astrocytic tumors of the brain especially GBM and cadherin cell–cell contacts in astrocytoma cells may decrease its invasion, and they could become a new potential therapeutic strategy for astrocytoma's treatment.

Determination and Comparison of Ki-67 Index in Astrocytic Tumours: A Tertiary Care Centre Experience

Introduction: The proper management of the astrocytic tumours largely depends on its correct diagnosis. But, smaller size and complicated histomorphology makes it difficult for the histopathologist to conclude the diagnosis. Monoclonal antibody Ki-67 {MIB-1/MIB-1 Labelling Index (LI)} plays a role of diagnostic as well as prognostic marker. It is an important marker, since it helps in deciding malignant potential of the astrocytic tumours where histology alone does not suffice. This study promotes the idea of including Ki-67 in routine practice for astrocytic tumours as it helps in quantifying the growth of the tumour which is of utmost importance in predicting the outcome accurately. Aim: The aim of this study was to determine the mean and ranges of Ki-67/MIB-1 LI in astrocytic tumours and comparing between different grades. Materials and Methods: This was a hospital based cross- sectional study with 50 cases of astrocytoma of varying grades over period of six years, retrospective study period started from 1st April 2009 till 30th November 2012 and prospective study period started from 1st December 2012 till 31st March 2014. Immunolabeling was done using Ki-67/MIB-1 antibody. The mean and ranges of Ki-67 was calculated in astrocytic tumours and its correlation with each World Health Organization (WHO) grade of histological diagnosis and clinical presentations were studied. One-way Analysis of Variance (ANOVA) and unpaired t-test were used for statistical analysis. Results: There were 50 astrocytic tumours, Pilocytic Astrocytoma (PA), grade I-5 (10%) cases; Diffuse Astrocytoma (DA), grade II-8 (16%) cases; Anaplastic Astrocytoma (AA), grade III-10 (20%) cases; and Glioblastoma Multiforme (GBM), grade IV-27 (54%) cases, with mean Ki-67 LI as 2.63%, 2.65%, 18.85% and 30.2%, respectively. The difference in mean Ki-67 LI for low grade astrocytoma and high grade astrocytoma was highly significant statistically (p&lt;0.0001). The most common presentation was seizure, which was seen in 26 (52%) cases. Conclusion: Histological grading with Ki-67 LI can work synergistically to reach the diagnosis, as both are subjected to heterogeneity induced diagnostic accuracy. Ki-67 LI increases with increase in the grade of the astrocytic tumours and hence, its quantification can help histopathologists as well as clinicians to agree on a point, especially in those cases where two differ diagnostically and it effects patients’ prognosis.

Thoraco-lumbar high grade spinal cord astrocytoma: first documented case in a tertiary medical center and review of literature

&lt;p class="abstract"&gt;This presents the first documented case of high grade spinal cord astrocytoma in a pediatric patient treated at a tertiary medical center and gives a comprehensive review of literature on the most current modes of diagnosis, treatment, and prognosis. We report the case of a 7-year-old male with complaints of inability to ambulate and associated low back pain, which rapidly deteriorated to complete paraplegia. Magnetic resonance imaging (MRI) of his spine revealed an intradural intramedullary spinal cord lesion extending from T11 to L5 vertebra, with considerations of spinal astrocytoma and ependymoma. The patient underwent en bloc laminectomy on T9-L3, partial resection of the intramedullary cord tumor, and subsequent laminoplasty with mini plates and screws. Histopathologic studies showed spinal cord astrocytoma, World Health Organization (WHO) grade 3 (anaplastic type). The patient’s neurologic status did not improve after the surgery and was advised to undergo chemo-radiation therapy but was lost to follow up. Ten months post-operation, patient sought consult due to severe back pain, generalized body weakness, and difficulty of breathing and was then admitted. Patient’s condition worsened that eventually resulted to his demise.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

PATH-05. A CASE OF PILOCYTIC ASTROCYTOMA HARBORING THE FGFR1 GENE MUTATION WITH A PREDOMINANT OLIGODENDROGLIOMA-LIKE COMPONENT

Pilocytic astrocytomas rarely present with oligodendroglioma-like morphological features, which gives rise to a diagnostic challenge. In this report we present a case of pilocytic astrocytoma harboring the FGFR1 mutation, accompanied with a predominant oligodendroglioma-like component, thus initially diagnosed as oligodendroglioma. A 14-year-old female presented with syncope and simple partial seizure involving her right upper limb. Contrast-enhanced MRI revealed an enhancing lesion with substantial cystic portion and perifocal edema in the left parietal lobe. Open surgery was performed and a gross total resection of the tumor was achieved. On initial histopathological diagnosis, tumor cells with monotonous round nuclei and perinuclear halo predominated with branching capillaries, which were strongly suggestive for oligodendroglioma. Immunohistochemically, IDH1 R132H was negative, and Ki-67 index was around 5%. The patient was thus initially diagnosed as oligodendroglioma, WHO grade II, based on the 2007 WHO classification criteria. However, histopathological re-review revealed a minor astrocytic component with Rosenthal fibers and rare eosinophilic granular bodies, thus the diagnosis was changed as pilocytic astrocytoma. FGFR1 K654E mutation was confirmed by Sanger sequencing. Although she postoperatively developed mild sensory disturbance in her right hands, finger agnosia, and left-right disorientation, her symptoms had gradually improved, and she was discharged on day 17 with a Karnofsky performance status (KPS) of 90 and no cognitive decline. Without any adjuvant therapies, she has remained recurrence-free for 85 months. While the diagnosis of pilocytic astrocytoma with predominant oligodendroglioma-like component can be challenging, analysis of IDH1 and FGFR1 mutations can be beneficial in certain cases.

SURG-14. ENDOSCOPIC SURGERY FOR PEDIATRIC INTRAVENTRICULAR TUMOR WITHOUT HYDROCEPHALUS: INDICATION, SURGICAL TECHNIQUE, AVOIDANCE OF COMPLICATION, AND ITS PROSPECT

INTRODUCTIONNeuroendoscopic surgery is useful for intraventricular tumors accompanied by ventriculomegaly. However, it is often challenging for cases with small ventricles. Our institution is actively performing surgeries for pediatric intraventricular tumors without frank ventriculomegaly.METHODSSeven cases of intraventricular tumors without ventriculomegaly (5 cases of subependymal giant cell astrocytoma (SEGA) and 2 cases of germ cell tumors (GCTs)) were analyzed. The age ranged between 3 and 14 years (median 5 years). The sizes of SEGA were between 10-27mm, and all the tumors showed an enlargement around the foramen of Monro, which was the indication for surgery. Biopsy and third ventriculostomy were performed for GCTs. For resection, after making a small craniotomy of 2 x 3 cm, ellipse-cone-like sheath with a diameter of 12mm or 17mm was inserted through it to the lateral ventricle, which enabled a wide surgical view. Under a rigid endoscope of 4mm diameter, 2 types of surgical instruments were employed, making the microsurgical procedure like under a microscope, with a wider view, possible. For the cases of tumor resection, septostomy and placement of a drain in the ventricle were performed at the end of surgery.RESULTSThe lesions were safely approached in all the cases. For resection, endoscopic microsurgery was possible, and tumor was totally removed in all the cases. No postoperative complication was observed in any of them.CONCLUSIONSOur experience shows that tumor resection can be safely achieved with the aid of endoscope even for cases without ventriculomegaly.

LGG-32. CLINICAL OUTCOME OF PEDIATRIC GLIOMAS IN SINGLE INSTITUTION

Gliomas in children are rarer than in adult, then treatment strategies might vary from facility to facility. We report clinical features and outcome of pediatric glioma in our institution. Twenty-nine patients diagnosed with glioma, exclude ependymoma, 14 boys and 15 girls, among 98 pediatric brain tumor patients treated at Kagoshima University Hospital since 2006 were reviewed histopathology, extent of resection, adjuvant therapy and outcome, etc. Mean age at surgery was 10.4 (S.D. 5.6) years. Median follow-up period was 19.1 months. Histopathological diagnosis comprised 8 pilocytic astrocytoma, 3 ganglioglioma, 2 subependymal giant cell astrocytoma, 5 WHO grade Ⅱ astrocytoma, 8 glioblastoma, and desmoplastic infantile astrocytoma, anaplastic astrocytoma and astroblastoma were one case each. Tumor resection was performed in 24 cases, and 5 cases underwent biopsy. Chemotherapy was performed in 15 cases and irradiation was performed in 9 cases. Out of 5 WHO grade Ⅱ astrocytoma cases, 2 cases underwent biopsy following chemotherapy, 1 case underwent biopsy only and other 1 case underwent total resection. The four cases show long survival ranged from 71 to 136 months without irradiation. All of eight glioblastoma cases show poor prognosis ranged from 8.6 to 26.7 months regardless of chemo-radiotherapy. In management for pediatric brain tumor patients, irradiation is often laid over until recurrence. In WHO grade Ⅱ astrocytoma, the treatment strategy might be reasonable using appropriate chemotherapy even though biopsy cases.

LGG-29. TREATMENT FOR RECURRENT OPTIC PATHWAY PILOCYTIC ASTROCYTOMA

Chemotherapy after biopsy or partial resection of the tumor is widely accepted as first-line therapy for optic pathway pilocytic astrocytoma. However, there is no standard of care for recurred tumors. We investigated our cases which showed recurrence after initial therapy. Retrospective analysis of four recurrent optic pathway pilocytic astrocytoma cases was performed. All patients underwent partial resection or biopsy of the tumor, and all received carboplatin and etoposide- based chemotherapy as initial treatment. Mean age at first therapy was 2.3 years old, and mean time from initial therapy to recurrence of the tumor was 5.6 years. Two patients were totally blind at the time of recurrence, and other two had partial visual field losses. One patient underwent total resection of the tumor, and other three patients underwent partial resection followed by chemotherapy. Visual function in patients with visual acuity did not deteriorate after removal of the recurrent tumor. There was no recurrence of the tumor who underwent total resection. All of the three patients who had partial resection followed by chemotherapy recurred. Mean time from first recurrence to second recurrence was 1.8 years. After second recurrence, all patients underwent radiation therapy. One patient died due to malignant transformation of the tumor. For recurrent optic pathway pilocytic astrocytoma, prognosis may be better if total resection of the tumor without deteriorating the vision is possible.

A pediatric case of anaplastic astrocytoma with a gliomatosis cerebri; the growth pattern and changes in serum VEGF-121 levels after bevacizumab treatment

Gliomatosis cerebri (GC) is a rare diffusely infiltrating glial neoplasm that carries a poor prognosis. Because tumors are undetectable in most patients at early-stage of the onset, a useful diagnostic method is expected. We compared serum vascular endothelial growth factor (VEGF)-121 levels in patients with GC or glioblastoma and controls. VEGF-121 levels were significantly higher in one patient with GC and patients with glioblastoma than in controls. VEGF-121 levels decreased in a patient with GC after bevacizumab-based therapy. Thus, VEGF-121 may be useful for diagnosing GC, its disease-monitoring and understanding its etiology.

Clinical Evaluation of Proline, Glutamic acid, and Leucine-Rich Protein 1 Expression in Astrocytomas and Correlations with the Proliferation Marker Ki-67

Malignant astrocytomas presenting in humans of any age group are a challenge to diagnose and treat. Hence, there is a quest for new markers to ascertain their grades and predict disease outcomes. Proline, glutamic acid, and leucine-rich protein 1 (PELP1), a nuclear receptor co-regulator, is an oncogene found in various cancers. We postulate that by screening for PELP1, its correlation with survival outcomes of patients across various grades can indicate a plausible novel diagnostic marker and a potential therapeutic target in gliomas. Immunostaining of 100 cases of astrocytomas for PELP1 was performed on paraffin-embedded sections. Results showed that PELP1 expression increases with higher grades; the mean H-score of PELP1 in grade-I astrocytomas was determined to be 112.3, whereas in grade-IV it was 235.1 (P value = 0.0001). Survival analysis of patients with H-score of 200-300 was only 8.8% and 68.8% in patients with scores of 0-100. PELP1 expression in high-grade astrocytomas is an important factor in determining the outcomes. Graphical abstract Evaluation of molecular expression of PELP1 along with Ki-67 LI signifies a linear increase in its expression pattern among different grades of astrocytomas from low- to high-grade tumors, which can serve as a potential prognostic molecular marker in differentiating various types of astrocytomas in humans.

Presurgical Identification of Primary Central Nervous System Lymphoma with Normalized Time-Intensity Curve: A Pilot Study of a New Method to Analyze DSC-PWI.

DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor curves were normalized relative to normal-appearing white matter. We performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. The generated algorithms were applied in a test subset. A total of 233 patients were included in the study: 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset (primary central nervous system lymphoma versus glioblastoma, area under the curve = 0.96 and accuracy = 93%; versus anaplastic astrocytoma, 0.83 and 71%; versus metastases, 0.95 and 93%; versus meningioma, 0.93 and 96%). The proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma.

Clinical Application of Multimodality Imaging in Intracranial Tumors

Objective: This study was aimed to investigate the advantage of new techniques for diagnosis and treatment of intracranial small lesions. Methods: We retrospectively analyzed the clinical data of 64 symptomatic patients suffering from intracranial small lesions and underwent magnetic resonance spectroscopy (MRS), perfusion weighted imaging (PWI) and neuro-navigation assisted surgery in the First Affiliated Hospital of Sun Yat-Sen University from January 2010 to December 2017, and evaluated the diagnosis, extent of resection and operation time. Results: Among 8 cases of neuronal and mixed neuronal-glial tumors, 3 underwent preoperative cerebral plain MR, enhanced MR, MRS and PWI, 1 underwent cerebral plain MR, enhanced MR and MRS, whose imaging diagnoses were consistent with postoperative pathology. Another 3 cases underwent neuro-navigation assisted surgery whose tumors were totally resected. Among 19 cases of astrocytoma, 7 underwent neuro-navigation assisted surgery and their tumors were totally resected, another 12 underwent traditional craniotomy with 1 case of subtotal resection. Total resection was performed in 37 patients with cavernous hemangioma, and the operation time of 16 patients with intraoperative neuro-navigation was shorter than that of the other 21 patients with traditional craniotomy (t = -2.164, P &lt; 0.05). Conclusions: The neuronal and mixed neuronal-glial tumors could be diagnosed accurately through combining MRS with PWI, which provide theoretical reference for surgical resection. With the aid of neuro-navigation, intracranial tumors can be precisely positioned and totally resected.

Is it a new culprit? “TERT promoter mutation” in an aggressive pediatric pilocytic astrocytoma

Recent advances in the genomic study have revolutionized the discovery of molecular biomarkers in glioma not only to aid in targeted therapy but also to prognosticate character of tumor and outcome of a patient.The usually benign nature of pilocytic astrocytoma (PA) can now be challenged with the discovery of genomic alterations that could promote more aggressive clinical behavior. CDKN2A deletion and ATRX gene inactivation or mutation have been the most common molecular alterations in worse prognosis.We will discuss a case of pilocytic astrocytoma showing the progressive recurrence with pilomyxoid features and the presence of TERT promoter mutation.

Detection of BRAF V600E Mutation in Ganglioglioma and Pilocytic Astrocytoma by Immunohistochemistry and Real-Time PCR-Based Idylla Test.

The BRAF V600E mutation is an important oncological target in certain central nervous system (CNS) tumors, for which a possible application of BRAF-targeted therapy grows continuously. In the present study, we aim to determine the prevalence of BRAF V600E mutations in a series of ganglioglioma (GG) and pilocytic astrocytoma (PA) cases. Simultaneously, we decided to verify whether the combination of fully automated tests—BRAF-VE1 immunohistochemistry (IHC) and Idylla BRAF mutation assay—may be useful to accurately predict it in the case of specified CNS tumors. The study included 49 formalin-fixed, paraffin-embedded tissues, of which 15 were GG and 34 PA. Immunohistochemistry with anti-BRAF V600E (VE1) antibody was performed on tissue sections using the VentanaBenchMark ULTRA platform. All positive or equivocal cases on IHC and selected negative ones were further assessed using the Idylla BRAF mutation assay coupled with the Idylla platform. The BRAF-VE1 IHC was positive in 6 (6/49; 12.3%) and negative in 39 samples (39/49; 79.6%). The interpretation of immunostaining results was complicated in 4 cases, of which 1 tested positive for the Idylla BRAF mutation assay. Therefore, the overall positivity rate was 14.3%. This included 2 cases of GG and 5 cases of PA. Our study found that BRAF V600E mutations are moderately frequent in PA and GG and that for these tumor entities, IHC VE1 is suitable for screening purposes, but all negative, equivocal, and weak positive cases should be further tested with molecular biology techniques, of which the Idylla system seems to be a promising tool.

A refractory case of CDK4-amplified spinal astrocytoma achieving complete response upon treatment with a Palbociclib-based regimen:a case report

BackgroundSpinal cord astrocytoma is a rare neoplasm, and patients usually recur within months after surgery. There is currently a lack of consensus regarding post-operative treatment. Clinical data on the activity of systemic treatment like chemoradiotherapy and anti-angiogenic agents also remained scant. Next-generation sequencing (NGS) -based genomic profiling thus may help identify potential treatment options for a subset of patients that harbor actionable genetic alterations.Case presentationWe reported for the first time a refractory case of grade III spinal cord astrocytoma that underwent two surgeries but eventually progressed following post-operative chemoradiotherapy plus bevacizumab. Hybridization capture-based NGS using a 381-gene panel disclosed cyclin dependent kinase 4 (CDK4) amplification and after receiving a triplet regimen containg palbociclib for 15 months, the patient achieved complete response.ConclusionsThis case demonstrated the importance of genetic profiling and the benefit of a multi-modality treatment strategy in cancer management.

Survival, Prognostic Factors, and Volumetric Analysis of Extent of Resection for Anaplastic Gliomas.

PurposeThe aim of this study is to evaluate the survival rate and prognostic factors of anaplastic gliomas according to the 2016 World Health Organization classification, including extent of resection (EOR) as measured by contrast-enhanced T1-weighted magnetic resonance imaging (MRI) and the T2-weighted MRI.Materials and MethodsThe records of 113 patients with anaplastic glioma who were newly diagnosed at our institute between 2000 and 2013 were retrospectively reviewed. There were 62 cases (54.9%) of anaplastic astrocytoma, isocitrate dehydrogenase (IDH) wild-type (AAw), 18 cases (16.0%) of anaplastic astrocytoma, IDH-mutant, and 33 cases (29.2%) of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted.ResultsThe median overall survival (OS) was 48.4 months in the whole anaplastic glioma group and 21.5 months in AAw group. In multivariate analysis, age, preoperative Karnofsky Performance Scale score, O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative tumor volume, and EOR measured from the T2 MRI sequence were significant prognostic factors. The EOR cut-off point for OS measured in contrast-enhanced T1-weighted MRI and T2-weighted MRI were 99.96% and 85.64%, respectively.ConclusionWe found that complete resection of the contrast-enhanced portion (99.96%) and more than 85.64% resection of the non-enhanced portion of the tumor have prognostic impacts on patient survival from anaplastic glioma.