Cases Of Low-grade Astrocytomas Research Articles

A Case of Low Grade Astrocytoma Induced Progressive Episodic Intractable Nausea and Vomiting

Chronic nausea and emesis, which may serve a protective function, pose a diagnostic challenge with a broad differential and contribute to numerous health care visits each year. We present a case of chronic intermittent nausea/emesis due to a brain mass without classic neurologic findings. A 36 year-old male presented with 3 months of intermittent episodes consisting of: relentless nausea, up to 10 bouts of forceful emesis a day, and PO intolerance. Episodes would last 2-3 days and occur once every 6 to 8 weeks with asymptomatic intervals between episodes. He denied preceding events, food triggers, and other related symptoms. He was taking lisinopril and aspirin and denied over the counter supplements. He remained afebrile and hemodynamically stable. Physical exam noted active emesis and non-peritoneal left quadrant pain. CBC, CMP, TSH, lipase were within normal limits. Urine drug screen and EtOH level were negative. CT abdomen/pelvis and right upper quadrant ultrasound were unremarkable. EGD revealed a small hiatal hernia with LA grade B esophagitis, chronic active gastritis, no food retention, and no evidence of obstruction. A trial of high dose PPI was unsuccessful. Subsequent imaging of the brain revealed a 1.6cm right posterior high frontal cortical mass without mass effect that was suspected to be benign; therefore, plan was for conservative management. However, in the following months, the patient had progression of symptoms with episodes increasing to once every 4 weeks and lasting 1-2 weeks. An elective sub-total resection of the mass was performed. Pathology demonstrated a diffuse grade II astrocytoma. The patient reported complete symptom resolutions at his 3-month follow up exam. The most common symptoms associated with brain masses are headache and neurologic deficits. However, nausea/vomiting are the initial presenting symptoms in up to 13% of cases. Nausea/emesis are typically the result of increased intracranial pressure, mass effect, involvement of the posterior fossa leading to gastroparesis, or involvement of the area postrema at the chemoreceptor trigger zone. However, lesions involving the higher cortical centers (such as the frontal lobe) can also lead to nausea and emesis. We highlight a rare case of a frontal astrocytoma initially presenting with unexplained nausea/emesis with resolution of symptoms following resection. It is important to consider the extra-intestinal etiologies for common gastrointestinal symptoms.3085_A Figure 1. MRI Brain Horizontal3085_B Figure 2. MRI Brain Sagittal

Low grade astrocytoma in children under the age of three years: a report from the Canadian pediatric brain tumour consortium

In children under the age of 3years, the most common solid tumors are brain tumors. Low grade astrocytomas represent 30-40% of brain tumours in this age group. This study reviewed the incidence, characteristics, therapy, and outcome of children less than 36months of age diagnosed with a low grade astrocytoma from 1990 to 2005 in Canada. A data bank was established using data collected from Canadian pediatric oncology centers on children less than age 3 diagnosed with brain tumors between 1990 and 2005. Cases of low grade astrocytoma were extracted from this data bank and their characteristics summarized. From the 579 cases in the data bank, 153 cases of low grade astrocytoma (26%) were identified. The mean duration of symptoms prior to presentation was 13weeks, and 53% of patients underwent a greater than 90% resection of their tumor, while 30% underwent 10-90% resection. Seventy-one percent of patients received no further therapy after surgery and of the 45 who received therapy following surgery, 43 received chemotherapy, and 5 received radiation therapy. Sixty-eight patients had recurrence or progression of their tumor. Eighty-seven percent of patients were alive at the time of the survey with a 2year survival rate of 95.3±1.8%, 5year survival rate of 93.1±2.1% and 10year survival rate of 89.1±2.8%. The 5year survival rate for Canadian children less than 36months of age with a low grade astrocytoma was 93.0±2.8% which is similar to that for older children with this tumor.

Factors Influencing Overall Survival Specific to Adult Low-grade Astrocytoma: A Population-based Study

AimsWe report a population-based overall survival and prognostic factor analysis specific to adult patients diagnosed with low-grade astrocytoma (LGA). Materials and methodsAll histologically confirmed cases of LGA diagnosed between 1992 and 1996 in the province of Ontario, Canada, were identified from the Ontario Cancer Registry and reviewed. ResultsIn total, 182 patients were identified; the mean age was 50 years and the mean survival time was 4.1 years (standard deviation = 5.1 years). Fifty-four per cent of patients had a surgical excision and 46% were biopsied alone. Both univariate and multivariate analyses showed that patients aged <30 years were significantly more likely to undergo an excision as compared with a biopsy alone (odds ratio = 4.26, 95% confidence interval 1.54–11.77). For the entire cohort, we observed a significant relationship between decreasing survival as a function of increasing age at diagnosis. In the biopsy sub-group, relative to patient's age <30 years, the hazard of dying increased significantly according to age when stratified by decade. However, in those patients having had a primary surgical excision, the hazard of dying relative to patient's age <30 years was similar for those aged 30–49 years and then significantly greater as patient age surpassed 50 years. ConclusionsAge is a significant prognostic factor for LGA. Our analysis suggests that in those patients amenable to a primary tumour excision, a survival benefit may be confined to those under age 50 years.

Combined value of susceptibility weighted imaging and dynamic susceptibility-weighted contrast-enhanced MR perfusion-weighted imaging in brain astrocytoma grading

Objective To assess the value of combination of susceptibility weighted imaging (SWI)and dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion-weighted magnetic resonance imaging in astrocytoma grading.Methods SWI and DSC scans were performed in 82 patients with pathologically confirmed astrocytoma.The patient group consisted of grade Ⅱ (15),grade Ⅲ (10),and grade Ⅳ (57).The intratumoral susceptibility signal intensity (ITSS) and relative cerebral blood volume (rCBV) max were used to determine the grade of astrocytomas by Kruskal Wallis test,Welch test,Spearman correlation coefficients,Pearson correlation coefficients,and receiver operating characteristic curve (ROC)statistic methods.Results There were no ITSS in 14 cases of low-grade astrocytomas,the degree of ITSS were grade 1 to 3 in anaplastic astrocytomas,the degree of ITSS were grade 3 in all of the glioblastomas,the degree of ITSS were significant difference in all grades (H =71.96,P ＜ 0.01).rCBV max in grade Ⅱ,grade Ⅲ and grade Ⅳ astrocytomas were 1.26 ± 0.42,3.59 ± 2.09 and 8.34 ± 1.16 respectively,rCBV max were significant difference in all grades (F' =681.72,P ＜ 0.01).ITSS showed significant correlation with rCBV max (r =0.72,P ＜0.01) and tumor grades (r =0.89,P ＜0.01),and rCBV and tumor grades showed significant correlation (r =0.78,P ＜ 0.01).Area under the ROC curve application SWI,DSC,SWI and DSC in differentiation of the grade Ⅱ and grade Ⅲ astrocytomas were 0.99,0.93,1.00,differentiate grade Ⅲ from grade Ⅳ were 0.70,0.94,0.94,and differentiate high-grade from low-grade astrocytomas were 1.00,0.99,1.00.Conclusions ITSS is helpful to determine the grade of astrocytomas.The use of SWI in combination with DSC may improve the diagnostic accuracy of astrocytoma grading. Key words: Astrocytoma; Magnetic resonance imaging; Perfusion ; Diagnosis, differential

Expression of proto-oncogene Wip1 in astrocytoma and its correlation with p53

Objective To explore the expression of wild-type p53-induced phosphatase 1 (Wip1)in astrocytomas and its clinical significance. Methods In 32 cases of high-grade astrocytomas, 35 cases of low-grade astrocytomas and 10 cases of normal brain tissues the expression of Wip1 mRNA and protein was detected by using immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR)and Western blotting. The expression of p53 was assayed in Wip1 positive tissues by using immunohistochemistry and Western blotting. The relationship between the Wip1 expression and clinicopathological features was analyzed. Results ( 1 ) Immunohistochemistry : The positve expression rate of Wip1 in highgrade astrocytoma, low-grade astrocytoma and normal brain tissues was 24/32 (75.0%), 11/35(31.4%) and 1/10 (10.0%) respectively. There was significant difference among three tissues (P＜0. 05 ). (2) RT-PCR: The expression level of Wip1 mRNA in high-grade astrocytoma, low-grade astrocytoma and normal brain tissues was 0. 35 ±0. 07, 0. 07±0. 03 and 0. 05 ±0. 02 respectively. The expression level of Wip1 mRNA in high-grade astrocytoma was higher than that in low-grade astrocytoma and normal brain tissues (P ＜0. 05). (3) Western blotting: The relative expression of Wipl protein in high-grade astrocytoma, low-grade astrocytoma and normal brain tissues was 1.67 ±0. 12, 1.05 ±0.25 and 0.41 ±0. 16 respectively, p53 immunohistochemical staining revealed that only 13 were positive for p53 in 36Wip1 positive tissues. The high expression rate of Wip1 protein was negatively correlated with the expression of p53 ( r = - 0. 29). The relative expression of p53 protein in high-grade astrocytoma, low-grade astrocytoma and normal brain tissues was 0. 77 ±0. 09, 0. 63 ±0. 13 and 0. 21 ±0. 11 respectively. They was no statistically significant difference between high-grade astrocytoma and low-grade astrocytoma (P ＞0. 05), but the relative expression of p53 protein in high-grade astrocytoma, low-grade astrocytoma was higher than in normal brain tissues ( P ＜ 0. 05 ). The expression of Wip1 was greatly correlated with its pathologic classification ( P ＜ 0. 05 ), but it had nothing to do with tumor size and age ( P ＞ 0. 05 ). Conclusion The high expression of Wipl mRNA and protein in astrocytoma is related to its pathologic classification and negatively correlated with the expression of p53. Wip1 may play an important role in the tumor development. Key words: Astrocytoma; p53; Treatment

Astrocitoma de vías ópticas: una causa infrecuente de retraso ponderal en el lactante

Failure to thrive is a frequent cause of consultation in pediatric services. The main objective in these patients is the early detection of an organic cause, if present. We report a case of low-grade astrocytoma of the optic pathway in a 2-month-old child whose main symptoms at diagnosis were failure to thrive and anorexia. Unfortunately, despite therapeutic efforts, the tumor showed local and metastatic progression refractory to chemotherapy. The patient died 3 months after diagnosis. We conclude that diencephalic tumors must be considered in the differential diagnosis of failure to thrive during the first year of life, especially when, after initial investigations, a cause is not found.

Low grade astrocytoma of the pituitary stalk

A case of low grade astrocytoma (WHO grade II) localised in the pituitary stalk is reported in a 46 year old female who presented with central diabetes insipidus. Six-monthly magnetic resonance imaging was use to determine the progression of the lesion. The patient had a stereotactic biopsy of the lesion 18 months after the initial presentation. The diagnosis was established with the aid of immunohistochemistry. We emphasize the importance of MRI before initiating therapy to evaluate the pituitary stalk lesion and the effectiveness of stereotactic biopsy in securing tissue diagnosis without additional deficit.

Clinicopathological examination of glioma by proton magnetic resonance spectroscopy background

Automation of proton magnetic resonance spectroscopy (MRS) in recent years has made it possible for MRS measurement to be performed in a shorter time than before, and the number of reports of its usefulness for the assessment of glioma malignancy has been increasing in the past several years. We studied the efficacy of proton MRS when used for glioma and conducted clinicopathological examination of glioma. The subjects were 15 patients who had received a pathological diagnosis of glioma at our hospital (6 cases of glioblastoma, 1 case of anaplastic astrocytoma, 4 cases of low-grade astrocytoma, and 4 cases of radiation necrosis); Siemens Magnetom Vision 1.5T was used for the study. Regions of interest (ROIs) were defined as the areas where abnormal signals were found on magnetic resonance imaging (MRI). Areas of primary peaks, such as choline (Cho), N-acetylaspartate (NAA), and lactate (Lac), were measured, and the ratios to normal brain tissue were examined. This study revealed a tendency of increased malignancy of glioma with a decrease in NAA. Some cases also displayed a decrease in Cho with an increase in malignancy. Assessment of malignancy must not be based on a single ROI alone, but several ROIs should be assessed comprehensively. Measurement was difficult when the tumor volume was small. Because diagnosis of very early glioma by MRS seemed difficult, other adjunctive diagnoses may be necessary. Proton MRS is very useful for diagnosis of glioblastoma.

Localization of gelatinase activities in glioma tissues by film in situ zymography

Malignant gliomas are characterized by their invasiveness and angiogenesis, which are mediated by metalloproteinases (MMPs). In this study, localization of gelatinase activities in six cases of glioblastoma, two cases of anaplastic astrocytoma, and six cases of low-grade astrocytomas was investigated by film in situ zymography (FIZ). FIZ is a novel technique, because it allows preservation of tissue structure with gelatinolytic activity and can detect net MMP activity in tumor tissues. In malignant gliomas, gelatinolytic activities were extensively localized in the vessel walls in the viable tumor areas and peritumoral areas as well as the tumor cell itself. These findings suggest that FIZ is a useful tool not only to detect tumor net MMP activities but also to detect angiogenic features in the invading front of malignant gliomas.

Human glioma-specific antigens detected by monoclonal antibodies.

Three murine monoclonal antibodies, designated GA-17, GB-4, and GC-3, were prepared by the hybridization of murine myeloma cells (NS-1) and spleen cells of BALB/c mice immunized with the crude membrane fraction of cultured human gliosarcoma cells (GI-1). Two of them (GA-17 and GB-4) reacted exclusively with the membrane of glioma cells, and the other (GC-3) reacted with the membrane of glioma cells and a T cell line (MOLT-4). Although these antibodies reacted with almost all of the gliomas, the reactions differed. GA-17 reacted equally well with all glioblastoma (17 cases) and low-grade astrocytoma (10 cases), whereas GB-4 reacted poorly with 7 cases of glioblastoma and GC-3 did not react with 7 cases of low-grade astrocytoma. The antigens, exclusively expressed on the cell surface, were analyzed by surface labeling with 125I followed by a cell lysis and immunoprecipitation with these antibodies. The findings obtained by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that GA-17, GB-4, and GC-3 reacted with Mr 140,000-145,000, Mr 160,000, and Mr 145,000-150,000 proteins, respectively. Some evidence has been obtained indicating that these antigens are composed of the same polypeptide chain (Mr 120,000) with the carbohydrate chains being different.

Human Glioma-Specific Antigens Detected by Monoclonal Antibodies

Three murine monoclonal antibodies, designated GA-17, GB-4, and GC-3, were prepared by the hybridization of murine myeloma cells (NS-1) and spleen cells of BALB/c mice immunized with the crude membrane fraction of cultured human gliosarcoma cells (GI-1). Two of them (GA-17 and GB-4) reacted exclusively with the membrane of glioma cells, and the other (GC-3) reacted with the membrane of glioma cells and a T cell line (MOLT-4). Although these antibodies reacted with almost all of the gliomas, the reactions differed. GA-17 reacted equally well with all glioblastoma (17 cases) and low-grade astrocytoma (10 cases), whereas GB-4 reacted poorly with 7 cases of glioblastoma and GC-3 did not react with 7 cases of low-grade astrocytoma. The antigens, exclusively expressed on the cell surface, were analyzed by surface labeling with 125I followed by a cell lysis and immunoprecipitation with these antibodies. The findings obtained by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that GA-17, GB-4, and GC-3 reacted with Mr 140,000-145,000, Mr 160,000, and Mr 145,000-150,000 proteins, respectively. Some evidence has been obtained indicating that these antigens are composed of the same polypeptide chain (Mr 120,000) with the carbohydrate chains being different.

Role of Real-Time Ultrasonography in Glioma Surgery

Glioma cases operated on since 1980 were analyzed in regard to the role of intraoperative ultrasonography (IOUS) . Perioperative MRI's and/or CT scans, and stained specimens and pathological reports were also reviewed. 3 cases of low-grade astrocytoma, 1 case of metastatic malignancy (for comparison), 2 cases of gemistocytic astrocytoma or astrocytoma with gemistocytic proliferation, and 1 case of glioblastoma multiforme were presented. Low-grade astrocytomas were generally hyperechoic with indistinct margins. IOUS was mostly helpful for guiding open biopsy maneuvers, but less so for needle biopsy. When located deep in the thalamus, however, IOUS was helpful in guiding needle biopsy. Gemistocytic astrocytomas were rather hyperechoic and proved good candidates for either echo-guided needle biopsy or open biopsy. Malignant gliomas were well visualized and good candidates both for needle biopsy and extensive excision under ultrasound guidance.