Presence Of Intratumoral Hemorrhage Research Articles

Factors associated with preoperative and postoperative seizures in patients undergoing resection of brain metastases.

Epileptic seizures are a common and potentially devastating complication of metastatic brain tumors. Although tumor-related seizures have been described in previous case series, most studies have focused on primary brain tumors and have not differentiated between different types of cerebral metastases. The authors analyzed a large surgical cohort of patients with brain metastases to examine risk factors associated with preoperative and postoperative seizures and to better understand the seizure risk factors of metastatic brain tumors. Patients who underwent resection of a brain metastasis at the University of California, San Francisco (UCSF), were retrospectively reviewed. Patients included in the study were ≥ 18 years of age, required resection of a brain metastasis, and were treated at UCSF. Primary cancers included melanoma, non-small cell lung adenocarcinoma, breast adenocarcinoma, colorectal adenocarcinoma, esophageal adenocarcinoma, gastric adenocarcinoma, renal cell carcinoma, urothelial carcinoma, ovarian carcinoma, cervical squamous cell carcinoma, and endometrial adenocarcinoma. Patients were evaluated for primary cancer type and seizure occurrence, as well as need for use of antiepileptic drugs preoperatively, at time of discharge, and at 6 months postoperatively. Additionally, Engel classification scores were assigned to those patients who initially presented with seizures preoperatively. Univariate and multivariate regression analyses were used to assess the association of tumor type with preoperative seizures. Data were retrospectively analyzed for 348 consecutive patients who underwent surgical treatment of brain metastases between 1998 and 2019. The cohort had a mean age of 60 years at the time of surgery and was 59% female. The mean and median follow-up durations after the date of surgery for the cohort were 22 months and 10.8 months, respectively. In univariate analysis, frontal lobe location (p = 0.05), melanoma (p = 0.02), KRAS mutation in lung carcinoma (p = 0.04), intratumoral hemorrhage (p = 0.04), and prior radiotherapy (p = 0.04) were associated with seizure presentation. Postoperative checkpoint inhibitor use (p = 0.002), prior radiotherapy (p = 0.05), older age (p = 0.002), distant CNS progression (p = 0.004), and parietal lobe tumor location (p = 0.002) were associated with seizures at 6 months postoperatively. The final multivariate model confirmed the independent effects of tumor location in the frontal lobe and presence of intratumoral hemorrhage as predictors of preoperative seizures, and checkpoint inhibitor use and parietal lobe location were identified as significant predictors of seizures at 6 months postoperatively. Within this surgical cohort of patients with brain metastases, seizures were seen in almost a quarter of patients preoperatively. Frontal lobe metastases and hemorrhagic tumors were associated with higher risk of preoperative seizures, whereas checkpoint inhibitor use and parietal lobe tumors appeared to be associated with seizures at 6 months postoperatively. Future research should focus on the effect of metastatic lesion-targeting therapeutic interventions on seizure control in these patients.

Predictive factors of overall survival in primary intracranial pure choriocarcinoma

The incidence of primary intracranial pure choriocarcinoma (PIPC) is extremely rare. Only several case and case series have been previously reported; therefore, there is still lack of knowledge about the prognosis and its standard treatment. We performed a collective study of all reported cases of PIPC to identify the predictive factors related with OS. A comprehensive search was performed on Pubmed’s electronic database using the terms “primary intracranial choriocarcinoma” and “malignant germ cell tumor”. Data about gender, various location, the presence of intratumoral hemorrhage, metastasis and treatment modalities were extracted from the published articles and we analyzed the overall survival based on this predictive factors. 51 cases were eligible and met the inclusion criteria. The majority of the patients were in the child population (44.7%) age between 6 and 12 years old. 77.1% of the patient were male and 22.9% were female. Tumor located other than suprasellar and pineal area showed better prognosis. Median OS of PIPC was 22 months. Patient underwent gross total resection had better outcomes compared with those who only had partial or subtotal resection. Adjuvant therapy (especially chemotherapy) significantly improved OS (p = 0.000, log-rank test). PIPC is chemosensitive and metastasis is the predictive factor for poor prognosis.

The Initial Volumetric Response and Local Control of NSCLC Brain Metastases Following Stereotactic Radiosurgery

The parameters determining local control and the initial volumetric response of brain metastases following stereotactic radiosurgery remains poorly characterized. We examined the impact of multiple tumor-specific characteristics and SRS treatment parameters on local control and initial volumetric response following SRS for brain metastases from NSCLC. 136 NSCLC patients treated between November 2008 and July 2016 with linear-accelerator based SRS for brain metastases were selected for retrospective study inclusion. Tumor volumes were measured prior to SRS session and on initial follow-up MRI at mean of 2.3 months post-SRS to evaluate initial volumetric response. Local control failure was defined as the time at which a brain metastasis increased to greater than 1.20 times its original size at initial SRS treatment and maintained this increase in size on subsequent imaging. The ratio of volume at initial post-treatment imaging to pre-treatment volume was used to determine initial volumetric response. Kaplan-Meier analysis and log rank tests were used to evaluate local control. The median radiographic follow-up was 9 months (range 1 – 72 months). Kaplan-Meier local control estimates at 6 and 12 months were 92.5% and 83.3%, respectively. Statistically significant positive predictors of improved local control included adenocarcinoma primary histology versus squamous cell carcinoma (p=0.007), adenocarcinoma versus adenosquamous carcinoma (p=0.013), and supratentorial metastases when compared to infratentorial metastases (p=0.011). Additionally, EGFR mutant and ALK-rearrangement positive metastases appeared to exhibit statistically significant improvements in local control outcomes when compared to EGFR and ALK negative and molecular status unknown metastases (p=0.016 and p=0.019, respectively). The mean initial volumetric response following SRS was 0.68 (SD +/- 0.43). Tumor parameters which resulted in worse initial volumetric response included cystic vs solid morphology (0.734 vs. 0.640; p=0.030), tumor volume ≥ 1cc (0.748 vs 0.656; p=0.027), and presence of intratumoral hemorrhage (0.793 vs. 0.658; p=.009). Tumor location, EGFR mutation status, ALK rearrangement status, and histologic subtype showed no significant effect on initial volumetric response. A significant improvement in initial volumetric response was observed for treatment with prescription dose ≥21Gy vs. <21Gy (0.640 vs. 0.812; p<0.001) and for maximum dose of >26 Gy vs. <26Gy (0.738 vs. 0.635; p=0.004). Improved initial volumetric response following SRS was associated with non-cystic morphology, tumor volume <1cc, and lack of intratumoral hemorrhage. Increased prescription and maximum dose was also associated with improved initial volumetric response. The overall local control rate was positively associated with adenocarcinoma subtype, supratentorial location, and the presence of EGFR mutation or ALK rearrangement.

Prognostic significance of PD-L1 expression, angiogenesis, and hypoxia in melanoma brain metastases (MBM): A histopathologic analysis.

9038 Background: We have previously shown that presence of intratumoral hemorrhage and absence of immune infiltrates in craniotomy specimens of MBM are associated with shorter overall survival (OS)...

Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor

BackgroundThe incidence of brain metastasis from hepatocellular carcinoma (HCC) is expected to increase as a result of prolonged survival due to the recent advances in HCC treatment. However, there is no definite treatment strategy for brain metastasis from HCC mainly due to its rarity and dismal prognosis. To provide helpful recommendations in treatment of brain metastasis from HCC, the authors aimed to identify prognostic factors that influence survival rates with a review of the recently published data.MethodsThirty-three cases of brain metastasis, whose incidence was 0.65%, were selected from a total of 5015 HCC patients and reviewed retrospectively in terms of clinical and radiological features.ResultsMedian overall survival time after diagnosis of brain metastasis was 10.4 weeks (95% confidence interval [CI], 5.1-15.7 weeks) with 1-, 6- and 12-month survival rates, of 79%, 24% and 6%, respectively. Median survival of the patients treated with surgical resection or surgical resection followed by whole-brain radiation therapy (WBRT) (25.3 weeks; range, 15.8-34.8 weeks) was longer than that of the patients treated with gamma knife surgery (GKS), WBRT, or GKS followed by WBRT (10.4 weeks; range, 7.5-13.3 weeks) as well as that of patients treated with only steroids (1 week; range, 0.0-3.3 weeks) (p < 0.001). Child-Pugh’s classification A group had a longer median survival time than Child-Pugh’s classification B or C group (14.4 weeks vs 8.4 weeks, p = 0.038). RPA class I & II group had also a longer median survival time than RPA class III group did (13.4 weeks vs 2.4 weeks, p = 0.001). Surgical resection (hazard ratio [HR] 0.23, 95% CI 0.08-0.66, p = 0.006) and good liver function at the time of brain metastasis (HR 0.25, 95% CI 0.09-0.69, p = 0.007) were found to be the powerful prognostic factors for favorable survival in the multivariate analysis. In addition, presence of intratumoral hemorrhage was a statistically significant prognostic factor for survival.ConclusionAlthough HCC patients with brain metastasis showed a very dismal prognosis, surgical intervention was shown to lead to relative prolongation of the survival time, especially in those with preserved hepatic function.

Fluid–fluid level in peripheral nerve schwannoma: report of a case with histological correlation

Fluid–fluid level was observed in an unusual case of a 74-year-old man with peripheral nerve schwannoma of the lower extremity. To our knowledge, we found that schwannomas with imaging findings of fluid–fluid level had rarely been reported in the literature, and these tumors were all intracranial. Fluid–fluid level seen in peripheral nerve schwannoma has never been reported. In this case, MRI signal characteristics are those of blood and histological analysis of the fluid–fluid level suggests cystic degeneration with presence of intratumoral hemorrhage.

Congenital glioblastoma multiforme

Congenital intracranial tumors are rare. If such a lesion is detected before birth, it is usually an incidental finding on fetal ultrasonography. The definition of a "congenital" tumor is controversial. The authors report the case of a "definite" congenital glioblastoma multiforme (GBM) diagnosed with the aid of ultrasonography and fetal magnetic resonance (MR) imaging in the 37th week of gestation. Postnatal MR imaging revealed a massive tumor occupying the patient's left temporoparietooccipital area. Angiography was performed to assess vascularity and embolize the main feeding arteries. Surgery was performed, and the tumor was successfully excised completely. The histopathological diagnosis of the tumor was GBM. An examination of the tumor cells revealed no p53 accumulation, a high MIB-1 index (87.5%), and no staining for epidermal growth factor receptor (EGFR). Adjuvant chemotherapy was administered, and the patient is doing well at 23 months of age. Congenital GBM should be considered in the differential diagnosis in cases in which a fetal ultrasonography study or fetal MR image reveals a tumor, especially in the presence of intratumoral hemorrhage. Radical tumor removal, administration of adjuvant therapy, and biological findings (such as a lack of the overexpression of p53 and EGFR in the tumor cells) all point to a longer survival time.

Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection.

To identify the pathologic features of prognostic significance in patients with resectable adrenocortical carcinomas. Retrospective review. Tertiary referral center. Review of the Memorial Sloan-Kettering Cancer Center prospective adrenocortical carcinoma database from 1986 through 1996 identified 46 patients who underwent curative adrenalectomy for primary disease. All cases were reviewed by a single pathologist and each primary tumor was characterized by 16 separate pathologic parameters. Overall survival rates in the patient population. The 5-year overall survival rate for the entire cohort was 36% (median survival rate, 28 months). Of the pathologic factors analyzed, tumor size, number of mitotic figures, and the presence of intratumoral hemorrhage were independent prognostic factors. Patients presenting with primary tumors larger than 12 cm (n = 30) had a worse outcome compared with those with smaller tumors (n = 16) (5-year survival rate: 53% vs. 22%, P<.05). Mitotic count (> or =6 per 10 high-power fields) was a negative prognostic feature (n = 15) with a 5-year survival rate of 13% vs. 51% for 0 to 6 mitotic figures per 10 highpower fields (n = 31, P<.05). Intratumoral hemorrhage (n = 23) was also a negative prognostic factor compared with no evidence of intratumoral hemorrhage (n = 23) (5-year survival rate, 53% vs. 22%, P<.05). Overall survival rates were also calculated based on the number of pathologic risk factors. Patients with no risk factors had an 83% 5-year survival rate, which decreased to 42% with 1 factor, 33% with 2 factors, and 0% with all 3 risk factors. Tumor size, hemorrhage, and mitotic count correlate with survival rates for patients undergoing curative resection. Based on these pathologic factors, adrenocortical carcinomas may be divided into low- and high-risk groups.