Tumor Mass Effect Research Articles

7564 Adrenal Pheochromocytoma In A Clinically Inapparent Adrenal Mass

Abstract Disclosure: L. Medina Mora: None. S. Htoo: None. A. Sanchez Ruiz: None. M. Harshan: None. A. Busta: None. Introduction: Pheochromocytomas (PCC) are rare tumors that arise from the adrenal medulla, with an estimated annual incidence of 0.8 per 100,000 person-years. These tumors have been associated with significant morbidity and mortality and are considered among the most life-threatening endocrine diseases, particularly if left undiagnosed. Its symptoms can be related to the tumor's mass effect or catecholamine excess. As a result, they can mimic other conditions, often leading to delayed or incorrect diagnosis. A study conducted on 296 patients with PCC treated from 2005 to 2016 found that 61% were discovered incidentally through cross-sectional imaging (CSI). The widespread use of CSI in recent years has led to the identification of asymptomatic cases that would have otherwise gone undetected. In this case, we present a middle-aged female who was incidentally found to have a PCC. Case Report: A 59-year-old female with a history of hypertension, cerebrovascular accident, pulmonary hypertension, systolic heart failure, mitral valve replacement, and asthma presented to the clinic for evaluation of a right adrenal lesion measuring 4.2 x 3.5 cm found during an emergency room visit during the evaluation of chest pain. She had no known family history of brain or endocrine disorders. Her lab results showed elevated plasma metanephrine and normetanephrine to 578.4 (reference range: 0-88) and 459.9 (reference: 0-244), respectively. Additionally, her 24-hour urine metanephrine was elevated to 984 mcg (normal range: 36-209), and Chromogranin A was 164.3 (reference range: 0-101). The rest of her labs, including cortisol, renin, aldosterone, and DHEA-S were unremarkable. A CT with and without contrast revealed a 3.0 x 3.5 x 5.1 cm solid non-calcified right adrenal mass measuring 39 Hounsfield units (HU). In addition, it measured 53 HU in the venous phase and 61 HU in the 15-minute delayed phase (relative washout of <1%; absolute washout of <7%). The patient was treated with alpha-blockers and underwent a robotic-assisted right adrenalectomy. The pathology was significant for a 5.4 cm well-differentiated PCC. The tumor had extended into but not beyond the adrenal capsule. The postoperative course of the patient was uncomplicated. Discussion: After a PCC is detected, the most effective treatment option is to surgically remove it. This procedure necessitates a combination of alpha and beta-blockade to regulate blood pressure and prevent a hypertensive crisis. Despite the success of surgery, there is still uncertainty about the optimal follow-up after the procedure, which often leads to many patients being lost during the process. Furthermore, even a decade after the initial surgery, there remains a substantial likelihood of illness reoccurrence or metastasis, making the situation even more complex. Therefore, it is crucial to adhere to a lifelong follow-up plan that includes annual biochemical testing. Presentation: 6/2/2024

7385 Prevalence of Central Hypothyroidism in Cushing Syndrome and Thyroid Function Tests After Cushing Treatment

Abstract Disclosure: T. Kunavisarut: None. A. Sriwijitkamol: None. Cushing syndrome can be associated with thyroid dysfunction. We investigated the association between Cushing syndrome and thyroid dysfunction. We conducted a retrospective study at Siriraj Hospital in Thailand and analyzed thyroid function tests in 80 Cushing's patients. The inclusion criteria were patients diagnosed with Cushing syndrome with thyroid function tests recorded at diagnosis of Cushing syndrome. Patients who had an abnormal thyroid function test at diagnosis of Cushing syndrome must have a thyroid function test after treatment of Cushing syndrome. Of the 80 patients, sixty-five patients (81.2%) had normal thyroid function at diagnosis, 12 patients (15%) had central hypothyroidism and three patients (3.8%) had subclinical hyperthyroidism.Interestingly, among 12 patients who had central hypothyroidism, eight patients (66.7%) were diagnosed with Cushing disease. Three patients (25%) were diagnosed with adrenal Cushing syndrome and one patient (8.3%) was diagnosed with ectopic Cushing syndrome. This finding suggested that central hypothyroidism may not be exclusively due to the mass effect of the pituitary tumor on the normal pituitary because adrenal Cushing syndrome and ectopic Cushing syndrome can also cause central hypothyroidism. Among 12 patients with central hypothyroidism at diagnosis of Cushing syndrome, nine patients (75%) normalized their thyroid function after remission of Cushing syndrome without Levothyroxine replacement. Moreover, patients with central hypothyroidism had significantly higher median 24-hour urine-free cortisol levels than euthyroid patients (1030.5 ug/day vs. 404.5 ug/day, p=0.017), indicating a potential correlation between cortisol excess and low FT4 levels. These findings suggest that hypercortisolism in Cushing syndrome can suppress the hypothalamic-pituitary-thyroid axis, but this suppression is often reversible with successful Cushing's treatment. This study highlights the importance of central hypothyroidism, which can occur in all types of Cushing syndrome. If the patients did not have hypothyroid symptoms, Levothyroxine replacement may not be necessary. For patients who already received Levothyroxine and had normal thyroid function tests, Levothyroxine can be carefully tapered and potentially discontinued because successful Cushing syndrome treatment can ultimately normalize thyroid function tests. Presentation: 6/1/2024

Retrograde instillation of methylene blue for the localization of bronchopleural fistula

Bronchopleural fistulas (BPF) resulting from pulmonary resection, radiation, or a direct tumor mass effect are associated with significant morbidity, reduced quality of life, and increased risk of mortality. Diagnosing BPF can be challenging, even with computed tomography, magnetic resonance imaging, and bronchoscopy. We report a case in which retrograde methylene blue instillation during bronchoscopy successfully confirmed the diagnosis of BPF.

Adenomas hipofisarios y adenomas funcionantes

Functioning pituitary adenomas (FPAs) are the most common pituitary lesions. They represent approximately 15% of all intracranial neoplasms, with prolactinomas accounting for 60% of FPAs. Its clinical manifestations are related to hypersecretion and/or local symptoms due to the tumor's mass effect, such as headache, visual disturbances, and/or hypopituitarism. The main clinical syndromes associated with pituitary hyperfunction include hyperprolactinemia with secondary hypogonadism, acromegaly, Cushing's syndrome, and secondary hyperthyroidism. Diagnosing FPA involves demonstrating an excess in hormone secretion through biochemical tests followed by imaging tests to localize the tumor. Magnetic resonance imaging (MRI) with contrast is the test of choice for this purpose. In regard to treatment, surgery is the first-line option for most FPAs except for prolactinomas, which usually respond well to dopamine agonists.

Spatially fractionated radiotherapy (Lattice SFRT) in the palliative treatment of locally advanced bulky unresectable head and neck cancer

ObjectivesLocally advanced bulky unresectable head neck cancer causes significant tumor mass effects, leading to severe symptoms. This study aims to report the safety and outcomes in patients undergoing Lattice spatially fractionated radiotherapy (Lattice SFRT) for locally advanced bulky unresectable head and neck cancer. MethodsPatients with bulky head and neck cancer received Lattice SFRT between June 2022 and June 2023. Lattice SFRT was administered in 2–3 fractions of 12 Gy (Gy) using 6-megavolt (MV) photon beams through a multileaf collimator (MLC) based on VMAT technology. The primary endpoints were symptomatic and tumor response rates. Secondary endpoints were overall survival, local control, and acute and late toxicity rates. Results19 consecutive patients meeting the study criteria were identified, predominantly with squamous cell carcinoma histology. The median patient age was 62 years (range 39–79 years), and the median tumor volume was 208 cc (cc) (range 48–701 cc). All patients completed radiotherapy. Among all investigated patients, 16 of 19 (84.2 %) patients achieved an objective response, including 10 individuals achieved a partial response (PR), with 3 of them exhibiting regression exceeding 75 %. 17 patients showed symptom improvement to varying degrees. Acute toxicity of Radiation Therapy Oncology Group (RTOG) grade 1 or higher occurred in 5 patients, while no grade 3 adverse events was observed. ConclusionsLattice SFRT proves to be a viable treatment option for the palliative management of bulky head and neck cancer. In the palliative setting, Lattice SFRT offers timely symptom relief, enhancing patient quality of life. Treatment toxicity remains within an acceptable range. Continued optimization of Lattice SFRT delivery and patient selection can benefit from further data on the feasibility and efficacy of this radiation modality.

Digital "flipbooks" for enhanced visual assessment of simple and complex brain tumors.

Typical longitudinal radiographic assessment of brain tumors relies on side-by-side qualitative visualization of serial magnetic resonance images (MRIs) aided by quantitative measurements of tumor size. However, when assessing slowly growing tumors and/or complex tumors, side-by-side visualization and quantification may be difficult or unreliable. Whole-brain, patient-specific "digital flipbooks" of longitudinal scans are a potential method to augment radiographic side-by-side reads in clinical settings by enhancing the visual perception of changes in tumor size, mass effect, and infiltration across multiple slices over time. In this approach, co-registered, consecutive MRI scans are displayed in a slide deck, where one slide displays multiple brain slices of a single timepoint in an array (eg, 3 × 5 "mosaic" view of slices). The flipbooks are viewed similarly to an animated flipbook of cartoons/photos so that subtle radiographic changes are visualized via perceived motion when scrolling through the slides. Importantly, flipbooks can be created easily with free, open-source software. This article describes the step-by-step methodology for creating flipbooks and discusses clinical scenarios for which flipbooks are particularly useful. Example flipbooks are provided in Supplementary Material.

Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas in Patients Presenting With Monocular Blindness.

Suprasellar tumors, particularly pituitary adenomas (PAs), commonly present with visual decline, and the endoscopic endonasal transsphenoidal approach (EETA) is the primary management for optic apparatus decompression. Patients presenting with complete preoperative monocular blindness comprise a high-risk subgroup, given concern for complete blindness. This retrospective cohort study evaluates outcomes after EETA for patients with PA presenting with monocular blindness. Retrospective analysis of all EETA cases at our institution from June 2012 to August 2023 was performed. Inclusion criteria included adults with confirmed PA and complete monocular blindness, defined as no light perception, and a relative afferent pupillary defect secondary to tumor mass effect. Our cohort includes 15 patients (9 males, 6 females), comprising 2.4% of the overall PA cohort screened. The mean tumor diameter was 3.8 cm, with 6 being giant PAs (>4 cm). The mean duration of preoperative monocular blindness was 568 days. Additional symptoms included contralateral visual field defects (n = 11) and headaches (n = 10). Two patients presented with subacute PA apoplexy. Gross total resection was achieved in 46% of patients, reflecting tumor size and invasiveness. Postoperatively, 2 patients experienced improvement in their effectively blind eye and 2 had improved visual fields of the contralateral eye. Those with improvements were operated within 10 days of presentation, and no patients experienced worsened vision. This is the first series of EETA outcomes in patients with higher-risk PA with monocular blindness on presentation. In these extensive lesions, vision remained stable for most without further decline and improvement from monocular blindness was observed in a small subset of patients with no light perception and relative afferent pupillary defect. Timing from vision loss to surgical intervention seemed to be associated with improvement. From a surgical perspective, caution is warranted to protect remaining vision and we conclude that EETA is safe in the management of these patients.

Partially Ablative Body Radiotherapy (PABR): A novel approach for palliative radiotherapy of locally advanced bulky unresectable sarcomas

BackgroundLocally advanced, bulky, unresectable sarcomas cause significant tumour mass effects, leading to burdensome symptoms. We have developed a novel Partially Ablative Body Radiotherapy (PABR) technique that delivers a high, ablative dose to the tumour core and a low, palliative dose to its periphery aiming to increase overall tumour response without significantly increasing treatment toxicity. AimThis study aims to report the safety and oncologic outcomes of PABR in patients with bulky, unresectable sarcomas. Methods and materialsA total of 18 patients with histologically proven sarcoma treated with PABR from January 2020 to October 2023 were retrospectively reviewed. The primary endpoints were symptomatic and structural response rates. Secondary endpoints were overall survival, freedom from local progression, freedom from distant progression, and acute and late toxicity rates. ResultsAll patients had tumours ≥5 cm with a median tumour volume of 985 cc, and the most common symptom was pain. The median age is 72.5 years and 44.5 % were ECOG 2–3. The most common regimen used was 20 Gy in 5 fractions with an intratumoral boost dose of 50 Gy (83.3 %). After a median follow-up of 11 months, 88.9 % of patients exhibited a partial response with a mean absolute tumour volume reduction of 49.5 %. All symptomatic patients experienced symptom improvement. One-year OS, FFLP and FFDP were 61 %, 83.3 % and 34.8 %, respectively. There were no grade 3 or higher toxicities. ConclusionPABR for bulky, unresectable sarcomas appears to be safe and may provide good symptomatic response, tumour debulking, and local control. Further study is underway.

Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment.

Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.

IDH1 mutation predicts seizure occurrence and prognosis in lower-grade glioma adults

Epileptic seizures are frequently the first symptom in glioma patients. However, the causal relationship between glioma and epilepsy is not yet fully understood, as it cannot be explained solely by tumor mass effect or peritumoral factors. In this study, we retrospectively enrolled 320 patients with grade 2–4 glioma who received treatment between January 2019 and July 2022, and explored the biomarkers of seizure occurrence and seizure outcome prediction using univariate and multivariate logistic regression analyses. Our results showed that IDH1 R132H mutation was an independent risk factor for seizure occurrence in lower-grade glioma (LGG) patients (OR = 4.915, 95%CI = 1.713 – 14.103, P = 0.003). Additionally, IDH1 R132H mutation predicted higher seizure-free ratios in LGG patients with intact ATRX expression (OR = 6.793, 95%CI = 1.217 – 37.923, P = 0.029) one year after diagnosis. Therefore, our findings suggest that IDH1 mutation can predict seizure occurrence and control in LGG patients, providing further insights into the relationship between glioma and epilepsy.

Jugulotympanic paraganglioma: A cause of sequential cranial nerve fallout and obstructive hydrocephalus

Abstract A 46-year-old male presented with a longstanding history of a sequential cranial nerve fallout. Following extensive imaging which included contrast enhanced computed tomography, computed tomography angiography, and diagnostic digital subtraction angiography, a diagnosis of jugulotympanic paraganglioma was made. The tumour was found to be locally invasive, encapsulating major neurovascular structures and ultimately inaccessible. Furthermore, the clinical presentation was complicated by acute obstructive hydrocephalus secondary to tumour mass effect. Given the rarity of the condition and unusually extensive presentation, neurosurgery alongside a multidisciplinary team collaborated to formulate a management plan aimed at maximizing functional outcome and minimizing intraoperative morbidity. A decision was made to perform palliative surgical debulking procedure followed by multidisciplinary care and rehabilitation. The patient demised in the care of his family prior to any further intervention.

NIMG-84. COMPARISON OF TRADITIONAL AND ADVANCED DEEP-LEARNING PATIENT SPECIFIC REGISTRATION METHODS IN PRESERVING TUMOR HABITAT IN GLIOBLASTOMA TUMORS: A PRELIMINARY STUDY

Abstract PURPOSE Registration of patient specific pre and post operative MRI scans in Glioblastoma patients is crucial to assess tumor progression, effect of radiation, and chemotherapy and survival prediction. However, in brain tumors longitudinal registration is challenging as tumor resection and mass effects causes tissue deformations and missing intensity correspondence across longitudinal scans. In this study, we compared effectiveness of traditional registration algorithms with state-of-the-art computationally extensive deep learning (DL) models in preserving intensity of tumor regions. METHODS Brain MRI scans (T1w,T1c,T2w,FLAIR) of 14 glioblastoma patients with first (tp1), intermediate (tp2) and follow up post operative scans (tp3) were obtained from two publicly available dataset (LUMIERE, XCURE). Preprocessing involved co-registration of all modalities within a timepoint, skull stripping, and uniformity in image dimensions, orientation, and origin across all timepoints. Tumor scans at tp2 and tp3 were registered to tp1 for all modalities independently, using different registration algorithms such as the traditional affine and symmetric diffeomorphic (SyN) registration with and without tumor masks using the ANTs software, along with the MICCAI-registration challenge winner DL algorithm (DIRAC). Intensity distribution of registered and unregistered scans for tp2 and tp3 were compared using the earth mover’s distance (EMD). RESULTS Traditional affine (tp2-0.074±0.06, tp3:0.058±0.051) and SyN (tp2-0.048±0.031 ,tp3:0.075±0.074) registration algorithm using T2w modality provided lower average EMD than DL method (tp2-0.624±0.69,tp3-0.595±0.67). Intensity distribution was better preserved for scans from intermediate timepoints compared to the post operative scans. CONCLUSION Our preliminary assessment suggests that traditional registration methods when implemented on pre-aligned MRI scans may better preserve image intensities in brain tumors scans compared to advanced and computationally expensive DL methods.

FRI312 Diplopia And Headache After Treatment With GnRH Agonist

Abstract Disclosure: A.A. Zakkar: None. M. Al Mushref: None. M. Fadanelli: None. Case Report: The Patient is a 46-year-old male with past medical history of hypertension and prostate cancer, currently undergoing treatment with leuprolide acetate injections, who presented to the emergency department with a complaint of worsening headache. He received his second injection 3 days prior to admission and within hours he developed a headache in the frontal area that was continuous and worsening over time, increasing with positional changes of his head. One day after the treatment he developed persistent double vision. The patient reported that he has had worsening vision over the last year and was to see an ophthalmologist but was diagnosed with prostate cancer at the same time so he became more focused on the oncologic care. He also reported poor balance, excessive thirst and increased urination of large volumes of urine every hour with nocturia several times. On exam the vital signs were normal, he was A&Ox4 and in no distress. He had left abducens and oculomotor nerve palsy but an otherwise benign exam. MRI of the brain revealed a sellar mass measuring 2.2 x 1.7 x 2.3 cm consistent with pituitary macroadenoma extending into the suprasellar cistern, compressing the pituitary stalk and the optic chiasm. Patient was evaluated by ophthalmology who noted +2 optic nerve edema of the left eye. Laboratory evaluation revealed low ACTH of 6 pg/mL at 5:30AM along with corresponding cortisol level of only 1.6 mcg/dL. FSH was low and LH undetectable as expected with GnRH agonist therapy. Growth hormone level, IGF-1, l and prolactin levels were all normal. The TSH was 0.50 microunits/mL with a freeT4 of 1.0. Urinalysis revealed dilute urine with specific gravity <1.006. Serum sodium on admission was 137 mmol/L and after overnight fasting was 140 mmol/L. The patient was started on desmopressin 0.1 mg po at bedtime and on intravenous dexamethasone 4 mg q6hrs. He was evaluated by neurosurgery and ENT who recommended trans-sphenoidal resection of the mass. Pathology report of the specimen was consistent with a pituitary adenoma with infarction without hemorrhage. The patient reported an improvement in his left eye vision and lateral rectus palsy. He was transitioned to oral hydrocortisone 20 mg daily and 10 mg every afternoon prior to discharge. On follow up with endocrinology several months later he was found to have persistent adrenal insufficiency and developed central hypothyroidism that required treatment. Conclusion: Patients with an undiagnosed pituitary adenoma are at risk of tumor expansion and mass effect as well as pituitary apoplexy during treatment with GnRH agonists. In our case clinical presentation was consistent with pituitary apoplexy without evidence of pituitary hemorrhage soon after GnRH agonist. A full ophthalmologic exam may be an appropriate screening prior to initiation of such therapy. Presentation: Friday, June 16, 2023

THU027 Challenges In The Management Of Extreme Hyperglycemia In An Acromegalic Patient

Abstract Disclosure: M. Sonbol: None. M. Novitskaya: None. J. Monye: None. S. Jafri: None. E. Japp: None. Introduction: Hyperglycemia in acromegalic patients presents a unique challenge given the disruption GH has on glucose homeostasis. Chronic hypersecretion of GH causes severe insulin resistance which can progress to uncontrolled DM. We describe a patient with acromegaly requiring >180 units/day of insulin in the perioperative period while awaiting transsphenoidal surgery. Clinical Case: A 49-year-old female with HTN and recent diagnosis of uncontrolled type 2 DM presented with several months of blurry vision and headaches. She had several prior admissions for hyperglycemia and DKA (with normal C-peptide, and negative GAD-65 and islet cell autoantibodies) despite compliance with insulin therapy. Her HbA1c was 12.2% on 2 units/kg TDD of insulin. Imaging was significant for a sellar/suprasellar solid mass with cystic components measuring 8.3 x 6.3 x 7.8 cm encasing bilateral internal carotid arteries, encroaching the left orbital apex, and applying mass effect on bilateral frontal lobes, and right temporal lobe and midbrain. Labwork was significant for IGF-1 1083 ng/mL (n<238), and GH of 96.4 ng/mL (n<8). FSH and LH were suppressed, with otherwise normal pituitary hormone levels. Interestingly, the patient did not exhibit classic clinical features of acromegaly such as macroglossia, enlarged digits or coarse facial features. Transsphenoidal biopsy demonstrated mature PIT-1 lineage NET with expression of GH and PRL. Given the significant tumor mass effect, she was placed on dexamethasone 4 mg q12h. Preoperatively, her blood glucose worsened and reached 500 mg/dL despite >180 units of insulin/day on a subcutaneous insulin regimen. Glycemic management was escalated with addition of regular insulin gtt up to 25 units/hr to achieve target blood glucose of 140-180 mg/dL. After successful surgical resection of the tumor, HbA1c decreased to 7.7% on 1.3 units/kg TDD of insulin, metformin and empagliflozin at eight weeks postoperatively. Clinical Lessons: Unusual presentations of rapidly increasing insulin requirements in newly diagnosed DM should raise clinical suspicion for secondary causes such as acromegaly. The degree of insulin resistance is often out of proportion to the patient’s body habitus given the GH-mediated lipodystrophy and adipose tissue dysfunction. In this case, the patient’s insulin requirement was 2 units/kg TDD of insulin, with her BMI being only 22.14 kg/m2. Given the need for semi-urgent surgery due to the tumor’s mass effect, SSA therapy or GH-receptor antagonist was not initiated, and insulin therapy was the mainstay for preoperative glucose management. In severe cases of acromegaly-related hyperglycemia, subcutaneous insulin alone may not be sufficient for adequate glucose control, especially in the setting of preoperative steroids, and large doses of IV insulin may be needed to reach inpatient glucose goals. Presentation: Thursday, June 15, 2023

P11.26.B THE CLINICAL RELEVANCE OF IMMUNE PERIPHERAL STATUS AND ITS RELATION TO NEURORADIOLOGICAL FINDINGS IN NEWLY DIAGNOSED GLIOBLASTOMAS

Abstract BACKGROUND High-grade gliomas are the most frequent and deadliest type of primary brain tumors in adults; despite the significant advances in understanding tumor biology, life expectancy of these patients is still limited. The aim of our study was to analyse blood cells counts and ratios as systemic inflammatory markers in newly diagnosed glioblastoma, to correlate these data with the radiological parameters and to identify their role as prognostic factors. MATERIAL AND METHODS A retrospective analysis was performed in 112 patients who underwent surgery for glioblastoma between 2016 and 2021. MRI for radiological features was available in all patients. Preoperative blood tests (neutrophils N, lymphocytes L, monocytes M, platelets PLT) were available in 105 patients. Inflammatory markers/ratios (NLR, LMR and PLR) were calculated. RESULTS Significant cut-offs for survival in inflammatory ratios were identified. Significant predictors for survival in Cox regression analysis were NLR > 2.3, LMR < 3 and high platelets counts. We then evaluated relationship with radiological parameters: midline location was statistically significantly correlated with higher N and PLT levels as well as NLR and PLR and with lower L levels; insular location with lower L and higher NLR and PLR; the involvement of more than one lobe with higher N and NLR, midline shift with higher N, NLR and PLR and lower L. The correlation with inflammatory markers was confirmed for tumor volume in FLAIR, associated with higher N, NLR and PLR and lower L, contrast-enhanced volume, associated with higher PLR, and necrosis volume, associated with higher N, NLR and PLR and PLT. Significant predictors in univariate Cox regression analysis were midline and insular location, involvement of more than 1 lobe and multifocality. In the multivariate analysis multifocality had the greater impact on survival (HR 2, p = 0.037) while contrast-enhanced volume and necrosis volume had a significant but lower impact on survival (HR 1.04 and 0.94, respectively); a LMR > 3 was associated with a benefit in survival (HR 0.56, p = 0.041), while increasing platelets were associated with poor outcome, even if with a lower impact (HR 1.01, p < 0.001). CONCLUSION We identified potential markers of systemic inflammation in gliobastoma patients calculated as ratios of preoperative blood cells counts (NLR, LMR, PLR) and proposed cut-points with significant impact on overall survival. We established a relationship between counts and ratios and radiological features, particularly tumor location, mass effect and volumes. We also identified a “trend” in blood cells counts and inflammatory markers correlated with those radiological features with a significant impact on survival. We identified platelets and lymphocytes (in the ratio relative to monocytes) as the inflammatory markers with the most significant effect on survival.

Machine learning identifies experimental brain metastasis subtypes based on their influence on neural circuits

A high percentage of patients with brain metastases frequently develop neurocognitive symptoms; however, understanding how brain metastasis co-opts the function of neuronal circuits beyond a tumor mass effect remains unknown. We report a comprehensive multidimensional modeling of brain functional analyses in the context of brain metastasis. By testing different preclinical models of brain metastasis from various primary sources and oncogenic profiles, we dissociated the heterogeneous impact on local field potential oscillatory activity from cortical and hippocampal areas that we detected from the homogeneous inter-model tumor size or glial response. In contrast, we report a potential underlying molecular program responsible for impairing neuronal crosstalk by scoring the transcriptomic and mutational profiles in a model-specific manner. Additionally, measurement of various brain activity readouts matched with machine learning strategies confirmed model-specific alterations that could help predict the presence and subtype of metastasis.

Symptoms: Sudden Sensorineural Hearing Loss and Aural Fullness

Symptoms: Sudden Sensorineural Hearing Loss and Aural Fullness

Ensemble Inversion for Brain Tumor Growth Models With Mass Effect.

We propose a method for extracting physics-based biomarkers from a single multiparametric Magnetic Resonance Imaging (mpMRI) scan bearing a glioma tumor. We account for mass effect, the deformation of brain parenchyma due to the growing tumor, which on its own is an important radiographic feature but its automatic quantification remains an open problem. In particular, we calibrate a partial differential equation (PDE) tumor growth model that captures mass effect, parameterized by a single scalar parameter, tumor proliferation, migration, while localizing the tumor initiation site. The single-scan calibration problem is severely ill-posed because the precancerous, healthy, brain anatomy is unknown. To address the ill-posedness, we introduce an ensemble inversion scheme that uses a number of normal subject brain templates as proxies for the healthy precancer subject anatomy. We verify our solver on a synthetic dataset and perform a retrospective analysis on a clinical dataset of 216 glioblastoma (GBM) patients. We analyze the reconstructions using our calibrated biophysical model and demonstrate that our solver provides both global and local quantitative measures of tumor biophysics and mass effect. We further highlight the improved performance in model calibration through the inclusion of mass effect in tumor growth models-including mass effect in the model leads to 10% increase in average dice coefficients for patients with significant mass effect. We further evaluate our model by introducing novel biophysics-based features and using them for survival analysis. Our preliminary analysis suggests that including such features can improve patient stratification and survival prediction.

An unusual case of mediastinal mass with pleural and pericardial effusion

Myeloid sarcoma is a tumor mass consisting of myeloid blasts, with or without maturation, occurring in an anatomical site other than bone marrow. More than 2000 case reports so far, only few comprehensive studies have been done, which reflects the rarity and difficulties in treatment of this neoplasm.: A 17-year-old female presented with complaints of neck swelling since 2 months, breathlessness since 5 days. PET CT- Bilateral pleural and pericardial effusion Large mediastinal mass, multiple enlarged lymph nodes and appendicular skeleton showing increased FDG uptake. CT-Guided biopsy of the mediastinal mass: Uniform blue cells in sheets.: CD45-Weak positive CD20, CD3, TdT-Negative CD99-Diffuse strong positive Parallelly, blood and bone marrow examination was done. Peripheral smear-80% blasts. Bone marrow-Monomorphous population of myeloblasts.: About 21% of Myeloid Sarcomas (MS) are reported to occur in the mediastinum. Clinical presentation is dependent on tumour location, with symptoms due to tumour mass effect or local organ dysfunction. Recent studies show a misdiagnosis of 25-47%, with Hodgkin's lymphoma, lymphoblastic lymphoma, DLBCL, Ewing's sarcoma, thymoma, round blue cell tumours, or poorly differentiated carcinomas, mostly due to inadequate immunophenotyping. It was not corrected until a diagnosis of acute leukaemia was later established by bone marrow biopsy or peripheral blood examination.: Recognition of MS with/without AML is essential for prognosis. Correlating radiological, hematological, bone marrow and flowcytometry features with histomorphology and immunohistochemistry of the tumor is essential. A rare possibility of MS should be kept in mind for mediastinal masses for timely diagnosis and treatment.

Hyperprolactinemia Associated with Attentional Processing and Interference Control Impairments in Patients with Prolactinomas.

The cognitive impairment of pituitary adenomas (PAs) has received increasing attention. Hyperprolactinemia and tumor mass effect are the potential causes. The aim of this study was to identify possible cognitive impairment and to further explore the correlation between these indices and prolactin (PRL) levels, based on the control of tumor size. Twenty-seven patients with prolactinomas (patient group) and twenty-six matched health control group (HC group) were enrolled in this study. All participants performed the flanker task while we continuously recorded electroencephalography data. On the behavioral performance level, patients showed a significantly slower reaction time (RT) in both flanker types. Concerning the event-related potentials level, patients elicited reduced P2 and enhanced N2 amplitudes compared with the HC group, suggesting an impairment of attentional processing (P2) and conflict monitoring (N2). Moreover, the patient group also induced lower P3 amplitudes relative to the HC group in both types, indicating that there were deficits in attentional resource allocation ability. We also found a significant correlation between the P3 amplitudes and incongruent condition RTs, as well as the subsequent PRL levels in the patient group. In conclusion, this is an innovative study that reveals the impaired cognition abilities in prolactinomas, and also proposes the possible cognitive toxicity of oversecreted PRL levels, which provides evidence for further research on the cognitive decline in PAs.