Tumor World Health Organization Grade Research Articles

Incidental presentation of appendix neuroendocrine tumor: Long-term results from a single institution.

Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic. Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival. The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes. Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.

Risk factors for lymph node metastasis in rectal neuroendocrine tumors: A recursive partitioning analysis based on multicenter data.

The well-differentiated rectal neuroendocrine tumors (RNETs) can also have lymph node metastasis (LNM). Large multicenter data were reviewed to explore the risk factors for LNM in RNETs. Further, we developed a model to predict the risk of LNM in RNETs. In total, 223 patients with RNETs from the Fujian Medical University Union Hospital, the First Affiliated Hospital of Fujian Medical University, and the First Affiliated Hospital of Xiamen University were retrospectively enrolled. Logistic regression analysis was performed to study the factors affecting LNM, and recursive partitioning analysis (RPA) was performed to stratify the risk of LNM. Among the 223 patients diagnosed with RNETs, the incidence of LNM was 10.8%. Univariate and multivariate regression analyses revealed that tumor size, World Health Organization (WHO) grade, and depth of tumor invasion were independent risk factors for LNM (p < 0.05). The area under the curve was 0.948 (95% confidence interval: 0.890-1.000). Furthermore, the incidence of LNM in patients divided into low- and high-risk groups according to RPA was 1.1% and 56.4%, respectively. Compared with tumor size, the depth of tumor invasion and WHO grade are more important factors in predicting LNM. Then, we developed a model based on RPA to predict the risk of LNM in RNETs and identify patients who are suitable for local resection.

Increased gamma and decreased fast ripple connections of epileptic tissue: A high-frequency directed network approach.

ObjectiveNew insights into high‐frequency electroencephalographic activity and network analysis provide potential tools to improve delineation of epileptic tissue and increase the chance of postoperative seizure freedom. Based on our observation of high‐frequency oscillations “spreading outward” from the epileptic source, we hypothesize that measures of directed connectivity in the high‐frequency range distinguish epileptic from healthy brain tissue.MethodsWe retrospectively selected refractory epilepsy patients with a malformation of cortical development or tumor World Health Organization grade I/II who underwent epilepsy surgery with intraoperative electrocorticography for tailoring the resection based on spikes. We assessed directed functional connectivity in the theta (4‐8 Hz), gamma (30‐80 Hz), ripple (80‐250 Hz), and fast ripple (FR; 250‐500 Hz) bands using the short‐time direct directed transfer function, and calculated the total, incoming, and outgoing propagation strength for each electrode. We compared network measures of electrodes covering the resected and nonresected areas separately for patients with good and poor outcome, and of electrodes with and without spikes, ripples, and FRs (group level: paired t test; patient level: Mann‐Whitney U test). We selected the measure that could best identify the resected area and channels with epileptic events using the area under the receiver operating characteristic curve, and calculated the positive and negative predictive value, sensitivity, and specificity.ResultsWe found higher total and outstrength in the ripple and gamma bands in resected tissue in patients with good outcome (rippletotal: P = .01; rippleout: P = .04; gammatotal: P = .01; gammaout: P = .01). Channels with events showed lower total and instrength, and higher outstrength in the FR band, and higher total and outstrength in the ripple, gamma, and theta bands (FRtotal: P = .05; FRin: P < .01; FRout: P = .02; gammatotal: P < .01; gammain: P = .01; gammaout: P < .01; thetatotal: P = .01; thetaout: P = .01). The total strength in the gamma band was most distinctive at the channel level (positive predictive value [PPV]good = 74%, PPVpoor = 43%).SignificanceInterictally, epileptic tissue is isolated in the FR band and acts as a driver up to the (fast) ripple frequency range. The gamma band total strength seems promising to delineate epileptic tissue intraoperatively.

Predictors of recurrence and postoperative outcomes in patients with non-skull base meningiomas based on modern neurosurgical standards

Abstract Background Advances in neurosurgical techniques and neuroimaging resolution questions the modern-day reliability of the Simpson grade for predicting meningioma recurrence. Therefore, we evaluated the reliability of predictors for recurrence and outcomes in detail in patients with non-skull base meningiomas (NSBMs). Methods We retrospectively analyzed data from consecutive 175 NSBMs underwent surgical resection. We performed Kaplan–Meier analyses of recurrence-free survival (RFS) according to Simpson and World Health Organization (WHO) grades. Predictors of RFS and clinical deterioration were estimated by univariate and multivariate analyses. Correlation between the Simpson grade and change in Karnofsky Performance Scale scores was assessed by Fisher's exact test. Results Log-rank tests revealed significant correlations of both the Simpson and WHO grades with RFS for the overall cohort, convexity, and falx/tentorium meningioma. Unlike patients undergoing Simpson grade I and II resections, RFS in patients with WHO grade I and II/III tumors differed significantly from the early postoperative stage. Multivariate analysis identified tumor size, Simpson grade, and MIB-1 labeling index as significant predictors of RFS. Clinical deterioration was more frequent among patients undergoing less aggressive resection. Tumor location was the only significant predictor of clinical deterioration. Conclusions Our findings indicate that tumor size, Simpson and WHO grades, and MIB-1 labeling index are significant predictors of NSBM recurrence. Moreover, the risk of recurrence markedly decreases within the follow-up duration of 80 months. Aggressive resection appears to minimize the risk of recurrence without evidence of clinical deterioration. Follow-up schedules should be based on the WHO grade and extent of resection.

Role of the microRNA 181 family in glioma development.

MicroRNAs (miRNAs) are small, noncoding regulatory RNAs that regulate protein expression by reducing mRNA stability and/or translation, via base pairing with full or partial sequence‑complementary target mRNAs. Recent evidence indicates that miRNAs have roles as tumor suppressors and oncogenes. The members of the miRNA181 (miR181) family have been reported to be downregulated in early stage human glioma, and to be involved in glioma development. The current study demonstrated that all subtypes of the miRNA 181 family were downregulated at stages of human glioma, including miR181a1, a2, b1, b2, c and d. In the present study, the family members were detected by reverse transcription-quantitative polymerase chain reaction in glioma tissues of different stages. miR181c declined the most in the samples from patients with World Health Organization (WHO) gradeI glioma. As glioma development progressed from gradeI to IV, the expression of miRN181 family members continued to decline, with miR181b1 exhibiting the fastest decline rate. Furthermore, a lentivirus was used to overexpress miR181c in primary glioma cells; the result indicated that miR181c overexpression was able to significantly inhibit glioma cell proliferation. Thus, miR181 may be a useful biomarker for human glioma at early stages. Detection of the level of miR181 family members may be a potential method for glioma diagnosis, determining the tumor WHO grade and guiding clinical treatment.

Expression level of human miR-34a correlates with glioma grade and prognosis

The aim of this study is to investigate the expression level of microRNA-34a (miR-34a) in glioma patients and its significance for predicting the prognosis of glioma. In this study, we examined the expression of miR-34a in glioma tissues of various World Health Organization (WHO) grades and explored the association between miR-34a expression and clinical and pathological parameters of glioma patients. We found that the tissues from high-grade gliomas (grade III and IV) had much lower miR-34a expression compared to normal brain tissues. The results of a 72-month follow-up in 146 glioma patients further demonstrated that miR-34a expression levels positively correlated with tumor WHO grades. Additionally, in the patients with grade III and IV gliomas, lower miR-34a expression correlated with worse progression-free survival and overall survival. Univariate and multivariate analysis revealed that miR-34a was an independent prognostic indicator for glioma. Additionally, we explored the correlation between miR-34a expression and p53 status and Bcl-2 expression in grade III and IV glioma tissues. Wild-type p53 tumors displayed significantly higher miR-34a expression level than mutant p53 tumors. In addition, glioma tissues with high miR-34a expression had dramatically lower Bcl-2 expression levels than tissues with low miR-34a expression. These findings indicate the role of miR-34a in tumor progression may be closely associated with p53 mutation and inversely correlated to Bcl-2 expression. In conclusion, our work presents comprehensive evidence for miR-34a expression as a novel and potentially useful signature for predicting prognosis of glioma.

Syndecan-1 expression in human glioma is correlated with advanced tumor progression and poor prognosis

Syndecan-1 has been implicated in tumorigenesis and progression of various human malignancies. Recent studies have demonstrated that syndecan-1 may have a different function and biological activity depending on the specific tumor type. Therefore, the aim of this study was to investigate the clinical significance of syndecan-1 in human gliomas. One hundred and sixteen glioma patients (26 World Health Organization (WHO) grade I, 30 WHO grade II, 30 WHO grade III, and 30 WHO grade IV) and 15 normal brain specimens acquired from 15 patients undergoing surgery for epilepsy as control were collected. Immunohistochemistry assay, quantitative real-time PCR and Western blot analysis were carried out to detect the expression of syndecan-1 at gene and protein levels in glioma samples with different WHO grades. Syndecan-1 gene and protein levels were both higher in glioma tissues compared to controls (both P < 0.001). In addition, its expression levels increased with ascending tumor WHO grades according to the results of immunohistochemistry assay, quantitative real-time PCR and Western blot analysis. Moreover, the survival rate of syndecan-1-positive patients was significantly lower than that of syndecan-1-negative patients (P = 0.006). We further confirmed that the increased expression of syndecan-1 was an independent prognostic indicator in glioma by multivariate analysis (P = 0.01). Our data suggest for the first time that the increased expression of syndecan-1 at gene and protein levels is correlated with advanced tumor progression and poor outcome in patients with glioma. Syndecan-1 might serve as a potential prognosis predictor of this dismal tumor.

Free and total human glandular kallikrein 2 in patients with prostate cancer

Objectives The use of prostate-specific antigen (PSA, hK3) results in the overdiagnosis and overtreatment of prostate cancer. Markers are needed that could identify aggressive, fast-growing tumors and help decide which patients would benefit most from aggressive treatment. Human glandular kallikrein 2 (hK2) could be such a marker. The aim of this study was to test how PSA and hK2 could predict the pathologic stage and grade in a set of patients with clinically organ-confined disease. Methods Heparin plasma was collected from 188 patients who had undergone radical prostatectomy at the Turku University Central Hospital. Total and free PSA, as well as total and free hK2, were measured and the results compared with the pathologic TNM stage, tumor World Health Organization grade, and Gleason score. Results Free and total hK2 performed similarly to PSA in their ability to separate groups of patients with different stages or grades. Concentrations of both kallikreins were significantly different in patients with World Health Organization grade 1 cancer compared with grade 2. Neither marker could separate patients with different Gleason scores. Although PSA concentrations increased most between patients with Stage pT2b and those with pT3a, the increase in hK2 was most pronounced between those with Stage pT3a and those with pT3b. Conclusions Although hK2 could not predict the cancer stage or grade better than PSA, changes in the hK2 and PSA concentrations occurred at different points in cancer progression. hK2 may have a role in the prognosis of prostate cancer, but additional studies with longer follow-up are required to determine whether hK2 can help when selecting treatment options.