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Pai V, Laughlin S, Ertl-Wagner B. Imaging of pediatric glioneuronal and neuronal tumors. Childs Nerv Syst 2024:10.1007/s00381-024-06502-9. [PMID: 38960918 DOI: 10.1007/s00381-024-06502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
Glioneuronal tumors (GNTs) are an expanding group of primary CNS neoplasms, commonly affecting children, adolescents and young adults. Most GNTs are relatively indolent, low-grade, WHO grade I lesions. In the pediatric age group, GNTs have their epicenter in the cerebral cortex and present with seizures. Alterations in the mitogen-activated protein kinase (MAPK) pathway, which regulates cell growth, are implicated in tumorigenesis. Imaging not only plays a key role in the characterization and pre-surgical evaluation of GNTs but is also crucial role in follow-up, especially with the increasing use of targeted inhibitors and immunotherapies. In this chapter, we review the clinical and imaging perspectives of common pediatric GNTs.
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Affiliation(s)
- Vivek Pai
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Birgit Ertl-Wagner
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada.
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada.
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2
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Waack A, Luna A, Norris J, King N, Bhavsar A, Schroeder J, Hoyt A. Cerebellar anaplastic ganglioglioma in a septuagenarian. Radiol Case Rep 2024; 19:1472-1475. [PMID: 38312752 PMCID: PMC10835114 DOI: 10.1016/j.radcr.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Ganglioglioma is a rare neoplasm most common in children and adolescents. It is typically located in the supratentorial compartment, with the temporal lobe being the most common tumor location. Anaplastic ganglioglioma is a WHO grade III ganglioglioma, a rare subtype accounting for a small minority of ganglioglioma cases. Posterior fossa anaplastic ganglioglioma in an adult is incredibly rare; only 3 prior cases have been reported. Only 1 adult anaplastic ganglioglioma in the cerebellum has been reported. We present the second reported adult cerebellar anaplastic ganglioglioma.
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Affiliation(s)
- Andrew Waack
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Alexander Luna
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Jordan Norris
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Noah King
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Aastha Bhavsar
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Jason Schroeder
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
| | - Alastair Hoyt
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave Toledo, OH 43614, USA
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3
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Lozano Guzmán I, Sandoval-Bonilla BA, Falcon Molina JE, Garcia Iturbide R, Castillejo Adalid LA, Valverde García YA, Amaya Morante LA. High-Grade Temporal Ganglioglioma in an Older Adult Woman. Cureus 2023; 15:e45862. [PMID: 37881386 PMCID: PMC10597542 DOI: 10.7759/cureus.45862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
Ganglioglioma (GG) is a WHO-grade 1 glioneuronal neoplasm. It is well differentiated with a slow-growing pattern and is composed of a combination of neoplastic ganglion and glial cells. Anaplastic ganglioglioma (AGG) is an extremely rare malignant variant of ganglioglioma, which is not included in the new WHO classification; however, the term is used to talk about gangliogliomas with data of malignancy. AGGs usually occur in children and young adults and are associated with high recurrence and mortality. The authors describe the case of a 62-year-old woman with AGG. She presented with cacosmia, vertigo, nausea, and focal-onset seizures with secondary generalization. Magnetic resonance imaging (MRI) revealed an intra-axial lesion in the left temporal lobe. She underwent microsurgical resection guided by electrocorticography (ECoG), and a diagnosis of AGG based on microscopic morphology and immunohistochemical analysis was obtained. She was discharged a few days after surgery with subtotal resection of the lesion, no additional neurological deficit, and adequate seizure control. AGG is a very rare and poorly studied entity. It is currently a controversial term used to refer to gangliogliomas with signs of malignancy. It occurs mainly in children and young adults with temporal lobe epilepsy. Total resection is the best prognostic factor, given the unknown efficacy of radiotherapy and chemotherapy. In our case, the patient was an adult woman with a subtotal resection followed by concomitant radiotherapy and chemotherapy, obtaining a mean survival similar to that reported in the literature, so it can be thought that there is a benefit obtained with chemotherapy and radiotherapy despite having performed a subtotal resection of the lesion. Further studies are needed to establish clear diagnostic criteria for AGG, and a multicenter database of AGGs is necessary for a better understanding of the pathology and to offer the best treatment and prognosis.
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Affiliation(s)
- Isauro Lozano Guzmán
- Neurological Surgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, MEX
| | - Bayron A Sandoval-Bonilla
- Neurological Surgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, MEX
| | - Jesús E Falcon Molina
- Neurological Surgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico city, MEX
| | - Ricardo Garcia Iturbide
- Neurological Surgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, MEX
| | - Luis A Castillejo Adalid
- Neurological Surgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, MEX
| | | | - Luis A Amaya Morante
- Pathology, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, MEX
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4
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Dang H, Khan AB, Gadgil N, Prablek M, Lin FY, Blessing MM, Aldave G, Bauer D. Primary spinal intramedullary anaplastic ganglioglioma in a pediatric patient. Surg Neurol Int 2023; 14:55. [PMID: 36895253 PMCID: PMC9990802 DOI: 10.25259/sni_825_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Background Gangliogliomas (GGs) are rare tumors of the central nervous system composed of neoplastic neural and glial cells and are typically low-grade. Intramedullary spinal anaplastic GGs (AGG) are rare, poorly understood, and often aggressive tumors that can result in widespread progression along the craniospinal axis. Due to the rarity of these tumors, data are lacking to guide clinical and pathologic diagnosis and standard of care treatment. Here, we present a case of pediatric spinal AGG to provide information on our institutional approach to work-up and to highlight unique molecular pathology. Case Description A 13-year-old female presented with signs of spinal cord compression including right sided hyperreflexia, weakness, and enuresis. Magnetic resonance imaging (MRI) revealed a C3-C5 cystic and solid mass which was treated surgically with osteoplastic laminoplasty and tumor resection. Histopathologic diagnosis was consistent with AGG, and molecular testing identified mutations in H3F3A (K27M), TP53, and NF1. She received adjuvant radiation therapy and her neurological symptoms improved. However, at 6-month follow-up, she developed new symptoms. MRI revealed metastatic recurrence of tumor with leptomeningeal and intracranial spread. Conclusion Primary spinal AGGs are rare tumors, but a growing body of literature shows some trends that may improve diagnosis and management. These tumors generally present in adolescence and early adulthood with motor/sensory impairment and other spinal cord symptoms. They are most commonly treated by surgical resection but frequently recur due to their aggressive nature. Further reports of these primary spinal AGGs along with characterization of their molecular profile will be important in developing more effective treatments.
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Affiliation(s)
- Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Abdul Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, United States
| | - Marc Prablek
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Frank Y Lin
- Department of Pediatric Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Dan L Duncan Cancer Center, Houston, United States
| | - Melissa M Blessing
- Department of Pathology, Baylor College of Medicine/Texas Children's Hospital, Houston, United States
| | - Guillermo Aldave
- Department of Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, United States
| | - David Bauer
- Department of Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, United States
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5
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Estevez-Ordonez D, Gary SE, Atchley TJ, Maleknia PD, George JA, Laskay NMB, Gross EG, Devulapalli RK, Johnston JM. Immunotherapy for Pediatric Brain and Spine Tumors: Current State and Future Directions. Pediatr Neurosurg 2022; 58:313-336. [PMID: 36549282 PMCID: PMC10233708 DOI: 10.1159/000528792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brain tumors are the most common solid tumors and the leading cause of cancer-related deaths in children. Incidence in the USA has been on the rise for the last 2 decades. While therapeutic advances in diagnosis and treatment have improved survival and quality of life in many children, prognosis remains poor and current treatments have significant long-term sequelae. SUMMARY There is a substantial need for the development of new therapeutic approaches, and since the introduction of immunotherapy by immune checkpoint inhibitors, there has been an exponential increase in clinical trials to adopt these and other immunotherapy approaches in children with brain tumors. In this review, we summarize the current immunotherapy landscape for various pediatric brain tumor types including choroid plexus tumors, embryonal tumors (medulloblastoma, AT/RT, PNETs), ependymoma, germ cell tumors, gliomas, glioneuronal and neuronal tumors, and mesenchymal tumors. We discuss the latest clinical trials and noteworthy preclinical studies to treat these pediatric brain tumors using checkpoint inhibitors, cellular therapies (CAR-T, NK, T cell), oncolytic virotherapy, radioimmunotherapy, tumor vaccines, immunomodulators, and other targeted therapies. KEY MESSAGES The current landscape for immunotherapy in pediatric brain tumors is still emerging, but results in certain tumors have been promising. In the age of targeted therapy, genetic tumor profiling, and many ongoing clinical trials, immunotherapy will likely become an increasingly effective tool in the neuro-oncologist armamentarium.
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Affiliation(s)
- Dagoberto Estevez-Ordonez
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA,
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA,
| | - Sam E Gary
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
| | - Pedram D Maleknia
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan A George
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
| | - Evan G Gross
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rishi K Devulapalli
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
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Tadipatri R, Eschbacher J, Fonkem E, Kresl J, Azadi A. Larotrectinib in NTRK Fusion-Positive High-Grade Glioneuronal Tumor: A Case Report. Cureus 2022; 14:e31449. [PMID: 36523718 PMCID: PMC9747057 DOI: 10.7759/cureus.31449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
Abstract
Glioneuronal tumors are rare central nervous system tumors with heterogeneous histological and molecular features. While the majority are low grade, a small percentage can behave aggressively. Due to the rarity of these tumors, there is no consensus on how to treat high-grade glioneuronal tumors, and they are often managed similarly to glial tumors. With the advent of molecular profiling, management decisions are increasingly determined by molecular alterations in the tumor rather than the tumor type, which can be a useful approach for tumor types that do not have robust supportive clinical trial data due to low prevalence. We present a case of an 18-year-old patient with a high-grade glioneuronal neoplasm initially treated with craniospinal irradiation, vincristine, and cyclophosphamide. He presented eight years later with a recurrent tumor and was found to be positive for MEF2D-NTRK1 fusion. He was treated with surgical resection and postoperative intensity-modulated radiation therapy (IMRT; 55.8 Gy) with concurrent temozolomide, followed by the NTRK inhibitor larotrectinib. He achieved a radiographic response, with a decrease in residual enhancement and radiographic improvement over the course of treatment. He remained in clinical and radiographic remission for six months. This demonstrates the successful treatment of a high-grade glioneuronal NTRK fusion-positive tumor with larotrectinib, which has only been previously reported once in the literature.
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Affiliation(s)
| | | | - Ekokobe Fonkem
- Neuro-Oncology, Barrow Neurological Institute, Phoenix, USA
| | - John Kresl
- Radiation Oncology, Radiosurgery, Phoenix CyberKnife and Radiation Oncology Center, Phoenix, USA
| | - Amir Azadi
- Neuro-Oncology, Banner Health, Phoenix, USA
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7
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Giglio MV, Matias LG, Formentin C, Joaquim AF, de Souza Queiroz L, Ghizoni E. Peritoneal metastasis of a brainstem anaplastic ganglioglioma in a 2-year-old boy: case report and literature review. Childs Nerv Syst 2022; 38:1999-2003. [PMID: 35389065 DOI: 10.1007/s00381-022-05516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022]
Abstract
Anaplastic gangliogliomas (AGG) are rare tumors of the central nervous system (CNS) that commonly affect children and young adults, with an unusual infratentorial presentation, which is related to hydrocephalus and a worse prognosis. We report a case of a brainstem AGG in a 2-year-old boy who underwent a ventriculoperitoneal shunting (VPS) and later presented peritoneal metastasis. We also reviewed the related literature. Even though rare, disease dissemination through VPS should be sought in patients with CNS tumors and VPS who develop new abdominal symptoms. The early diagnosis and intervention may minimize morbidity and improve quality of life of such patients.
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Affiliation(s)
- Marcus Vinicius Giglio
- Neurosurgery Division, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Leo Gordiano Matias
- Neurosurgery Division, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Cleiton Formentin
- Neurosurgery Division, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Andrei Fernandes Joaquim
- Neurosurgery Division, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Enrico Ghizoni
- Neurosurgery Division, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
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8
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Rudà R, Capper D, Waldman AD, Pallud J, Minniti G, Kaley TJ, Bouffet E, Tabatabai G, Aronica E, Jakola AS, Pfister SM, Schiff D, Lassman AB, Solomon DA, Soffietti R, Weller M, Preusser M, Idbaih A, Wen PY, van den Bent MJ. EANO - EURACAN - SNO Guidelines on circumscribed astrocytic gliomas, glioneuronal, and neuronal tumors. Neuro Oncol 2022; 24:2015-2034. [PMID: 35908833 PMCID: PMC9713532 DOI: 10.1093/neuonc/noac188] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the new WHO 2021 Classification of CNS Tumors the chapter "Circumscribed astrocytic gliomas, glioneuronal and neuronal tumors" encompasses several different rare tumor entities, which occur more frequently in children, adolescents, and young adults. The Task Force has reviewed the evidence of diagnostic and therapeutic interventions, which is low particularly for adult patients, and draw recommendations accordingly. Tumor diagnosis, based on WHO 2021, is primarily performed using conventional histological techniques; however, a molecular workup is important for differential diagnosis, in particular, DNA methylation profiling for the definitive classification of histologically unresolved cases. Molecular factors are increasing of prognostic and predictive importance. MRI finding are non-specific, but for some tumors are characteristic and suggestive. Gross total resection, when feasible, is the most important treatment in terms of prolonging survival and achieving long-term seizure control. Conformal radiotherapy should be considered in grade 3 and incompletely resected grade 2 tumors. In recurrent tumors reoperation and radiotherapy, including stereotactic radiotherapy, can be useful. Targeted therapies may be used in selected patients: BRAF and MEK inhibitors in pilocytic astrocytomas, pleomorphic xanthoastrocytomas, and gangliogliomas when BRAF altered, and mTOR inhibitor everolimus in subependymal giant cells astrocytomas. Sequencing to identify molecular targets is advocated for diagnostic clarification and to direct potential targeted therapies.
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Affiliation(s)
- Roberta Rudà
- Corresponding Author: Roberta Rudà, Department of Neurology, Castelfranco Veneto/Treviso Hospital and Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy ()
| | - David Capper
- Department of Neuropathology, Charité Universitätsmedizin Berlin, Berlin and German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh and Department of Brain Science, Imperial College London, United Kingdom
| | - Johan Pallud
- Department of Neurosurgery, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy and IRCCS Neuromed (IS), Italy
| | - Thomas J Kaley
- Department of Neurology, Brain Tumor Service, Memorial Sloan Kettering Cancer Center, New York, US
| | - Eric Bouffet
- Division of Paediatric Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ghazaleh Tabatabai
- Department of Neurology & Neurooncology, University of Tübingen, German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Germany
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam and Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
| | - Stefan M Pfister
- Hopp Children´s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - David Schiff
- Department of Neurology, Division of Neuro-Oncology, University of Virginia, Charlottesville, US
| | - Andrew B Lassman
- Division of Neuro-Oncology, Department of Neurology and the Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, US
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, US
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
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Anaplastic ganglioglioma in pregnancy a cause of cerebral edema and maternal death. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The true incidence of anaplastic ganglioglioma during pregnancy is extremely rare, very few cases have been reported in the literature.
Case presentation
This is a report of a case of anaplastic ganglioglioma diagnosed in pregnancy. The patient is a 23-year-old primigravida who presented at 19 weeks of gestation headache and a convulsive episode. Her workup revealed a rare cerebral tumor that progressed to a neurological decline and died during the postpartum period.
Conclusions
Anaplastic ganglioglioma is an aggressive counterpart of Glial tumors; in pregnancy they are rare and symptoms are nonspecific. The outcome for the mother in this case fatal and a protocol for these cases has not yet been reported.
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Fujii Y, Hatae R, Hata N, Suzuki SO, Sangatsuda Y, Takigawa K, Funakoshi Y, Fujioka Y, Kuga D, Mizoguchi M, Iwaki T, Yoshimoto K. A case of ganglioglioma grade 3 with
H3 K27M
mutation arising in the medial temporal lobe in an elderly patient. Neuropathology 2022; 42:197-203. [DOI: 10.1111/neup.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Yutaro Fujii
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Ryusuke Hatae
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Satoshi O. Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yuhei Sangatsuda
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Kosuke Takigawa
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yusuke Funakoshi
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yutaka Fujioka
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Toru Iwaki
- Department of Neuropathology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
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11
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A Whole-Slide Image Managing Library Based on Fastai for Deep Learning in the Context of Histopathology: Two Use-Cases Explained. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app12010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Processing whole-slide images (WSI) to train neural networks can be intricate and labor intensive. We developed an open-source library dealing with recurrent tasks in the processing of WSI and helping with the training and evaluation of neuronal networks for classification tasks. Methods: Two histopathology use-cases were selected and only hematoxylin and eosin (H&E) stained slides were used. The first use case was a two-class classification problem. We trained a convolutional neuronal network (CNN) to distinguish between dysembryoplastic neuroepithelial tumor (DNET) and ganglioglioma (GG), two neuropathological low-grade epilepsy-associated tumor entities. Within the second use case, we included four clinicopathological disease conditions in a multilabel approach. Here we trained a CNN to predict the hormone expression profile of pituitary adenomas. In the same approach, we also predicted clinically silent corticotroph adenoma. Results: Our DNET-GG classifier achieved an AUC of 1.00 for the ROC curve. For the second use case, the best performing CNN achieved an area under the curve (AUC) of 0.97 for the receiver operating characteristic (ROC) for corticotroph adenoma, 0.86 for silent corticotroph adenoma, and 0.98 for gonadotroph adenoma. All scores were calculated with the help of our library on predictions on a case basis. Conclusions: Our comprehensive and fastai-compatible library is helpful to standardize the workflow and minimize the burden of training a CNN. Indeed, our trained CNNs extracted neuropathologically relevant information from the WSI. This approach will supplement the clinicopathological diagnosis of brain tumors, which is currently based on cost-intensive microscopic examination and variable panels of immunohistochemical stainings.
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12
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Fabris D, Karmelić I, Muharemović H, Sajko T, Jurilj M, Potočki S, Novak R, Vukelić Ž. Ganglioside Composition Distinguishes Anaplastic Ganglioglioma Tumor Tissue from Peritumoral Brain Tissue: Complementary Mass Spectrometry and Thin-Layer Chromatography Evidence. Int J Mol Sci 2021; 22:ijms22168844. [PMID: 34445547 PMCID: PMC8396361 DOI: 10.3390/ijms22168844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
Gangliosides serve as antitumor therapy targets and aberrations in their composition strongly correlate with tumor growth and invasiveness. Anaplastic ganglioglioma is a rare, poorly characterized, malignant neuronal–glial tumor type. We present the first comparative characterization of ganglioside composition in anaplastic ganglioglioma vs. peritumoral and healthy brain tissues by combining mass spectrometry and thin-layer chromatography. Anaplastic ganglioglioma ganglioside composition was highly distinguishable from both peritumoral and healthy tissue despite having five to six times lower total content. Ten out of twelve MS-identified ganglioside classes, defined by unique glycan residues, were represented by a large number and considerable abundance of individual species with different fatty acid residues (C16–C24) in ceramide portions. The major structurally identified class was tumor-associated GD3 (>50%) with 11 species; GD3 (d18:1/24:0) being the most abundant. The dominant sphingoid base residue in ganglioside ceramides was sphingosine (d18:1), followed by eicosasphingosine (d20:1). The peritumoral tissue ganglioside composition was estimated as normal. Specific ganglioside composition and large variability of ganglioside ceramide structures determined in anaplastic ganglioglioma demonstrate realistic ganglioside expression patterns and correspond to the profile of high-grade malignancy brain tumors.
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Affiliation(s)
- Dragana Fabris
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; (I.K.); (S.P.)
- Correspondence: (D.F.); (Ž.V.)
| | - Ivana Karmelić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; (I.K.); (S.P.)
| | - Hasan Muharemović
- Department of Physical Chemistry, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia;
| | - Tomislav Sajko
- Department of Neurosurgery, University Hospital Center “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia; (T.S.); (M.J.)
| | - Mia Jurilj
- Department of Neurosurgery, University Hospital Center “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia; (T.S.); (M.J.)
| | - Slavica Potočki
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; (I.K.); (S.P.)
| | - Ruđer Novak
- Department for Protemics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Šalata 11, 10000 Zagreb, Croatia;
| | - Željka Vukelić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; (I.K.); (S.P.)
- Correspondence: (D.F.); (Ž.V.)
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Vlachos N, Lampros MG, Zigouris A, Voulgaris S, Alexiou GA. Anaplastic gangliogliomas of the spinal cord: a scoping review of the literature. Neurosurg Rev 2021; 45:295-304. [PMID: 34312775 DOI: 10.1007/s10143-021-01612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/24/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
Gangliogliomas (GGs) are rare, usually low-grade tumors that account for 1-2% of all central nervous system (CNS) neoplasms. Spinal GGs are exceedingly rare (1% of all spinal tumors) and the presentation of anaplastic features in them is even rarer. According to the last World Health Organization (WHO) classification of CNS neoplasms, anaplastic GG (AGG) is classified as a malignant neoplasm (grade III). We performed a scoping review of the literature to elucidate the epidemiology, clinical features, histopathology, treatment, and outcome of primary spinal AGGs, which, to the best of our knowledge, is the first such review. Relevant studies were identified by a search of the MEDLINE and SCOPUS databases, using the following combination of search strings: (anaplastic ganglioglioma or malignant ganglioglioma or high grade ganglioglioma) AND (spine or spinal or spinal cord). We included studies related to primary or recurrent AGGs and malignant transformation of low-grade GGs. The search produced 15 eligible studies, plus two studies from the references, all of which were case reports of patients with spinal AGGs (17 studies with 22 patients). The mean age of the patients was 21.4 years and the sex ratio was 1:1, with male predominance. Motor impairment was the most common presentation, followed by sensory impairment, gait problems, urinary disturbances, and back pain. The thoracic spine was the most frequently involved area (14/22) followed by the cervical (6/22) and lumbar (5/22) spine. In terms of histology, the anaplastic features were usually predominant in the glial element, resembling high-grade astrocytomas, while the neuronal element was composed of the so-called dysplastic ganglion (neuronal) synaptophysin-positive cells, without mitotic figures. Complete surgical resection of the tumor without neurological compromise, plus adjuvant chemotherapy and radiotherapy, was the treatment protocol implemented in the two patients with the best outcome. Primary spinal AGG is an exceedingly rare entity, with only 22 cases being retrieved after an extensive literature search. They appear to affect children and young adults and tend to manifest aggressive behavior. Most studies report that only the glial component of AGGs presents high-grade malignant features, with low mitotic activity in the neuronal component. We therefore suggest that, pending novel targeted therapy, AGGs should be treated as high-grade gliomas, with an aggressive treatment protocol consisting of maximal safe resection and adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Marios G Lampros
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece.
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Poologaindran A, Lowe SR, Sughrue ME. The cortical organization of language: distilling human connectome insights for supratentorial neurosurgery. J Neurosurg 2021; 134:1959-1966. [PMID: 32736348 DOI: 10.3171/2020.5.jns191281] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/06/2020] [Indexed: 11/06/2022]
Abstract
Connectomics is the production and study of detailed "connection" maps within the nervous system. With unprecedented advances in imaging and high-performance computing, the construction of individualized connectomes for routine neurosurgical use is on the horizon. Multiple projects, including the Human Connectome Project (HCP), have unraveled new and exciting data describing the functional and structural connectivity of the brain. However, the abstraction from much of these data to clinical relevance remains elusive. In the context of preserving neurological function after supratentorial surgery, abstracting surgically salient points from the vast computational data in connectomics is of paramount importance. Herein, the authors discuss four interesting observations from the HCP data that have surgical relevance, with an emphasis on the cortical organization of language: 1) the existence of a motor speech area outside of Broca's area, 2) the eloquence of the frontal aslant tract, 3) the explanation of the medial frontal cognitive control networks, and 4) the establishment of the second ventral stream of language processing. From these connectome observations, the authors discuss the anatomical basis of their insights as well as relevant clinical applications. Together, these observations provide a firm platform for neurosurgeons to advance their knowledge of the cortical networks involved in language and to ultimately improve surgical outcomes. It is hoped that this report encourages neurosurgeons to explore new vistas in connectome-based neurosurgery.
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Affiliation(s)
- Anujan Poologaindran
- 1Brain Mapping Unit, Department of Psychiatry, University of Cambridge
- 2The Alan Turing Institute, London, United Kingdom
| | - Stephen R Lowe
- 3Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and
| | - Michael E Sughrue
- 1Brain Mapping Unit, Department of Psychiatry, University of Cambridge
- 4Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Quiroz Tejada AR, Miranda-Lloret P, Llavador Ros M, Plaza Ramirez E, Pancucci G, Roca Barber A, Simal-Julián JA, Botella-Asunción C. Gangliogliomas in the pediatric population. Childs Nerv Syst 2021; 37:831-837. [PMID: 32989499 DOI: 10.1007/s00381-020-04900-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gangliogliomas are neoplastic lesions composed by a mixed population of neoplastic glial and dysplastic neural cells. They represent around 5% of all CNS tumors in the pediatric population. These usually are well-differentiated, slow-growing tumors, meaning that complete resection could cure most of these patients. Although most lesions remain stable over time after incomplete resection, some patients develop progression of the residual lesions: the optimal approach to treat these tumors is still to be defined. METHODS This is a retrospective study in which we obtained data from medical records of pediatric patients who had a histological diagnosis of ganglioglioma following surgical treatment at a single center between 2001 and 2020. RESULTS We included 17 pediatric subjects with gangliogliomas. The median age at diagnosis was 6.7 years, and the median follow-up duration was 60 months. The most common clinical presentation was epileptic seizures (41.1%). Hydrocephalus was present in 29.4% of cases. 52.9% of tumors involved exclusively the cerebral hemispheres, with the temporal lobe being the most affected location. Gross total tumor resection (GTR) was accomplished in 47% of all cases and in 75% of hemispheric tumors. Of patients, 33% in whom GTR could not be achieved showed progression of the residual tumor. BRAF V600E mutation was present in 44.4% of cases. CONCLUSION Gangliogliomas are typically grade I tumors that occasionally affect children. They classically localize in the cerebral hemisphere but may involve deep structures like the basal ganglia, brain stem, and cerebellum, which seems to be particularly frequent in the pediatric population, implying further challenge to achieve adequate oncological control with surgery as the only treatment modality. Although most cases in which GTR could not be performed remained stable over the follow-up, significant progression of the tumor remains was observed in some patients. BRAF inhibitors should be considered as a feasible treatment option in this setting.
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Klimko A, Dandes M, Paslaru F, Giovani A. Primary Anaplastic Ganglioglioma of the Temporal Lobe With Brainstem Involvement: A Case Report and Literature Review. Cureus 2020; 12:e12060. [PMID: 33447489 PMCID: PMC7802110 DOI: 10.7759/cureus.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Anaplastic ganglioglioma (AGG) is a rare and aggressive counterpart of the more benign and frequently encountered glioma. Herein, we present a 21-year-old female who presented with episodes of total amnesia and complex partial seizures, which led to the diagnosis of AGG localized to the medial temporal lobe. She subsequently underwent surgical cytoreduction of the tumor three times with adjuvant chemoradiotherapy. The extent of resection throughout the surgeries was hindered by the extension of the tumor to critical neurovascular structures; during the last surgery, invasion into the pons was noted, which posed a significant clinical challenge.
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Affiliation(s)
- Artsiom Klimko
- Division of Physiology and Neuroscience, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Mariana Dandes
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
| | - Francesca Paslaru
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
| | - Andrei Giovani
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
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Omofoye OA, Lechpammer M, Steele TO, Harsh GR. Pituitary stalk gangliogliomas: Case report and literature review. Clin Neurol Neurosurg 2020; 201:106405. [PMID: 33340839 DOI: 10.1016/j.clineuro.2020.106405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Gangliogliomas rarely occur in the sella or suprasellar region and are almost never seen in the pituitary stalk. Seven cases of gangliogliomas occurring in this region have been reported; only one case involved a tumor within the pituitary stalk. Of the six tumors external to the pituitary stalk, two occurred in the neurohypophysis, one was in the adenohypophysis, the location of one was unspecified, and two extensively invaded the optic chiasm, hypothalamus and brainstem. This is only the second reported case of a pituitary stalk ganglioglioma, and it is unique in its use of an extended endoscopic endonasal approach for biopsy. CASE REPORT A 51-year old woman presented with an eleven-month history of polydipsia and polyuria leading to the diagnosis of diabetes insipidus. Magnetic Resonance Imaging of the brain revealed contrast-enhanced thickening and anterior bowing of the hypophyseal stalk. An extended endoscopic endonasal approach permitted midline removal of the tuberculum sella, opening of underlying dura, and exposure of the pituitary stalk. A firm, white, 4 mm diameter mass, integral to the right side of the enlarged pituitary stalk was seen and biopsied. Histopathological analysis was consistent with WHO grade 1 ganglioglioma. The patient tolerated the procedure well and required no endocrinologic treatment other than desmopressin. CONCLUSION Pituitary stalk gangliogliomas are extremely rare. The diagnosis should be considered in patients with pituitary stalk enlargement. Endoscopic endonasal approach is a safe surgical approach to establish a tissue diagnosis which is essential for pathologic certainty given the wide differential diagnosis of stalk lesions.
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Affiliation(s)
- Oluwaseun A Omofoye
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
| | - Mirna Lechpammer
- Department of Pathology and Laboratory Medicine, University of California Davis Health, 4400 V Street, Sacramento, CA 95817, USA.
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, 2521 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Griffith R Harsh
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
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Lin X, Huang R, Zhang P, Sun J, Dong G, Huang Y, Tian X. Low-grade gangliogliomas in adults: A population-based study. Cancer Med 2020; 10:416-423. [PMID: 33107220 PMCID: PMC7826489 DOI: 10.1002/cam4.3577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low-grade gangliogliomas (GGs) are rare tumors of the central nervous system in adults. This study aims to define their characteristics, prognostic factors, and the impact of different treatment patterns on survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to investigate the potential clinicopathological factors of low-grade GGs in adult patients (age ≥18 years). Kaplan-Meier method and Cox regression model were utilized to evaluate the associations between variables and overall survival (OS). RESULTS A total of 703 adult patients diagnosed with low-grade GGs were identified between 2004 and 2016, with a median follow-up period of 60.0 months. The median age at diagnosis was 32.0 years, with 50.1% of patients being male, 84.2% white people, and 40.2% of married status. The predominant tumor site was located in temporal lobe (38.8%). The median OS time for the whole cohort was not reached. The 5- and 10-year OS rates for patients underwent gross total resection (GTR) were 92.5% and 87.2%, respectively. Univariate and multivariate analysis showed age, gender, tumor site, and treatment pattern were significant factors for OS. The employment of adjuvant radiotherapy (RT) and/or chemotherapy would significantly shorten OS time. CONCLUSIONS This is the largest retrospective study of adult low-grade GGs up to date. Younger age, female gender, temporal lobe location, and GTR indicated better survival. Adjuvant RT and/or chemotherapy should not be considered after whatever surgery in adult patients with low-grade GGs, unless the malignant transformation has been confirmed.
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Affiliation(s)
- Xiaoning Lin
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Rong Huang
- Department of Child Health, Women and Children's Hospital, Xiamen University, Xiamen, China
| | - Pengfei Zhang
- Institute of Molecular Immunology, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Jin Sun
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Guijiang Dong
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yanlin Huang
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Xinhua Tian
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
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Gatto L, Franceschi E, Nunno VD, Tomasello C, Bartolini S, Brandes AA. Glioneuronal tumors: clinicopathological findings and treatment options. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2020-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glioneuronal tumors are very rare CNS neoplasms that demonstrate neuronal differentiation, composed of mixed glial and neuronal cells. The majority of these lesions are low grade and their correct classification is crucial in order to avoid misidentification as ‘ordinary’ gliomas and prevent inappropriate aggressive treatment; nevertheless, precise diagnosis is a challenge due to phenotypic overlap across different histologic subtype. Surgery is the standard of therapeutic approach; literature concerning the benefit of adjuvant treatments is inconclusive and a globally accepted treatment of recurrence does not exist. Targetable mutations in the genes BRAF and FGFR1/2 are recurrently found in these tumors and could take a promising role in future treatment management.
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Affiliation(s)
- Lidia Gatto
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Chiara Tomasello
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alba Ariela Brandes
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
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Anaplasic ganglioglioma: Cervical-dorso-lumbar leptomeningeal dissemination. About a case. Neurocirugia (Astur) 2020; 32:89-93. [PMID: 32265155 DOI: 10.1016/j.neucir.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 11/22/2022]
Abstract
Gangliogliomas are well-differentiated, slow-growing tumors. The majority are gradeI of WHO. It appears predominantly in children and young adults. Most are located at the temporal lobe, and as symptomatology more frequent epileptic seizures of difficult pharmacological control. In general, they have a good prognosis after surgical resection. The anaplasic variant, considered to be gradeIII of the WHO, presents greater clinical and radiological aggressiveness. Leptomeningeal dissemination is exceptional in these types of tumors, but when diagnosed it presents a rapidly progressive and fatal course for the patient.
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Sharma V, Bhaskar S, Hire SR, Ahuja A. A case report of rare location of ganglioglioma. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0060-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Gangliogliomas are rare tumors of the central nervous system. They can occur anywhere in the central nervous system but are most commonly located in the temporal lobe and are mainly found in children. Anaplastic ganglioglioma can result from either de novo or transformation of a pre-existing lesion.
Case presentation
We report a case of de novo anaplastic ganglioglioma in the parieto occipital region, which is a rare location. A 34-year-old lady presented with features of raised intracranial pressure (ICP) with right side hemiparesis. Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain showed well-defined intense heterogenously enhancing solid cystic mass lesion 5.3 × 5.2 cm in the left parieto occipital region with mass effect and midline shift. Intraoperatively, a cystic mass lesion with reddish brown nodule was seen in the left occipital lobe. Complete tumor excision was done. Microscopic and IHC examination was suggestive of anaplastic ganglioglioma. The post-operative period was uneventful. The patient received 60-Gy radiotherapy with temozolamide as adjuvant therapy, and repeat imaging showed no tumor recurrence.
Conclusion
Anaplastic gangliogliomas are rare tumors with parieto occipital as rare location.
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Cheaney B, Bowden S, Krause K, Sloan EA, Perry A, Solomon DA, Han SJ, Wood MD. An unusual recurrent high-grade glioneuronal tumor with MAP2K1 mutation and CDKN2A/B homozygous deletion. Acta Neuropathol Commun 2019; 7:110. [PMID: 31288852 PMCID: PMC6617605 DOI: 10.1186/s40478-019-0763-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/28/2019] [Indexed: 03/04/2023] Open
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Bouali S, Ben Said I, Zehani A, Drissi C, Bouhoula A, Kallel J, Jemel H. Pediatric Intracranial Anaplastic Gangliogliomas: Illustrative Case and Systematic Review. World Neurosurg 2018; 119:220-231. [DOI: 10.1016/j.wneu.2018.07.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Hong Y, Fang Y, Wu Q, Zhang J, Wang Y. Ganglioglioma of the adenohypophysis mimicking pituitary adenoma: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e11583. [PMID: 30045287 PMCID: PMC6078729 DOI: 10.1097/md.0000000000011583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ganglioglioma is a generally benign tumor, mostly occurring in patients <30 years old. Temporal lobe is most frequently involved. Up to now, only 3 cases were reported of ganglioglioma in the pituitary gland, all being confined to the neurohypophysis. Here, we are the first to report an adenohypophysis ganglioglioma. CASE PRESENTATION A 43-year-old woman presented with chronic headache was referred to our hospital. Magnetic resonance imaging (MRI) indicated pituitary adenoma. Endoscopic transnasal transsphenoidal surgery was performed. The tumor was rich in blood supply, with tough texture, therefore only subtotal resection was conducted. Pathology analysis revealed an adenohypophysial tumor composed of dysplastic ganglion cells and neoplastic glial cells collided with nonspecific hyperplasia of pituitary cells. Immunohistochemistry revealed positive staining of synaptophysin, glial-fibrillary acidic protein, and CD34. The results were consistent with the diagnosis of ganglioglioma. After the surgery the patient recovered well except developing cerebrospinal fluid rhinorrhea, which was controlled by lumbar drainage. MRI 6 months later did not show any sign of progression. CONCLUSION According to the findings of our case, concerns should be raised considering ganglioglioma as a differential diagnosis of mass located in the sellar region. Furthermore, an ideal management strategy for pituitary ganglioglioma is not known; therefore, more cases and long-term follow-up are needed to enrich our knowledge of the diagnosis, treatment, and prognosis of this rare intracranial lesion.
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Affiliation(s)
- Yuan Hong
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Qun Wu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
- Brain Research Institute
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Yongjie Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine
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Impact of surgery, adjuvant treatment, and other prognostic factors in the management of anaplastic ganglioglioma. Childs Nerv Syst 2018; 34:1207-1213. [PMID: 29594461 DOI: 10.1007/s00381-018-3780-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 03/16/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Anaplastic ganglioglioma (AGG) is a rare tumor with both glial and neuronal component accounting for less than 1% of all CNS tumors with limited information about the optimum treatment and outcome of these tumors. METHOD AND MATERIALS We did a thorough search of the PubMed with the following MesH terms: "Ganglioglioma; Anaplastic ganglioglioma; Ganglioglioma AND treatment; and Anaplastic ganglioglioma AND survival" to find all possible publications related to AGG to perform an individual patient data analysis and derive the survival outcome and optimum treatment of these tumors. RESULTS A total of 56 articles were retrieved pertaining to AGG with 88 patients. However, a total of 40 publications found eligible with 69 patients for individual patient data analysis. Median age for the entire cohort was 16 years (range 0.2-77 years). Surgical details were available for 64 patients. A gross total or near total resection was reported in 21 cases (32.8%), subtotal resection or debulking was reported in 25 cases (39.1%). Surgical details were available for 64 patients. A gross total or near total resection was reported in 21 cases (32.8%), and subtotal resection or debulking was reported in 25 cases (39.1%). Median overall survival (OS) was 29 months [95% CI 15.8-42.2 months] with 2- and 5-year OS 61 and 39.4% respectively. CONCLUSION AGG is associated with a dismal. Pediatric age and a gross total resection of tumor confer a better progression-free survival and OS. Hence, surgery should remain the cornerstone of therapy. However, because of modest survival, there is enough opportunity to improve survival with addition of adjuvant radiation and chemotherapy. A whole genome sequencing and molecular characterization would help to derive the best treatment option.
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Subtotal Resection of an Anaplastic Ganglioglioma in Pregnancy. Case Rep Obstet Gynecol 2018; 2018:4606354. [PMID: 29862102 PMCID: PMC5971236 DOI: 10.1155/2018/4606354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background Anaplastic ganglioglioma is a rare malignant brain tumor associated with high morbidity and mortality. The diagnosis of a central nervous system malignancy in the early 3rd trimester presents management challenges to both neurosurgeons and obstetricians. Case A 33-year-old woman, gravida 2 para 1, presented at 28 6/7 weeks with four months of worsening headaches, nausea, vomiting, and mental status changes due to a 7.5 cm anaplastic ganglioglioma. Maternal deterioration necessitated subtotal tumor debulking allowing prolongation of the gestation to 34 6/7 weeks. After delivery, the patient underwent further resection, followed by chemotherapy and radiation. Both mother and infant are well. Discussion This case underscores the importance of timely diagnostic imaging in pregnant women and demonstrates subtotal tumor debulking as a viable means of prolonging gestation.
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Marks AM, Bindra RS, DiLuna ML, Huttner A, Jairam V, Kahle KT, Kieran MW. Response to the BRAF/MEK inhibitors dabrafenib/trametinib in an adolescent with a BRAF V600E mutated anaplastic ganglioglioma intolerant to vemurafenib. Pediatr Blood Cancer 2018; 65:e26969. [PMID: 29380516 DOI: 10.1002/pbc.26969] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 01/28/2023]
Abstract
Efficacy of BRAF V600E targeted therapies in brain tumors harboring the mutation has been shown in several case reports and is currently being studied in larger clinical trials. Monotherapy with vemurafenib has been associated with significant side effects, including rashes, papillomas, and squamous cell carcinomas. Here we describe an adolescent female with anaplastic ganglioglioma and significant skin reaction to vemurafenib with subsequent tumor response and tolerance to the BRAF/MEK inhibitor combination of dabrafenib and trametinib without recurrence of previous reaction.
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Affiliation(s)
- Asher M Marks
- Department of Pediatric Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Ranjit S Bindra
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Michael L DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Vikram Jairam
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Mark W Kieran
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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28
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Terrier LM, Bauchet L, Rigau V, Amelot A, Zouaoui S, Filipiak I, Caille A, Almairac F, Aubriot-Lorton MH, Bergemer-Fouquet AM, Bord E, Cornu P, Czorny A, Dam Hieu P, Debono B, Delisle MB, Emery E, Farah W, Gauchotte G, Godfraind C, Guyotat J, Irthum B, Janot K, Le Reste PJ, Liguoro D, Loiseau H, Lot G, Lubrano V, Mandonnet E, Menei P, Metellus P, Milin S, Muckenstrum B, Roche PH, Rousseau A, Uro-Coste E, Vital A, Voirin J, Wager M, Zanello M, François P, Velut S, Varlet P, Figarella-Branger D, Pallud J, Zemmoura I. Natural course and prognosis of anaplastic gangliogliomas: a multicenter retrospective study of 43 cases from the French Brain Tumor Database. Neuro Oncol 2018; 19:678-688. [PMID: 28453747 DOI: 10.1093/neuonc/now186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022] Open
Abstract
Background Anaplastic gangliogliomas (GGGs) are rare tumors whose natural history is poorly documented. We aimed to define their clinical and imaging features and to identify prognostic factors. Methods Consecutive cases of anaplastic GGGs in adults prospectively entered into the French Brain Tumor Database between March 2004 and April 2014 were screened. After diagnosis was confirmed by pathological review, clinical, imaging, therapeutic, and outcome data were collected retrospectively. Results Forty-three patients with anaplastic GGG (median age, 49.4 y) from 18 centers were included. Presenting symptoms were neurological deficit (37.2%), epileptic seizure (37.2%), or increased intracranial pressure (25.6%). Typical imaging findings were unifocal location (94.7%), contrast enhancement (88.1%), central necrosis (43.2%), and mass effect (47.6%). Therapeutic strategy included surgical resection (95.3%), adjuvant radiochemotherapy (48.8%), or radiotherapy alone (27.9%). Median progression-free survival (PFS) and overall survival (OS) were 8.0 and 24.7 months, respectively. Three- and 5-year tumor recurrence rates were 69% and 100%, respectively. The 5-year survival rate was 24.9%. Considering unadjusted significant prognostic factors, tumor midline crossing and frontal location were associated with shorter OS. Temporal and parietal locations were associated with longer and shorter PFS, respectively. None of these factors remained statistically significant in multivariate analysis. Conclusions We report a large series providing clinical, imaging, therapeutic, and prognostic features of adult patients treated for an intracerebral anaplastic GGG. Our results show that pathological diagnosis is difficult, that survivals are only slightly better than for glioblastomas, and that complete surgical resection followed with adjuvant chemoradiotherapy offers longer survival.
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Affiliation(s)
- Louis-Marie Terrier
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Luc Bauchet
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Valérie Rigau
- French Brain Tumor DataBase, ICM, Montpellier, France.,Department of Neuropathology and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France
| | - Aymeric Amelot
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Sonia Zouaoui
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Isabelle Filipiak
- Plateforme CIRE, UMR-PRC, 37380 Nouzilly, Centre INRA Val de Loire, France
| | - Agnès Caille
- Université François-Rabelais de Tours, Tours, France.,Inserm, CIC 1415, CHRU de Tours, Tours, France.,Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Fabien Almairac
- Department of Neurosurgery, Hôpital Pasteur, University Hospital Center, 06000, Nice, France
| | - Marie-Hélène Aubriot-Lorton
- Department of Pathology, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | | | - Eric Bord
- Department of Neurosurgery and Neurotraumatology, Nantes University Hospital, Nantes, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Alain Czorny
- Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Phong Dam Hieu
- Department of Neurosurgery, CHU de la Cavale Blanche, Brest, France
| | - Bertrand Debono
- Department of Neurosurgery, Cèdres Hospital, Toulouse, France
| | - Marie-Bernadette Delisle
- Laboratoire Universitaire d'Anatomie Patholgique, Neuropathologie humaine et expérimentale, CHU Rangueil, Toulouse, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France
| | - Walid Farah
- Service de Neurochirurgie, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - Guillaume Gauchotte
- Department of Pathology, CHU Nancy and INSERM U954, Faculty of Medicine, Université de Lorraine, France
| | | | - Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France
| | - Bernard Irthum
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - Kevin Janot
- Service de Neuroradiologie, CHRU de Tours, Tours, France
| | - Pierre-Jean Le Reste
- Department of Neurosurgery, University Hospital Pontchaillou, 2, Rue Henri Le Guilloux, 35000, Rennes, France
| | - Dominique Liguoro
- Service de neurochirurgie A, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Hugues Loiseau
- Université de Bordeaux - Service de Neurochirurgie B, hôpital Pellegrin Tripode, Bordeaux, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Ophtalmologique Rothschild, Paris, France
| | - Vincent Lubrano
- Service de neurochirurgie, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA, Toulouse, France
| | | | - Philippe Menei
- Département de neurochirurgie, CHU d'Angers, 4, rue Larrey, 49940 Angers cedex 9, France
| | - Philippe Metellus
- Département de neurochirurgie, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Serge Milin
- Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France
| | | | - Pierre-Hugues Roche
- Service de Neurochirurgie, Hôpital Nord, APHM, University Hospital of Marseille Aix-Marseille Univ, Marseille, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalo-universitaire d'Angers, 4 rue Larrey, Angers Cedex, France
| | - Emmanuelle Uro-Coste
- CHU Toulouse, Hôpital de Rangueil, Service d'Anatomie et Cytologie Pathologique, Toulouse, France
| | - Anne Vital
- Bordeaux Institute of Neuroscience, CNRS UMR 5227, F-33076, Bordeaux, France
| | - Jimmy Voirin
- Department of Neurosurgery, Strasbourg-Colmar Hospital, France
| | - Michel Wager
- Department of Neurosurgery, Imaging Laboratory, University Hospital Poitiers, 2 Rue de La Miletrie, Poitiers Cedex, France
| | - Marc Zanello
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | | | - Stéphane Velut
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | | | - Johan Pallud
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Ilyess Zemmoura
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
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Bouali S, Maatar N, Zehani A, Mahmoud M, Kallel J, Jemel H. A case of adult anaplastic cerebellar ganglioglioma. Surg Neurol Int 2018. [PMID: 29527389 PMCID: PMC5838827 DOI: 10.4103/sni.sni_295_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Anaplastic posterior fossa ganglioglioma in adults is exceedingly rare. To date, only one case of adult anaplastic posterior fossa ganglioglioma has been reported in the English literature and none has been described at the cerebellum. To our knowledge, this report is the third case of malignant posterior fossa ganglioglioma in adults and the first at the cerebellum. In general, this entity can be misdiagnosed preoperatively as a primary posterior fossa neoplasm, and by reporting our clinical and radiographic observations we want to add to the existing literature on this rare entity. Case Description: A 40-year-old man presented with a history of headaches and dizziness and progressive gait disturbance and was diagnosed with anaplastic ganglioglioma in the posterior fossa. Conclusions: Although rare, our case demonstrates that anaplastic ganglioglioma should be considered in the differential diagnosis of infratentorial tumors in adult patients.
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Affiliation(s)
- Sofiene Bouali
- Department of Neurosurgery, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia
| | - Nidhal Maatar
- Department of Neurosurgery, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia
| | - Alia Zehani
- Department of Histopathology, la Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Maha Mahmoud
- Department of Neuroradiology, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia
| | - Jalel Kallel
- Department of Neurosurgery, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, National Institute of Neurology Tunis, Tunisia Faculty of Medicine, University of Tunis el MANAR, Tunisia
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30
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Beland B, Tsang RY, Sutherland G. Unprecedented response to combination BRAF and MEK inhibitors in adult anaplastic ganglioglioma. J Neurooncol 2018; 137:667-669. [PMID: 29335912 DOI: 10.1007/s11060-018-2760-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Beland
- McGill University Faculty of Medicine, 3655 Promenade Sir William Osler, Montréal, QC, H3G 1Y6, Canada.
| | - Roger Y Tsang
- Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Garnette Sutherland
- Foothills Hospital, University of Calgary Faculty of Medicine, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
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31
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Rosselló A, Plans G, Vidal-Sarró N, Fernández-Coello A, Gabarrós A. Ganglioglioma Progression to Combined Anaplastic Ganglioglioma and Anaplastic Pleomorphic Xanthoastrocytoma. Case Report and Literature Review. World Neurosurg 2017; 108:996.e17-996.e25. [PMID: 28939541 DOI: 10.1016/j.wneu.2017.09.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Composite ganglioma and pleomorphic xanthoastrocytoma with anaplastic features in both components is an extremely rare glioneuronal tumor. Five cases of anaplastic progression in the glioma component have been reported. These tumors generally affect young patients who have brain tumor-related epilepsy, which are usually located in the temporal lobe or in the cerebellum and may have associated leptomeningeal spreading. Its current optimal treatment consists of maximal safe surgical resection and adjuvant chemoradiotherapy. Overall survival at 5 years is 33% in anaplastic pleomorphic xanthoastrocytoma and 53% in anaplastic ganglioglioma. CASE DESCRIPTION We describe a progression from ganglioglioma to this composite anaplastic entity after 32 months of follow-up, with apparently nontumoral parenchyma separating the 2 components. Polymerase chain reaction showed a wild-type BRAF gene. Seven months after concomitant chemoradiotherapy, radiologic progression led to a second line of chemotherapy, and a third line of chemotherapy was initiated after a subsequent progression at 11 months. CONCLUSIONS This case may add some evidence in favor of the glioneuronal maldevelopment hypothesis to explain the oncogenesis of these neuroepithelial tumors.
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Affiliation(s)
- Aleix Rosselló
- Department of Neurosurgery, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
| | - Gerard Plans
- Department of Neurosurgery, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Noemi Vidal-Sarró
- Department of Neuropathology, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Alejandro Fernández-Coello
- Department of Neurosurgery, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Andreu Gabarrós
- Department of Neurosurgery, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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32
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Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery 2017; 83:333-344. [DOI: 10.1093/neuros/nyx408] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Aditya V Karhade
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra M G Larsen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heloise M Dubois
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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33
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Lüdemann W, Banan R, Hartmann C, Bertalanffy H, Di Rocco C. Pediatric intracranial primary anaplastic ganglioglioma. Childs Nerv Syst 2017; 33:227-231. [PMID: 27921213 DOI: 10.1007/s00381-016-3302-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary intracranial anaplastic gangliogliomas are rare tumors in the pediatric patient group. Most of them present with symptoms of elevated pressure or symptomatic epilepsy. Extraaxial location is far more common than axial location. On MRI examination, they mimic pilocytic astrocytomas. The outcome after surgery depends mainly on the possible amount of surgical resection, and oncological therapy is necessary to prevent recurrence of the disease. CASE REPORT An 11-year-old boy presented with headache and double vision due to obstructive hydrocephalus. MRI of the brain revealed an axial partially contrast enhancing lesion in the quadrigeminal plate extending from the cerebellum to the pineal gland and causing hydrocephalus. Subtotal removal of the lesion was performed, and the diagnosis of an anaplastic ganglioglioma was established and confirmed by the reference center. At the latest follow up (3 months), the boy is without any neurological symptoms and scheduled for radiation therapy as well as chemotherapy.
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Affiliation(s)
- Wolf Lüdemann
- Neurosurgical Department, Helios Klinik Hildesheim, 31135, Hildesheim, Germany.
| | - Rouzbeh Banan
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Helmut Bertalanffy
- International Neuroscience Institute, Rudolf Pichlmayrstr. 4, 30625, Hannover, Germany
| | - Concezio Di Rocco
- International Neuroscience Institute, Rudolf Pichlmayrstr. 4, 30625, Hannover, Germany
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35
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Darlix A, Zouaoui S, Rigau V, Bessaoud F, Figarella-Branger D, Mathieu-Daudé H, Trétarre B, Bauchet F, Duffau H, Taillandier L, Bauchet L. Epidemiology for primary brain tumors: a nationwide population-based study. J Neurooncol 2016; 131:525-546. [PMID: 27853959 DOI: 10.1007/s11060-016-2318-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/06/2016] [Indexed: 01/20/2023]
Abstract
Primary central nervous system tumors (PCNST) are rare tumors responsible for high mortality and morbidity. Their epidemiology is poorly known, and clinical data are scarcely analyzed at a national level. In this study, we aimed at providing descriptive epidemiological data and incidence rates for all histological subtypes of PCNST according to the WHO classification. We conducted a nationwide population-based study of all newly diagnosed and histologically confirmed PCNST in France, between 2006 and 2011. A total of 57,816 patients were included: male 46.4%, median age at diagnosis 56 years old (range 0-99). For all newly diagnosed PCNST with histological confirmation the crude incidence rate was 15.5/105 per 100,000 person-years. To enable international comparisons, standardized rates were calculated: 14.1/105 (population of reference: USA), 14.5/105 (population of reference: Europe), and 12.0/105 (population of reference: world). 23.4% of samples were cryopreserved. Resection was performed in 79.1% of cases. Results are detailed (incidence rate, sex ratio, median age at diagnosis, number of cryopreserved samples, and type of surgery) for each of the 143 histological subtypes of PCNST, including all rare tumors. For example, incidence rates (population of reference: USA) were 0.018/105 for anaplastic gangliogliomas, 0.054/105 for malignant meningiomas, and 0.036/105 for hemangiopericytomas. Our study is the first to describe incidence rates and epidemiological data for all histological subtypes of PCNST, including rare tumors, at a national level. Its methodology ensures the exhaustiveness of the data collection for histologically-proven cases. Histological population-based studies have many perspectives in the field of clinical epidemiology and research.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France.
- INSERM U1051, 80 avenue Augustin Fliche, 34091, Montpellier, France.
| | - Sonia Zouaoui
- Department of Epidemiology, French brain tumor database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34090, Montpellier, France
| | - Valérie Rigau
- Department of Pathology, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34090, Montpellier, France
| | - Faiza Bessaoud
- Department of Epidemiology, French brain tumor database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Dominique Figarella-Branger
- Department of Neuropathology and INSERM U911, Timone Hospital, Université de la Méditerranée, 40 rue Ste Baume, 13010, Marseille, France
| | - Hélène Mathieu-Daudé
- Department of Epidemiology, French brain tumor database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Brigitte Trétarre
- Department of Epidemiology, French brain tumor database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Fabienne Bauchet
- Department of Epidemiology, French brain tumor database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM)-Val d'Aurelle, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Hugues Duffau
- INSERM U1051, 80 avenue Augustin Fliche, 34091, Montpellier, France
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34090, Montpellier, France
| | - Luc Taillandier
- Neuro-oncology Unit, University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - Luc Bauchet
- INSERM U1051, 80 avenue Augustin Fliche, 34091, Montpellier, France
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34090, Montpellier, France
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36
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Zanello M, Pagès M, Roux A, Peeters S, Dezamis E, Puget S, Devaux B, Sainte-Rose C, Zerah M, Louvel G, Dumont SN, Meder JF, Grill J, Huberfeld G, Chrétien F, Parraga E, Sauvageon X, Varlet P, Pallud J. Epileptic seizures in anaplastic gangliogliomas. Br J Neurosurg 2016; 31:227-233. [PMID: 27550627 DOI: 10.1080/02688697.2016.1220506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Prevalence and predictors of epileptic seizures are unknown in the malignant variant of ganglioglioma. METHODS In a retrospective exploratory dataset of 18 supratentorial anaplastic World Health Organization grade III gangliogliomas, we studied: (i) the prevalence and predictors of epileptic seizures at diagnosis; (ii) the evolution of seizures during tumor evolution; (iii) seizure control rates and predictors of epilepsy control after oncological treatments. RESULTS Epileptic seizures prevalence progresses throughout the natural course of anaplastic gangliogliomas: 44% at imaging discovery, 67% at histopathological diagnosis, 69% following oncological treatment, 86% at tumor progression, and 100% at the end-of-life phase. The medical control of seizures and their refractory status worsened during the tumor's natural course: 25% of uncontrolled seizures at histopathological diagnosis, 40% following oncological treatment, 45.5% at tumor progression, and 45.5% at the end-of-life phase. Predictors of seizures at diagnosis appeared related to the tumor location (i.e. temporal and/or cortical involvement). Prognostic parameters of seizure control after first-line oncological treatment were temporal tumor location, eosinophilic granular bodies, TP53 mutation, and extent of resection. Prognostic parameters of seizure control at tumor progression were a history of epileptic seizures at diagnosis, seizure control after first-line oncological treatment, eosinophilic granular bodies, and TP53 mutation. CONCLUSION Epileptic seizures are frequently observed in anaplastic gangliogliomas and both prevalence and medically refractory status worsen during the tumor's natural course. Both oncological and antiepileptic treatments should be employed to improve the control of epileptic seizures and the quality of life of patients harboring an anaplastic ganglioglioma.
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Affiliation(s)
- Marc Zanello
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Mélanie Pagès
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,c Department of Neuropathology , Sainte-Anne Hospital , Paris , France
| | - Alexandre Roux
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Sophie Peeters
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Edouard Dezamis
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Stéphanie Puget
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,d Department of Pediatric Neurosurgery , Necker Enfants Malades Hospital , Paris , France
| | - Bertrand Devaux
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Christian Sainte-Rose
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,d Department of Pediatric Neurosurgery , Necker Enfants Malades Hospital , Paris , France
| | - Michel Zerah
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,d Department of Pediatric Neurosurgery , Necker Enfants Malades Hospital , Paris , France
| | - Guillaume Louvel
- e Department of Neurooncology , Gustave Roussy , Villejuif , France
| | - Sarah N Dumont
- e Department of Neurooncology , Gustave Roussy , Villejuif , France
| | - Jean-François Meder
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,f Department of Neuroradiology , Sainte-Anne Hospital , Paris , France
| | - Jacques Grill
- g Department of Pediatric Oncology , Gustave Roussy , Villejuif , France
| | - Gilles Huberfeld
- h Clinical Neurophysiology Department & Epileptology Unit , Pitié-Salpêtrière University Hospital, UPMC - APHP , Paris , France
| | - Fabrice Chrétien
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,c Department of Neuropathology , Sainte-Anne Hospital , Paris , France
| | - Eduardo Parraga
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
| | - Xavier Sauvageon
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,i Department of Neuro-Anaesthesia and Neuro-Intensive Care , Sainte-Anne Hospital , Paris , France
| | - Pascale Varlet
- b Paris Descartes University, Sorbonne Paris Cité , Paris , France.,c Department of Neuropathology , Sainte-Anne Hospital , Paris , France
| | - Johan Pallud
- a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.,b Paris Descartes University, Sorbonne Paris Cité , Paris , France
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Zanello M, Pages M, Tauziède-Espariat A, Saffroy R, Puget S, Lacroix L, Dezamis E, Devaux B, Chrétien F, Andreiuolo F, Sainte-Rose C, Zerah M, Dhermain F, Dumont S, Louvel G, Meder JF, Grill J, Dufour C, Pallud J, Varlet P. Clinical, Imaging, Histopathological and Molecular Characterization of Anaplastic Ganglioglioma. J Neuropathol Exp Neurol 2016; 75:971-980. [PMID: 27539475 DOI: 10.1093/jnen/nlw074] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Anaplastic ganglioglioma (AGG) is a rare and malignant variant of ganglioglioma. According to the World Health Organization classification version 2016, their histopathological grading criteria are still ill-defined. The aim of the present study was to assess the clinical, imaging, histopathological, and molecular characteristics and outcomes of AGGs in a large consecutive and retrospective adult and pediatric case series. Eighteen patients with AGGs (13 adults and 5 children) were identified (14 de novo and 4 secondary) from a cohort of 222 gangliogliomas (GG) (8%) treated at our institution between 2000 and 2015. AGGs represented a very aggressive disease with poor outcome (median progression-free survival, 10 months; median overall survival, 27 months). They were located in the temporal lobe only in 22% and presented with seizures (44%) or increased intracranial pressure (44%) at diagnosis. Concerning histopathological and molecular data, they shared morphological characteristics and BRAF V600E mutation (39%) with their benign counterparts but also showed hTERT promoter mutation (61%), p53 accumulation (39%), ATRX loss (17%), or p.K27M H3F3A mutation (17%). AGGs are malignant neoplasms requiring aggressive oncological treatment. In the perspective of targeted therapies, AGGs should be screened for BRAF V600E, hTERT, ATRX, and mutations of histone genes.
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Affiliation(s)
- Marc Zanello
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Mélanie Pages
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Arnault Tauziède-Espariat
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Raphael Saffroy
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Stéphanie Puget
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Ludovic Lacroix
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Edouard Dezamis
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Bertrand Devaux
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Fabrice Chrétien
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Felipe Andreiuolo
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christian Sainte-Rose
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Michel Zerah
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Frédéric Dhermain
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Sarah Dumont
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Guillaume Louvel
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jean-François Meder
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jacques Grill
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christelle Dufour
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Johan Pallud
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Pascale Varlet
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
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Arko L, Passer JZ, Ahye N, Quach E, Gibani S, Manoochehri S, Fierst TM. Journal Club. Neurosurgery 2016; 79:306-8. [DOI: 10.1227/neu.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Varshneya K, Sarmiento JM, Nuño M, Lagman C, Mukherjee D, Nuño K, Babu H, Patil CG. A national perspective of adult gangliogliomas. J Clin Neurosci 2016; 30:65-70. [PMID: 27083133 DOI: 10.1016/j.jocn.2015.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/27/2015] [Indexed: 11/30/2022]
Abstract
Gangliogliomas (GG) are rare tumors of the nervous system. Patient characteristics and clinical outcomes of low and high-grade GG have been difficult to elucidate in the adult population. This study aims to further elaborate on GG treatment and overall survival utilizing a larger cohort than previously published. The USA National Cancer Database was utilized to evaluate adult (age 18years and older) patients diagnosed with GG between 2004 and 2006. Descriptive statistics and Kaplan-Meier overall survival estimates were provided. A total of 198 adult GG patients were diagnosed between 2004 and 2006. Of these, 181 (91.4%) were low-grade and 17 (8.6%) high-grade GG. Overall, the median age was 36years; approximately 50% of patients were female, and 86.5% Caucasian. Most patients (59%) had near/gross total resection. Radiation and chemotherapy were prescribed in 18 (9.1%) and 11 (5.7%) patients, respectively. Radiation (64.7% versus 3.9%, p<.0001) and chemotherapy (47.1% versus 1.7%, p<.0001) were more frequently given to patients with high-grade tumors than low-grade. The median overall survival of high-grade GG was 44.4months (95% confidence interval [CI]: 10.5-92.5) while the corresponding estimate for low-grade tumors was not reached. Older age (hazard ratio [HR] 1.72, 95% CI: 1.26-2.34) and high tumor grade (HR 3.91, 95% CI: 1.43-10.8) were found to be associated with poor survival. Adult GG have a temporal lobe predilection and overall gross total resection rate of 59%. Older patients with high-grade tumors had an increased hazard of mortality. High-grade GG were significantly more likely to be treated with radiation therapy and chemotherapy.
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Affiliation(s)
- Kunal Varshneya
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - J Manuel Sarmiento
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Carlito Lagman
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Debraj Mukherjee
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Karla Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Harish Babu
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Chirag G Patil
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA.
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Abstract
This chapter describes the epidemiology, pathology, molecular characteristics, clinical and neuroimaging features, treatment, outcome, and prognostic factors of the rare glial tumors. This category includes subependymal giant cell astrocytoma, pleomorphic xanthoastrocytoma, astroblastoma, chordoid glioma of the third ventricle, angiocentric glioma, ganglioglioma, desmoplastic infantile astrocytoma and ganglioma, dysembryoplastic neuroepithelial tumor, papillary glioneuronal tumor, and rosette-forming glioneuronal tumor of the fourth ventricle. Many of these tumors, in particular glioneuronal tumors, prevail in children and young adults, are characterized by pharmacoresistant seizures, and have an indolent course, and long survival following surgical resection. Radiotherapy and chemotherapy are reserved for recurrent and/or aggressive forms. New molecular alterations are increasingly recognized.
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Affiliation(s)
- Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy.
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - David Reardon
- Center for Neuro-Oncology, Harvard Medical School and Dana-Farber Cancer Institute, Boston, USA
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Abstract
OPINION STATEMENT Seizures represent a common symptom in low- and high-grade gliomas. Tumor location and histology influence the risk for epilepsy. Some molecular factors (BRAF V 600E mutations in glioneuronal tumors and IDH1/2 mutations in diffuse grade II and III gliomas) are molecular factors that are relevant for diagnosis and prognosis and have been associated with the risk of epilepsy as well. Glutamate plays a central role in epileptogenicity and growth of glial and glioneuronal tumors, based on the release of glutamate from tumor cells that enhances excitotoxicity, and a downregulation of the inhibitory GABAergic pathways. Several potential targets for therapy have been identified, and m-TOR inhibitors have already shown activity. Gross total resection is the strongest predictor of seizure freedom in addition to clinical factors, such as preoperative seizure duration, type, and control with antiepileptic drugs (AEDs). Radiotherapy and chemotherapy with alkylating agents (procarbazine, CCNU, vincristine, temozolomide) are effective in reducing the frequency of seizures in patients with pharmacoresistant epilepsy. Newer AEDs (in particular levetiracetam and lacosamide) seem to be better tolerated than the old AEDs (phenobarbital, phenytoin, carbamazepine), but randomized clinical trials are needed to prove their superiority in terms of efficacy.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Torino, Italy,
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Lucas JT, Huang AJ, Mott RT, Lesser GJ, Tatter SB, Chan MD. Anaplastic ganglioglioma: a report of three cases and review of the literature. J Neurooncol 2015; 123:171-7. [PMID: 25862009 DOI: 10.1007/s11060-015-1781-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/05/2015] [Indexed: 01/22/2023]
Abstract
Gangliogliomas are rare tumors of the central nervous system that are thought to arise from a glioneuronal precursor and consist of both neuronal and glial elements. Grade III, or anaplastic ganglioglioma (AGG), most commonly affects children and young adults, generally arises in a supratentorial location, is highly epileptogenic, and often results in diffuse local and distant failure within the craniospinal axis. Pathologically, these tumors are graded by the degree of malignancy in their glial portion and radiologic diagnosis is difficult due to the wide variation in its degree of solid and cystic components, contrast uptake, and calcification patterns. This report presents three cases of AGG, with initial treatment including subtotal resection followed by conformal radiotherapy. In the case where the AGG developed in the setting of an existent low-grade astrocytoma, the patient received no chemotherapy. Both of the other de novo cases were managed with adjuvant chemoradiotherapy with temozolomide. Recurrence occurred at 6, 16, and 20 months following therapy. Two of the three patients experienced symptomatic decline at recurrence, but experienced Karnofsky performance status (KPS) improvement after salvage therapy, including the reduction of cranial neuropathy and balance. All patients had a significant reduction in presenting symptoms following salvage therapy. Patients died at 23, 20, and 22 months following initial surgical management, respectively. A review of anaplastic and malignant gangliogliomas is presented in the context of these three cases.
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Affiliation(s)
- John Thomas Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA,
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Ma SP, Tsui A, Kaye AH. Multicentric hemispheric ganglioglioma in a 20-year-old adult. J Clin Neurosci 2015; 22:418-20. [DOI: 10.1016/j.jocn.2014.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/02/2014] [Indexed: 11/26/2022]
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Kubicky CD, Sahgal A, Chang EL, Lo SS. Rare primary central nervous system tumors. Rare Tumors 2014; 6:5449. [PMID: 25276324 PMCID: PMC4178277 DOI: 10.4081/rt.2014.5449] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 11/23/2022] Open
Abstract
There are close to 70,000 new cases of primary central nervous system tumors diagnosed annually in the United States. Meningiomas, gliomas, nerve sheath tumors and pituitary tumors account for 85% of them. There is abundant literature on these commonly occurring tumors but data from the literature on infrequently encountered tumors such as atypical teratoid/rhabdoid tumor, choroid plexus carcinoma, ganglioglioma, hemangiopericytoma, and pleomorphic xanthoastrocytoma are limited. This review provides an overview of the clinicopathologic and therapeutic aspects of these rare primary central nervous system tumors.
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Affiliation(s)
- Charlotte Dai Kubicky
- Department of Radiation Medicine, Oregon Health Science University , Portland, OR, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto , ON, Canada
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine and Norris Cancer Center at University of Southern California , Los Angeles, CA, USA
| | - Simon S Lo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, OH, USA
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El Majdoub F, Rezk E, Hunsche S, Bührle C, Sturm V, Maarouf M. Intracranial ganglioglioma WHO I: results in a series of eight patients treated with stereotactic interstitial brachytherapy. J Neurooncol 2014; 118:345-350. [PMID: 24771287 DOI: 10.1007/s11060-014-1438-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 04/05/2014] [Indexed: 11/30/2022]
Abstract
In this retrospective study we evaluated the efficacy of interstitial brachytherapy (IBT) using (125)Iodine seeds ((125)I) for intracranial ganglioglioma WHO I. Between October 1994 and March 2010, eight patients (m/f = 5/3, median age 30.4 years, age range 7-42.5 years) with intracranial ganglioglioma WHO I were treated with IBT using stereotactically implanted (125)I seeds. The median follow-up time was 41.5 months (range 16.7-140.1 months). Prior to interstitial brachytherapy one patient underwent microsurgical resection for three times; seven patients were treated with IBT primarily. In all patients we implanted the (125)I seeds stereotactically guided. The cumulative tumor surface dose ranged between 50 and 65 Gy (permanent implantation) and the median tumor volume was 5.6 ml (range 0.9-26 ml). After brachytherapy, follow-up MR imaging revealed complete remission in one patient, partial remission in three and stable disease in the remaining four patients. Five of eight patients presented with seizures were either seizure-free (1/5) or improved (4/5). Temporary treatment-related morbidity occurred in one patient only (headache, nausea/vomiting) and resolved completely under steroid medication after 4 weeks. No treatment-related mortality was observed. This study indicates that interstitial brachytherapy for the treatment of intracranial ganglioglioma WHO I is safe and provides a high rate of local tumor control. Due to the limited number of cases, it is not possible to conduct a rigorous statistical evaluation. Thus, larger numbers of patients are required.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany. .,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany.
| | - Essam Rezk
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Christian Bührle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany.,Department of Neurosurgery, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Hospital of Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
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Yust-Katz S, Anderson MD, Liu D, Wu J, Yuan Y, Olar A, Fuller GN, Brown PD, de-Groot JF. Clinical and prognostic features of adult patients with gangliogliomas. Neuro Oncol 2013; 16:409-13. [PMID: 24305706 DOI: 10.1093/neuonc/not169] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gangliogliomas (GGs) represent <1% of primary brain tumors in adults. Little is known regarding prognostic features, clinical characteristics, or the impact of treatment on patient outcomes. METHODS Our neuro-oncology longitudinal database was screened for patients with GG from 1992 to 2012. Sixty-seven patients (age >18 y) were identified. RESULTS Sixty-two patients presented with low-grade GG and 5 with anaplastic GG. The median age at diagnosis was 29 years. With a median follow-up of 4.7 years after the initial diagnosis, 23 patients had progressive disease. Range of time to progression was 0.2-20 years. Nine patients with low-grade GG progressed to a malignant tumor. The median overall survival (OS) for all patients was not reached. The 2-, 5-, and 10-year OS for patients with low-grade GG were 100%, 88% (95% confidence interval [CI]: 73%, 95%), and 84% (95% CI: 67%, 93%), respectively. Factors identified by univariate analysis that were significantly associated with OS were age, KPS, extent of resection (EOR), and grade. Factors on univariate analysis that were significantly associated with progression-free survival were grade and EOR. On multicovariate Cox regression, lower tumor grade and younger age were significant factors for longer OS. EOR is a significant factor for progression-free survival. CONCLUSIONS While GG has excellent prognosis, malignant histologic grade, older age, and diagnosis with biopsy could indicate worse prognosis. The late nature and high rate of progression emphasize the importance of long-term follow-up. The role of chemotherapy and radiation therapy for incompletely resected low-grade GG remains unclear.
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Affiliation(s)
- Shlomit Yust-Katz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., D.L., J.F.de-G.); Department of Neurology, The University of Mississippi Medical Center, Jackson, Mississippi (M.D.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.W., Y.Y.); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O., G.N.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.)
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Limited utility despite accuracy of the national SEER dataset for the study of craniopharyngioma. J Neurooncol 2012; 110:271-8. [DOI: 10.1007/s11060-012-0966-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/10/2012] [Indexed: 01/04/2023]
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Abstract
The term long-term epilepsy associated tumor (LEAT) encompasses lesions identified in patients investigated for long histories (often 2 years or more) of drug-resistant epilepsy. They are generally slowly growing, low grade, cortically based tumors, more often arising in younger age groups and in many cases exhibit neuronal in addition to glial differentiation. Gangliogliomas and dysembryoplastic neuroepithelial tumors predominate in this group. LEATs are further united by cyto-architectural changes that may be present in the adjacent cortex which have some similarities to developmental focal cortical dysplasias (FCD); these are now grouped as FCD type IIIb in the updated International League Against Epilepsy (ILAE) classification. In the majority of cases, surgical treatments are beneficial from both perspectives of managing the seizures and the tumor. However, in a minority, seizures may recur, tumors may show regrowth or recurrence, and rarely undergo anaplastic progression. Predicting and identifying tumors likely to behave less favorably are key objectives of the neuropathologist. With immunohistochemistry and modern molecular pathology, it is becoming increasingly possible to refine diagnostic groups. Despite this, some LEATs remain difficult to classify, particularly tumors with "non-specific" or diffuse growth patterns. Modification of LEAT classification is inevitable with the goal of unifying terminological criteria applied between centers for accurate clinico-pathological-molecular correlative data to emerge. Finally, establishing the epileptogenic components of LEAT, either within the lesion or perilesional cortex, will elucidate the cellular mechanisms of epileptogenesis, which in turn will guide optimal surgical management of these lesions.
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Affiliation(s)
- Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology, Queen Square, London, UK.
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