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d’Amati A, Bargiacchi L, Rossi S, Carai A, Bertero L, Barresi V, Errico ME, Buccoliero AM, Asioli S, Marucci G, Del Baldo G, Mastronuzzi A, Miele E, D’Antonio F, Schiavello E, Biassoni V, Massimino M, Gessi M, Antonelli M, Gianno F. Pediatric CNS tumors and 2021 WHO classification: what do oncologists need from pathologists? Front Mol Neurosci 2024; 17:1268038. [PMID: 38544524 PMCID: PMC10966132 DOI: 10.3389/fnmol.2024.1268038] [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: 07/27/2023] [Accepted: 02/23/2024] [Indexed: 05/14/2024] Open
Abstract
The fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS), published in 2021, established new approaches to both CNS tumor nomenclature and grading, emphasizing the importance of integrated diagnoses and layered reports. This edition increased the role of molecular diagnostics in CNS tumor classification while still relying on other established approaches such as histology and immunohistochemistry. Moreover, it introduced new tumor types and subtypes based on novel diagnostic technologies such as DNA methylome profiling. Over the past decade, molecular techniques identified numerous key genetic alterations in CSN tumors, with important implications regarding the understanding of pathogenesis but also for prognosis and the development and application of effective molecularly targeted therapies. This review summarizes the major changes in the 2021 fifth edition classification of pediatric CNS tumors, highlighting for each entity the molecular alterations and other information that are relevant for diagnostic, prognostic, or therapeutic purposes and that patients' and oncologists' need from a pathology report.
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Affiliation(s)
- Antonio d’Amati
- Unit of Anatomical Pathology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
- Unit of Human Anatomy and Histology, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
- Unit of Anatomical Pathology, Department of Radiology, Oncology and Anatomical Pathology, University La Sapienza, Rome, Italy
- Neuropathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica S. Cuore, Roma, Italy
| | - Lavinia Bargiacchi
- Unit of Anatomical Pathology, Department of Radiology, Oncology and Anatomical Pathology, University La Sapienza, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Elena Errico
- Department of Pathology, AORN Santobono Pausilipon, Pediatric Hospital, Naples, Italy
| | | | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giada Del Baldo
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Federica D’Antonio
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica S. Cuore, Roma, Italy
| | - Manila Antonelli
- Unit of Anatomical Pathology, Department of Radiology, Oncology and Anatomical Pathology, University La Sapienza, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Francesca Gianno
- Unit of Anatomical Pathology, Department of Radiology, Oncology and Anatomical Pathology, University La Sapienza, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
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Oda Y, Amano K, Chiba K, Masui K, Kawamata T. Endoscope-assisted Trans-lamina Terminalis Resection of Chordoid Glioma at the Third Ventricle: A Case Report. NMC Case Rep J 2023; 10:285-289. [PMID: 37953907 PMCID: PMC10635905 DOI: 10.2176/jns-nmc.2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 11/14/2023] Open
Abstract
As per the 2021 World Health Organization (WHO) Classification of Tumors of the Central Nervous System, chordoid glioma (CG) is defined as a slow-growing glial neoplasm categorized as grade II tumor. This tumor is primarily located in the anterior part of the third ventricle, often adheres to important surrounding structures, and is hemorrhagic in nature. Therefore, dissecting this tumor is extremely difficult. In this study, we present the case of a 44-year-old man who initially complained of mild headache and was diagnosed with a homogeneous gadolinium-enhanced lesion in the third ventricle via magnetic resonance imaging. The pathological diagnosis based on his biopsy at the previous hospital was CG. The patient demonstrated no neurological deficit at that time, but the tumor had gradually grown, hydrocephalus appeared 2 years after the tumor was detected, and the patient developed short memory disorder and daytime sleepiness. We resected the tumor via the anterior interhemispheric trans-lamina terminalis approach using a microscope and an endoscope. The residual tumor at the blind spot of the microscopic view was resected under an angled rigid endoscopic view using dedicated tools for transsphenoidal surgery. The tumor was grossly resected, and the histopathological diagnosis was CG. Postoperative neurological findings included slight memory disorder and hypothalamic adrenal dysfunction. No tumor recurrence was reported 3 years post resection. The endoscope-assisted anterior interhemispheric trans-lamina terminalis approach was determined useful for CG resection with minimal surgical complications and without tumor recurrence.
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Affiliation(s)
- Yuichi Oda
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Amano
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Chiba
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenta Masui
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Park YW, Vollmuth P, Foltyn-Dumitru M, Sahm F, Ahn SS, Chang JH, Kim SH. The 2021 WHO Classification for Gliomas and Implications on Imaging Diagnosis: Part 2-Summary of Imaging Findings on Pediatric-Type Diffuse High-Grade Gliomas, Pediatric-Type Diffuse Low-Grade Gliomas, and Circumscribed Astrocytic Gliomas. J Magn Reson Imaging 2023; 58:690-708. [PMID: 37069764 DOI: 10.1002/jmri.28740] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
The fifth edition of the World Health Organization (WHO) classification of central nervous system tumors published in 2021 advances the role of molecular diagnostics in the classification of gliomas by emphasizing integrated diagnoses based on histopathology and molecular information and grouping tumors based on genetic alterations. This Part 2 review focuses on the molecular diagnostics and imaging findings of pediatric-type diffuse high-grade gliomas, pediatric-type diffuse low-grade gliomas, and circumscribed astrocytic gliomas. Each tumor type in pediatric-type diffuse high-grade glioma mostly harbors a distinct molecular marker. On the other hand, in pediatric-type diffuse low-grade gliomas and circumscribed astrocytic gliomas, molecular diagnostics may be extremely complicated at a glance in the 2021 WHO classification. It is crucial for radiologists to understand the molecular diagnostics and imaging findings and leverage the knowledge in clinical practice. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Philipp Vollmuth
- Section for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Martha Foltyn-Dumitru
- Section for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
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Pinto SN, Chiang J, Qaddoumi I, Livingston D, Bag A. Pediatric diencephalic tumors: a constellation of entities and management modalities. Front Oncol 2023; 13:1180267. [PMID: 37519792 PMCID: PMC10374860 DOI: 10.3389/fonc.2023.1180267] [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: 03/05/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The diencephalon is a complex midline structure consisting of the hypothalamus, neurohypophysis, subthalamus, thalamus, epithalamus, and pineal body. Tumors arising from each of these diencephalic components differ significantly in terms of biology and prognosis. The aim of this comprehensive review is to describe the epidemiology, clinical symptoms, imaging, histology, and molecular markers in the context of the 2021 WHO classification of central nervous system neoplasms. We will also discuss the current management of each of these tumors.
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Affiliation(s)
- Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jason Chiang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ibrahim Qaddoumi
- Departments of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - David Livingston
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Asim Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Wu PB, Filley AC, Miller ML, Bruce JN. Benign Glioma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:31-71. [PMID: 37452934 DOI: 10.1007/978-3-031-23705-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign glioma broadly refers to a heterogeneous group of slow-growing glial tumors with low proliferative rates and a more indolent clinical course. These tumors may also be described as "low-grade" glioma (LGG) and are classified as WHO grade I or II lesions according to the Classification of Tumors of the Central Nervous System (CNS) (Louis et al. in Acta Neuropathol 114:97-109, 2007). Advances in molecular genetics have improved understanding of glioma tumorigenesis, leading to the identification of common mutation profiles with significant treatment and prognostic implications. The most recent WHO 2016 classification system has introduced several notable changes in the way that gliomas are diagnosed, with a new emphasis on molecular features as key factors in differentiation (Wesseling and Capper in Neuropathol Appl Neurobiol 44:139-150, 2018). Benign gliomas have a predilection for younger patients and are among the most frequently diagnosed tumors in children and young adults (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). These tumors can be separated into two clinically distinct subgroups. The first group is of focal, well-circumscribed lesions that notably are not associated with an increased risk of malignant transformation. Primarily diagnosed in pediatric patients, these WHO grade I tumors may be cured with surgical resection alone (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). Recurrence rates are low, and the prognosis for these patients is excellent (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). Diffuse gliomas are WHO grade II lesions with a more infiltrative pattern of growth and high propensity for recurrence. These tumors are primarily diagnosed in young adult patients, and classically present with seizures (Pallud et al. Brain 137:449-462, 2014). The term "benign" is a misnomer in many cases, as the natural history of these tumors is with malignant transformation and recurrence as grade III or grade IV tumors (Jooma et al. in J Neurosurg 14:356-363, 2019). For all LGG, surgery with maximal safe resection is the treatment of choice for both primary and recurrent tumors. The goal of surgery should be for gross total resection (GTR), as complete tumor removal is associated with higher rates of tumor control and seizure freedom. Chemotherapy and radiation therapy (RT), while not typically a component of first-line treatment in most cases, may be employed as adjunctive therapy in high-risk or recurrent tumors and in some select cases. The prognosis of benign gliomas varies widely; non-infiltrative tumor subtypes generally have an excellent prognosis, while diffusely infiltrative tumors, although slow-growing, are eventually fatal (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). This chapter reviews the shared and unique individual features of the benign glioma including diffuse glioma, pilocytic astrocytoma and pilomyxoid astrocytoma (PMA), subependymal giant cell astrocytoma (SEGA), pleomorphic xanthoastrocytoma (PXA), subependymoma (SE), angiocentric glioma (AG), and chordoid glioma (CG). Also discussed is ganglioglioma (GG), a mixed neuronal-glial tumor that represents a notable diagnosis in the differential for other LGG (Wesseling and Capper 2018). Ependymomas of the brain and spinal cord, including major histologic subtypes, are discussed in other chapters.
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Affiliation(s)
- Peter B Wu
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, UCLA, Los Angeles, USA
| | - Anna C Filley
- Department of Neurosurgery, Columbia University Medical Center, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Columbia University Medical Center, New York, USA.
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Zhang M, Xu B, Li C, Liu Z, Gao Y, Song Y, Liu R. Occurrence of Chordoid Glioma With Sodium Ion Metabolism Disorder 5 Years After Meningioma Surgery and Whole-Exome Sequencing: A Case Report and Literature Review. Front Genet 2021; 12:617575. [PMID: 34040630 PMCID: PMC8143433 DOI: 10.3389/fgene.2021.617575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Chordoid glioma (CG), a rare slow-growing brain tumor, mainly occurs in the region of the third ventricle. Although its degree of malignancy is relatively low, its clinical prognosis is poor due to obscure clinical manifestations and the particular growing position. Currently, gross total resection is the best available method for treatment of CG. However, the tumor is located in the deep structure of the brain and close to neurovascular structure so it is difficult to remove completely. This study reported a case of CG of the third ventricle 5 years after surgery of right frontal parietal fibrous meningioma, accompanied with peri and post-operative sodium ion metabolism disorder. Whole-exome sequencing (WES) revealed 25 gene mutations shared by meningioma and CG. In addition, the PRKCA D463H CG marker gene mutation also existed in this patient. We reviewed the latest literature on this rare brain tumor, summarized its clinical manifestations, imaging and pathological characteristics, and discussed the mechanism related to its occurrence and the reasons for sodium ion disorder.
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Affiliation(s)
- Mei Zhang
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Chang Li
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ziwei Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuanyuan Gao
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuming Song
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
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Yao K, Duan Z, Du Z, Fan X, Qu Y, Zhang M, Wang Y, Liu H, Sun L, Qi X. PRKCA D463H Mutation in Chordoid Glioma of the Third Ventricle: A Cohort of 16 Cases, Including Two Cases Harboring BRAFV600E Mutation. J Neuropathol Exp Neurol 2021; 79:1183-1192. [PMID: 33085976 DOI: 10.1093/jnen/nlaa107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chordoid gliomas (CG) of the third ventricle are characterized by chordoid and glial features, but the extent of histological variations across CG is not fully understood. Herein, we report 16 consecutive cases of CG. All 16 patients had histories of headache and vision loss; their median age was 41.7 years at the surgery. Histological examination revealed typical features of CG, including cords of epithelioid cells within the mucinous stroma and lymphoplasmacytic infiltration. Two cases exhibited atypical histological features including histiocyte-like cells. PRKCA mutation was found in 14 cases, including the 2 with histiocytic features. BRAFV600E mutation was found only in the 2 cases with histiocytic features. The patients underwent gross total tumor resection without radiotherapy or chemotherapy. Three patients died between 1 and 4 months postsurgery. Only one had a recurrence. Eleven were alive at the most recent follow-up (range: 2-58 months). These data indicate that PRKCA mutation was a good diagnostic marker for CG and additionally suggest that histiocyte-like features can be present in CG in association with BRAF mutations.
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Affiliation(s)
- Kun Yao
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Zejun Duan
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China.,The Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zunguo Du
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Xiaolong Fan
- Beijing Key Laboratory of Gene Resource and Molecular Development, Laboratory of Neuroscience and Brain Development, School of Life Sciences Beijing Normal University
| | - Yanming Qu
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Mingshan Zhang
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yin Wang
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China.,The Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hailong Liu
- The Department of Neurosurgery, Chinese PLA General Hospital (301 Hospital)
| | - Lingyan Sun
- The Department of Molecular Pathology Laboratory, Shanghai Ackermann Medical Laboratory, Shanghai, China
| | - Xueling Qi
- Departments of Pathology and Neurosurgery, San Bo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
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Lee YS, Yeung TW, Leung OC. One of a kind-chordoid glioma in the fourth ventricle: a case report and literature review. Acta Radiol Open 2020; 9:2058460120980143. [PMID: 33403125 PMCID: PMC7739103 DOI: 10.1177/2058460120980143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Chordoid glioma (CG) is a rare brain tumor that is known for its characteristic location in the third ventricle. A wide spectrum of radiological presentations has been described, with few common features among them. Its radiological diagnosis is mainly suggested by location. However, several cases of CG with atypical locations have been described, illustrating that CG is not limited to the third ventricle, and should be considered in the list of radiological differential diagnosis for intraventricular masses. We present here a case of CG that was found in the fourth ventricle.
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Chung C. Unique Glioma Requiring Unique Management. Int J Radiat Oncol Biol Phys 2020; 108:520-521. [DOI: 10.1016/j.ijrobp.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 08/17/2019] [Accepted: 09/13/2019] [Indexed: 10/23/2022]
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Zhang GB, Huang HW, Li HY, Zhang XK, Wang YG, Lin S. Intracranial chordoid glioma: A clinical, radiological and pathological study of 14 cases. J Clin Neurosci 2020; 80:267-273. [PMID: 33099359 DOI: 10.1016/j.jocn.2020.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chordoid gliomas (CGs) are rare neuroepithelial tumors, which commonly arise from the anterior part of the third ventricle. Most studies on CGs included only one or two cases. To better understand the disease, we report 14 patients with pathologically confirmed CGs. METHOD The clinical characteristics, including radiological and histological examination, operative records, and prognoses were analyzed and reviewed. RESULT The case series included six male and eight female patients with an average age of 44.4 years. The most common preoperative symptom was headache (64.3%) and visual deterioration (57.1%). Radiological results showed that the third ventricle (12/14) was the most common site of the brain involved, and the lesions presented with solid (n = 9, 64.3%) or cystic-solid (n = 5, 35.7%) appearance. All patients were misdiagnosed as non-CG tumors. The operation approach was mainly determined by tumor location, thus trans-callosal approach (9/14) and trans-laminar terminalis approach were commonly used. Gross total resection (GTR) was achieved in all cases and none of them received any adjuvant therapy postoperatively. The most frequent postoperative complications were diabetes insipidus, electrolyte disturbance, hypopituitarism, cognitive dysfunction, and obstructive hydrocephalus. During an average follow-up period of 40.1 months, 2 cases (14.3%) were died of refractory hypopituitarism and pulmonary embolism, respectively. The preoperative symptoms and postoperative complications were all significantly improved in other 12 patients, and MRI showed no tumor recurrence. CONCLUSION According to our experience, we recommend GTR as the primary goal, which is associated with improved rates of tumor control and without increasing rates of postoperative complications.
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Affiliation(s)
- Guo-Bin Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Hao-Yi Li
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Xiao-Kang Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Yong-Gang Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Song Lin
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
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A Rare Instance of Chordoid Glioma With Large Calcification Mimicking Craniopharyngioma. J Craniofac Surg 2020; 31:e173-e175. [PMID: 31895860 DOI: 10.1097/scs.0000000000006137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chordoid glioma (CG) is a world health organization classified grade II tumor whose typical localization is in the anterior part of the third ventricle. It's clinical, neuroimaging, and pathologic features may vary and furthermore mimic other types of benign lesions usually associated with a better outcome, thus representing a potential radiological and diagnostic pitfall. In this article, the authors present a novel case of a 51-year-old male who underwent gross total removal of the tumor of the third ventricle with high calcification. The imaging studies and the intraoperative examination led at first to a hypothesis of craniopharyngioma. In this case, the patient underwent successful operative management and has remained well throughout follow-up.
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Chen X, Zhang B, Pan S, Sun Q, Bian L. Chordoid Glioma of the Third Ventricle: A Case Report and a Treatment Strategy to This Rare Tumor. Front Oncol 2020; 10:502. [PMID: 32328466 PMCID: PMC7160695 DOI: 10.3389/fonc.2020.00502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Chordoid glioma (CG) of the third ventricle is a rare type of brain tumor. Here, we present a case, review of the literature and proposed a treatment strategy for this rare tumor. Here, A 33-years-old woman presented with the menstrual disorder and progressive obesity. Magnetic resonance imaging showed a large irregularly circular tumor in the third ventricle. The tumor was subtotally resected by microsurgery via the right modified port approach. Immunohistochemical staining was positive for glial fibrillary acidic protein (GFAP), Vimentin and transcription termination factor-1 (TTF-1), and the Ki-67 proliferation index was low (5%), which indicating CG. Residual tumor decreased after treated by Gamma Knife radiosurgery (GKRS) with a dose of 15 Gy. During 30 months of follow-up, the tumor did not recur, and the patient suffered no complications. The diagnosis of CG requires a combination of clinical presentation, neuroimaging, and pathology. The ideal therapy is gross total resection (GTR) of the tumor. However, GTR is usually difficult and carries a high risk of postoperative complications because of the tumor location. This case indicates that planed subtotal resection followed by GKRS with a proper marginal dose could be a good treatment strategy for CG.
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Affiliation(s)
- Xiao Chen
- Department of Neurosurgery/Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Benyan Zhang
- Department of Neurosurgery/Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sijian Pan
- Department of Neurosurgery/Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery/Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liuguan Bian
- Department of Neurosurgery/Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Liang J, Lv X, Lu C, Ye X, Chen X, Fu J, Luo C, Zhao Y. Prognostic factors of patients with Gliomas - an analysis on 335 patients with Glioblastoma and other forms of Gliomas. BMC Cancer 2020; 20:35. [PMID: 31941467 PMCID: PMC6961387 DOI: 10.1186/s12885-019-6511-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022] Open
Abstract
Background The prognosis of glioma is poor, despite recent advances in diagnosis and treatment of the disease. It is important to investigate the clinical characteristics and prognostic factors of glioma so as to provide basis for treatment and management of patients. Method A total of 335 patients with glioma were included in this study. These patients were admitted to the medical center between November 2015 and December 2018. The clinical data, including demographic data, tumor characteristics, treatment strategy, expression pattern of tumor markers, and survival data, were retrospectively reviewed. Survival data were analyzed using Kaplan-Meier curves with log-rank test, while multivariate analysis Cox regression model was used to investigate risk factors for mortality. Results In this patient cohort, glioblastoma (40%), diffuse glioma (14.6%) and oligodendroglioma (9.6%) were the most common pathological types. The expression of Ki-67 was associated with several clinicopathological parameters (e.g. tumor type, grade, and number of lesions). In addition, Ki-67 correlated with the mortality within the first year of the post-treatment follow-up (P < 0.001). Kaplan-Maier analysis revealed that older patients (≥ 45 years) displayed worse prognosis than those aged under 45 years (P = 0.038). Dismal prognosis was also associated with clinical parameters, including high tumor grade, multiple lesions, and Karnofsky performance score (KPS). Multivariate analysis showed that low KPS (< 85) increased the risk of mortality by 2.3 folds with a 95% CI of 1.141 to 4.776 (P = 0.020). Low tumor grade (grade 1–2) oppositely reduced the mortality risk by 0.22 folds (95% CI, 0.065 to 0.763, P = 0.0168). Conclusion KPS and tumor grade were independent prognostic factors in patients with gliomas.
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Affiliation(s)
- Jianfeng Liang
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China
| | - Xiaomin Lv
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Changyu Lu
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China
| | - Xun Ye
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Xiaolin Chen
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jia Fu
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China
| | - Chenghua Luo
- Department of Retroperitoneal Tumors Surgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China.
| | - Yuanli Zhao
- Department of Neurosurgery, Peking University International Hospital, No.1 Science Park Road, ZGC Life Science Park, Beijing, 102206, China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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14
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Chordoid glioma of the third ventricle: A systematic review and single-center experience. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Wang J, Hu G, Quan X. Analysis of the Factors Affecting the Prognosis of Glioma Patients. Open Med (Wars) 2019; 14:331-335. [PMID: 30997396 PMCID: PMC6463817 DOI: 10.1515/med-2019-0031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/29/2019] [Indexed: 01/29/2023] Open
Abstract
This retrospective study was carried out to investigate factors affecting the prognosis of gliomas for better management of treatment. Clinical data from 186 glioma patients treated in our hospital from January 2013 to June 2016 were analyzed. There was slightly more male than female patients in the cohort. The main clinical symptoms included sudden limb twitching, headache and fatigue, vomiting, vision reduction and speaking disorders. The malignancy was high and the prognosis was poor in the patients, with an overall survival rate of 54.84 % by October 2017. Univariate analysis showed that the prognosis was mainly affected by age, tumor grade, preoperative Karnofsky performance status (KPS), surgical method, postoperative radiotherapy and chemotherapy, and postoperative use of temozolomide (TMZ). Multivariate Cox regression analysis showed that the independent risk factors for the prognosis were old age (≥ 60), advanced tumor, partial tumor resection, KPS of < 70, no chemotherapy after operation and < 4 courses of postoperative TMZ. The prognosis is negatively affected by age, tumor grade, KPS, and partial tumor resection. Surgical resection combined with chemotherapy and multi-course use of TMZ prolongs the survival time of patients.
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Affiliation(s)
- Jiancun Wang
- Department of Neurosurgery, Zhangjiajie People's Hospital, 192 Guyong road, Zhangjiajie, Hunan, China 427000
| | - Guancheng Hu
- Department of Neurosurgery, Zhangjiajie People's Hospital, 192 Guyong road, Zhangjiajie, Hunan, China 427000
| | - Xingyun Quan
- Department of Neurosurgery, Zhangjiajie People's Hospital, 192 Guyong road, Zhangjiajie, Hunan, China 427000
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16
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Danilowicz K, Abbati SG, Sosa S, Witis FL, Sevlever G. Suprasellar chordoid glioma: a report of two cases. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 62:648-654. [PMID: 30624507 PMCID: PMC10118663 DOI: 10.20945/2359-3997000000092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022]
Abstract
Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.
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Affiliation(s)
- Karina Danilowicz
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | | | - Soledad Sosa
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | - Florencia Lustig Witis
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | - Gustavo Sevlever
- Instituto de Investigaciones Neurológicas "Dr. Raúl Carrea", FLENI, Pathology, Buenos Aires, Argentina
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17
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Sellar and Parasellar Pain Syndromes. Curr Pain Headache Rep 2019; 23:7. [PMID: 30712067 DOI: 10.1007/s11916-019-0740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically. RECENT FINDINGS In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment. Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.
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18
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Persaud-Sharma D, Burns J, Trangle J, Castro G, Barengo N, Moulik S, Manuel Lozano J. Demographic Variation in the Frequency of Gliomas in Florida. ACTA ACUST UNITED AC 2019; 55:medicina55010005. [PMID: 30621205 PMCID: PMC6358829 DOI: 10.3390/medicina55010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. However, such analyses did not include demographic data specific to the state of Florida. This study assessed the association between race and glial vs. non-glial Central Nervous System (CNS) cancers in Florida, USA. Materials and Methods: This case-control study utilized the Florida Cancer Data Registry (FCDS), in which race was considered the exposure and development of glioma as the measured outcome. The sample was comprised of patients in Florida diagnosed with brain tumors from 1981 to 2013. Relative racial frequencies were compared between patients with glial brain tumors and those with other CNS tumors. Data was analyzed using logistic regression in order to determine any associations between race and frequency of diagnosis adjusting for several confounders (age, sex, smoking status, year of diagnosis, and insurance status). Results: Between 1981 and 2013 a total of 14,092 patients meeting the inclusion and exclusion criteria were diagnosed in Florida with a primary brain tumor. Being of non-white race was associated with 60% decreased odds of glioma diagnosis compared to the reference white population (adjusted OR 0.4, 95% CI 0.34⁻0.47). Secondary findings include associations between increasing age and male sex with increased odds of glioma diagnosis. Decreased adjusted odds of glioma diagnosis were found with former smoking status (reference non-smokers), diagnosis between 2001 and 2010 (reference 1981⁻1990), and Medicaid or Medicare insurance (reference private insurance). Hispanic ethnicity, current smoking status, no insurance/self-pay, and geographical location (urban vs. rural) all had no association with glioma diagnosis. Conclusions: These findings are consistent with and help reinforce previous studies utilizing national databases (SEER) which also showed increasing odds of glioma diagnosis in older white males. Various potential explanations for these findings include genetic predisposition, lifestyle and behavioral factors, and socioeconomic status, including access to healthcare. Future research aims at identifying potential genetic etiologies.
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Affiliation(s)
- Dharam Persaud-Sharma
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Joseph Burns
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Jeran Trangle
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Grettel Castro
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Noel Barengo
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Sabyasachi Moulik
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
| | - Juan Manuel Lozano
- Herbert Wertheim College of Medicine Miami, Florida International University, Miami, FL 33199, USA.
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19
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Shinohara T, Inoue A, Kohno S, Ueda Y, Suehiro S, Matsumoto S, Nishikawa M, Ozaki S, Shigekawa S, Watanabe H, Kitazawa R, Kunieda T. Usefulness of neuroimaging and immunohistochemical study for accurate diagnosis of chordoid glioma of the third ventricle: A case report and review of the literature. Surg Neurol Int 2018; 9:226. [PMID: 30533273 PMCID: PMC6238323 DOI: 10.4103/sni.sni_306_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Chordoid glioma of the third ventricle is a rare neuroepithelial tumor characterized by a unique histomorphology within the third ventricular region, but with radiological and histopathological features mimicking benign lesions such as meningioma. We report a case of chordoid glioma of the third ventricle and suggest a useful indicator for accurate diagnosis. Case Description: A previously healthy 46-year-old woman was admitted to our hospital with mild headache. Neuroimaging revealed a large tumor measuring approximately 18 mm in the suprasellar region, and perifocal edema in the optic tract and internal capsule on magnetic resonance imaging. Laboratory findings revealed no pituitary dysfunction including diabetes insipidus. Gross total resection of the tumor was performed by the interhemispheric translamina terminalis approach. Histological findings revealed nests of regular epithelioid cells with large nuclei and abundant eosinophilic cytoplasm within myxoid stroma. Immunohistochemical studies demonstrated diffuse cytoplasmic expression of glial fibrillary acidic protein (GFAP) and CD34, and strong nuclear staining for thyroid transcription factor 1 (TTF-1). We, therefore, histologically classified the tumor as chordoid glioma of the third ventricle. Headache improved immediately postoperatively, and follow-up neuroimaging after 12 months showed no signs of recurrence. Conclusions: Chordoid glioma of the third ventricle is a very rare tumor that is difficult to diagnose on routine neuroimaging. Accurate diagnosis requires detailed analysis of neuroimaging and immunohistochemical studies using CD34 and TTF-1 staining.
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Affiliation(s)
- Tomoki Shinohara
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shohei Kohno
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yasuo Ueda
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Satoshi Suehiro
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masahiro Nishikawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Saya Ozaki
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
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20
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Goode B, Mondal G, Hyun M, Ruiz DG, Lin YH, Van Ziffle J, Joseph NM, Onodera C, Talevich E, Grenert JP, Hewedi IH, Snuderl M, Brat DJ, Kleinschmidt-DeMasters BK, Rodriguez FJ, Louis DN, Yong WH, Lopes MB, Rosenblum MK, Butowski N, Tihan T, Bollen AW, Phillips JJ, Wiita AP, Yeh I, Jacobson MP, Bastian BC, Perry A, Solomon DA. A recurrent kinase domain mutation in PRKCA defines chordoid glioma of the third ventricle. Nat Commun 2018; 9:810. [PMID: 29476136 PMCID: PMC5824822 DOI: 10.1038/s41467-018-02826-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/02/2018] [Indexed: 12/15/2022] Open
Abstract
Chordoid glioma is a rare brain tumor thought to arise from specialized glial cells of the lamina terminalis along the anterior wall of the third ventricle. Despite being histologically low-grade, chordoid gliomas are often associated with poor outcome, as their stereotypic location in the third ventricle makes resection challenging and efficacious adjuvant therapies have not been developed. Here we performed genomic profiling on 13 chordoid gliomas and identified a recurrent D463H missense mutation in PRKCA in all tumors, which localizes in the kinase domain of the encoded protein kinase C alpha (PKCα). Expression of mutant PRKCA in immortalized human astrocytes led to increased phospho-ERK and anchorage-independent growth that could be blocked by MEK inhibition. These studies define PRKCA as a recurrently mutated oncogene in human cancer and identify a potential therapeutic vulnerability in this uncommon brain tumor. Chordoid glioma is a rare low-grade brain tumor that originates from the anterior wall of the third ventricle where surgical resection is challenging; the clinical outcome of patients after subtotal resection or disease recurrence is poor. Here the authors identify a recurrent missense mutation in PRKCA that may serve as a potential therapeutic target in this uncommon brain cancer.
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Affiliation(s)
- Benjamin Goode
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Gourish Mondal
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Michael Hyun
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Diego Garrido Ruiz
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, 94158, USA
| | - Yu-Hsiu Lin
- Department of Laboratory Medicine, University of California, San Francisco, CA, 94107, USA
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Nancy M Joseph
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Courtney Onodera
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Eric Talevich
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Iman H Hewedi
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Matija Snuderl
- Departments of Pathology and Neurology, NYU Langone Medical Center, New York, NY, 10016, USA
| | - Daniel J Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - David N Louis
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - William H Yong
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - M Beatriz Lopes
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - Arun P Wiita
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, 94158, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, 94107, USA
| | - Iwei Yeh
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Matthew P Jacobson
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, 94158, USA
| | - Boris C Bastian
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA, 94143, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, 94143, USA. .,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, 94115, USA.
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21
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The trans-laminar terminalis approach reduces mortalities associated with chordoid glioma resections: A case report and a review of 20 years of literature. J Clin Neurosci 2018; 47:43-55. [DOI: 10.1016/j.jocn.2017.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/23/2022]
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22
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Zhao XW, Zhan YB, Bao JJ, Zhou JQ, Zhang FJ, Bin Y, Bai YH, Wang YM, Zhang ZY, Liu XZ. Clinicopathological analysis of HOXD4 expression in diffuse gliomas and its correlation with IDH mutations and 1p/19q co-deletion. Oncotarget 2017; 8:115657-115666. [PMID: 29383189 PMCID: PMC5777801 DOI: 10.18632/oncotarget.23371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022] Open
Abstract
Backgrounds HOX (homologous box) is known as the dominant gene of vertebrate growth and cell differentiation. Abnormal expression of HOX gene in various tumors has attracted the attention of scholars. As a component of HOX clusters, HOXD4 plays a controversial role in the tumorigenesis of central nervous system. Results The data demonstrated that and the results demonstrated that HOXD4 was overexpressed in glioma tissues compared to that of normal brain tissues. patients with high HOXD4 expression had a significant shorter survival than those with low HOXD4 expression in total glioma cohort (p<0.001), WHO Grade II cohort (p=0.003) and Grade III cohort (p<0.001), but not in Grade IV cohort when OS (overall survival) was analyzed (p=0.216). The findings were confirmed by the large-scale omics data analysis including lower-grade glioma (LGG) and glioblastoma multiforme (GBM) in TCGA (the cancer genome atlas) and CGGA (Chinese glioma genome atlas). Moreover, it was revealed that the expression of HOXD4 have a significant impact on the OS of Grade IV glioma with IDH wild-type and 1p/19q intact according to TCGA data. Methods Clinicopathological analysis of HOXD4 expression in 453 glioma patients was performed in the current study. Expression of HOXD4 was evaluated by qPCR and immunohistochemical (IHC) staining. Univariate and multivariate analysis were conducted to investigate the prognostic role of HOXD4 in glioma patients. Conclusions Expression of HOXD4 was closely related to the clinical outcomes of patients with gliomas, and HOXD4 may be a potential prognostic biomarker of gliomas.
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Affiliation(s)
- Xin-Wei Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yun-Bo Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jian-Ji Bao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jin-Qiao Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Feng-Jiang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yu Bin
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Ya-Hui Bai
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yan-Min Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Zhen-Yu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Xian-Zhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China
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23
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Persaud-Sharma D, Burns J, Trangle J, Moulik S. Disparities in Brain Cancer in the United States: A Literature Review of Gliomas. ACTA ACUST UNITED AC 2017; 5:medsci5030016. [PMID: 29099032 PMCID: PMC5635804 DOI: 10.3390/medsci5030016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
Abstract
In the human body, the central regulatory system of homeostasis is maintained by the brain. Its complexity is mesmerizing and many of its functions are largely uncharted. Unfortunately, its functionality is often impaired through neoplastic growths, like gliomas, which are devastating to patients and their families. Annually, gliomas are the most common primary brain tumours affecting over 20,000 people in the United States. However, despite their status as the third most common cause of cancer related death for individuals between ages 20 and 39, the aetiology of gliomas remains unknown. This paper aims to review the latest information regarding the 2016 World Health Organization (WHO) 4th edition classifications of gliomas, their malignant effects, and disparities within these classifications, as well as identify areas for further research. These suggestions for future inquiry may contribute to a better understanding of the pathology of these cancers enabling improvement in prevention, screening, and treatment.
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Affiliation(s)
- Dharam Persaud-Sharma
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Joseph Burns
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Jeran Trangle
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Sabyasachi Moulik
- Florida International University, Herbert Wertheim College of Medicine, Department of Cellular Biology and Pharmacology, Miami, FL 33199, USA.
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24
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Zehani A, Bouali S, Chelly I, Bouhoula A, Jemel H, Haouet S, Kchir N. [Misleading ventricular tumor]. Ann Pathol 2017; 37:270-273. [PMID: 28552263 DOI: 10.1016/j.annpat.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/17/2016] [Accepted: 04/02/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Alia Zehani
- Service d'anatomie pathologique, hôpital la Rabta, Tunis, Tunisie.
| | - Sofiene Bouali
- Service de neurochirurgie, institut de neurologie de Tunis, Tunis, Tunisie
| | - Ines Chelly
- Service d'anatomie pathologique, hôpital la Rabta, Tunis, Tunisie
| | - Asma Bouhoula
- Service de neurochirurgie, institut de neurologie de Tunis, Tunis, Tunisie
| | - Hafedh Jemel
- Service de neurochirurgie, institut de neurologie de Tunis, Tunis, Tunisie
| | - Slim Haouet
- Service d'anatomie pathologique, hôpital la Rabta, Tunis, Tunisie
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25
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Chordoid glioma of the third ventricle: report of a rapidly progressive case. J Neurooncol 2017; 132:487-495. [DOI: 10.1007/s11060-017-2399-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/26/2017] [Indexed: 11/25/2022]
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26
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García Carretero R, Romero Brugera M, Vazquez-Gomez O, Rebollo-Aparicio N. Neurogenic fever in a patient with a chordoid glioma. BMJ Case Rep 2016; 2016:bcr-2016-218205. [PMID: 27856533 DOI: 10.1136/bcr-2016-218205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chordoid gliomas are rare tumours. Despite being considered low-grade neoplasms, recent reviews have reported generally poor prognosis due to complications involving severe hypothalamic symptoms. We report a patient aged 30 years with chordoid glioma. What makes this case report interesting is the presence of neurogenic fever, which was already present before the final diagnosis of the brain tumour and also several months after the surgical removal. Since the patient underwent a subtotal resection of the tumour, it remains unclear whether the fever was due to hypothalamic dysfunction or remnants of the tumour. We also performed temperature logging with a continuous-monitoring recording device.
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Affiliation(s)
| | | | - Oscar Vazquez-Gomez
- Department of Infectious Diseases, Hospital Universitario de Mostoles, Mostoles, Spain
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