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Ji C, Cheng H, Zhou X, Cao X, Qiao N, Shi C, Zhang Y, Ye Z, Zhao Y. Ectopic recurrence craniopharyngioma: series report and literature review. Chin Neurosurg J 2023; 9:13. [PMID: 37147737 PMCID: PMC10163818 DOI: 10.1186/s41016-023-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Craniopharyngioma is a common intracranial tumor located in the sellar-suprasellar region. Due to the involvement of adjacent structures, it can lead to increased intracranial pressure, visual impairment, and endocrine deficiencies. Surgical resection is the primary treatment, but it is a tough challenge to achieve total resection, which will led to the frequency of recurrences and progressions. Among them, distant spread is extremely rare, but important complication, identifying and providing proper therapy, is crucial. METHODS We report two cases of ectopic recurrence craniopharyngioma and make a literature review for the published similar case reports. RESULTS Our literature review revealed 63 cases (including our patient). The onset age in children group and adult group ranges from 2-14 years old (6.70 ± 3.33) to 17-73 years old (40.63 ± 15.58), while the interval year between tumor initiation and ectopic recurrence ranges from 0.17-20 (7.28 ± 6.76) years to 0.3-34 (6.85 ± 7.29). Achieving gross total resection seems not to prevent the ectopic recurrence. The major pathology of ectopic recurrence craniopharyngioma is adamantinomatous type. The most common site of ectopic recurrence is frontal lobe. According to the pathogenesis, 35 cases were seeding along the surgical approach, and 28 cases were seeding via the CSF pathway. CONCLUSION Ectopic recurrence craniopharyngioma is rare, but it can lead to serious symptoms. Delicate surgical procedure can help to reduce the risk of ectopic recurrence, and standardized follow-up can provide valuable information for treatment.
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Affiliation(s)
- Chenxing Ji
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Xiang Zhou
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Xiaoyun Cao
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Nidan Qiao
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Chengzhang Shi
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Yichao Zhang
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Zhao Ye
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China.
| | - Yao Zhao
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
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The Challenging Management of Craniopharyngiomas in Adults: Time for a Reappraisal? Cancers (Basel) 2022; 14:cancers14153831. [PMID: 35954494 PMCID: PMC9367482 DOI: 10.3390/cancers14153831] [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: 07/07/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Craniopharyngiomas (CPs) currently represent one of the most challenging diseases to deal with in the group of skull base tumors. Due to their location near, within, or surrounding the pituitary gland and stalk, CPs can be revealed by pituitary tumor syndrome and/or symptoms of hormonal deficiencies. Furthermore, surgery, which represents the first-line therapy, almost always results in hypopituitarism, diabetes insipidus and, in the case of hypothalamic involvement by the tumor, the occurrence of hypothalamic syndrome. The latter is characterized by intractable weight gain associated with severe morbid obesity, memory impairment, attention deficit, reduced impulse control and, eventually, increased risk of cardiovascular and metabolic disorders. Recent progress made in the understanding of the molecular pathways involved in CPs tumorigenesis paves the way for promising alternative therapeutic approaches and diagnostic procedures. Taken together, they lay the groundwork for new paradigms in the management of CPs in adults. Abstract Craniopharyngiomas (CPs) are rare tumors of the skull base, developing near the pituitary gland and hypothalamus and responsible for severe hormonal deficiencies and an overall increase in mortality rate. While surgery and radiotherapy represent the recommended first-line therapies for CPs, a new paradigm for treatment is currently emerging, as a consequence of accumulated knowledge concerning the molecular mechanisms involved in tumor growth, paving the way for anticipated use of targeted therapies. Significant clinical and basic research conducted in the field of CPs will undoubtedly constitute a real step forward for a better understanding of the behavior of these tumors and prevent associated complications. In this review, our aim is to summarize the multiple steps in the management of CPs in adults and emphasize the most recent studies that will contribute to advancing the diagnostic and therapeutic algorithms.
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Xu J, You C, Zhou L, Li Q, Zhou P, Chen N. The cell-cycle kinetics of craniopharyngioma and its clinical significance. J Neurooncol 2009; 98:71-6. [PMID: 19937088 DOI: 10.1007/s11060-009-0047-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 10/26/2009] [Indexed: 02/05/2023]
Abstract
Craniopharyngioma (CP) is a pathologically benign tumor with high incidence of recurrence and poor prognosis. DNA ploidy, S-phase fraction (SPF), and G2 phase/mitosis phase + S phase (G2/M + S) measured by flow cytometry (FCM) have been shown to correlate with cell cycle characteristics and clinical prognosis of other tumors. By use of FCM and terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) peroxidase, we compared DNA content, SPF, G2/M + S, necrosis and apoptosis in non-recurrent and recurrent tumor cells of CP from 63 cases including 32 adamantine epitheliomas (AEs) and 31 squamous papillary tumors (SPTs), and the ultrastructure of the CP cell was observed by transmission electron microscopy. Although no obvious differences between DNA content and necrosis and apoptosis rate were observed in subgroups of CPs, SPF and G2/M + S for recurrent tumors were statistically higher than those for recurrence-free tumors, and the recurrence rate of AE tumors is higher than that of SPT. Therefore, CP cells are diploid, and SPF and G2/M + S are related to recurrence of CP.
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Affiliation(s)
- Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37# Guoxuexiang Street, 610041, Chengdu, People's Republic of China.
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Xu J, Zhang S, You C, Huang S, Cai B, Wang X. Expression of human MCM6 and DNA Topo II alpha in craniopharyngiomas and its correlation with recurrence of the tumor. J Neurooncol 2007; 83:183-9. [PMID: 17410335 DOI: 10.1007/s11060-006-9284-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 10/19/2006] [Indexed: 02/05/2023]
Abstract
Craniopharyngioma often recurs after resection resulting in poor outcome for the affected patients. The reliable criteria for predicting the tumor behavior are still lacking. It has been suggested that proliferative potential of the tumor cells is necessary for recurrence. Present study evaluated the cell multiplication activity, which is possibly related to relapse in 32 patients with adamantine epithelioma (AE) and 31 patients with squamous papillary tumor (SP). For this tissue specimens from their primary and recurring tumors were collected and immunohistochemical analysis of the expression of minichromosome maintenance protein 6 (MCM6) and DNA topoisomerase II alphalpha (DNA Topo II alpha) in the tumor sections was performed by quantitative microscopy. It was found that the MCM6 label index (LI) was significantly higher in AE than that of SP, and in the primary tumors of both subtypes the LIs of tumors with recurrence were higher than those without recurrence. There was a strong linear positive correlation between MCM6 LI and DNA Topo II alpha LI (r = 0.713; p = 0.000) in the craniopharyngiomas studied. The median MCM6 LI of the total 20 recurrent craniopharyngiomas (31.49%) was not significantly different from that of their primary tumors (29.65%). The long term risk of tumor recurrence is higher in AE than SP and it is associated with MCM6 and DNA Topo II alpha expression.
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Affiliation(s)
- Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
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Abstract
The present study was performed to evaluate the role of neovascularization on the behavior of craniopharyngiomas as well as the contribution of endothelial cell proliferation and migration in the remodeling and expansion of the vascular network associated with angiogenesis. Fourteen primary tumors were studied, all of the adamantinomatous type. CD34 immunostaining, an endothelial cell marker, localized vessels within the connective tissue stroma. MIB-1 immunopositivity was apparent in the nuclei of neoplastic cells, few endothelial cells, and stromal elements. MIB-1 counts were higher in epithelial than connective tissue cells. A positive correlation was found between the number of MIB-1 immunopositive cells and microvessel density (MVD). Immunohistochemistry demonstrated that integrin alphavbeta3 expression was restricted to tumor vasculature; the tumor cells were immunonegative. Only 2.5% of vessels detected with CD34 were immunopositive for integrin alphavbeta3. At present, no therapeutic implications can be drawn from our observations. More studies are needed to assess whether integrin alphavbeta3 antagonists or drugs that arrest the cell cycle of endothelial cells can inhibit angiogenesis in craniopharyngiomas.
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Affiliation(s)
- Sergio Vidal
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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