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Machetanz K, Wang SS, Oberle L, Tatagiba M, Naros G. Sex Differences in Vestibular Schwannoma. Cancers (Basel) 2023; 15:4365. [PMID: 37686642 PMCID: PMC10486905 DOI: 10.3390/cancers15174365] [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: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Vestibular schwannoma (VS) are equally common in men and woman. A number of epidemiological studies have reported on sex-specific aspects of incidence, tumor size, tinnitus and hearing loss. However, data on sex-specific, pre- and post-surgically quality of life (QoL) are rare. The objective of the present study was to determine sex-specific aspects on QoL in VS. Health-related QoL was analyzed in 260 patients (112 male/148 female) with unilateral sporadic VS using general (SF-36: general Short-Form Health Survey), disease-specific (PANQOL: Penn Acoustic Neuroma Quality-of-Life Scale, PANQOL) and symptom-specific (DHI: Dizziness Handicap Inventory; HHI: Hearing Handicap Inventory; THI: Tinnitus Handicap Inventory; FDI: Facial Disability Index) QoL questionnaires. Sex differences were evaluated pre- and postoperative by multi- and univariate analyses based on 200 preoperative and 88 postoperative questionnaires. Female patients were significantly more affected by dizziness, headaches, reduced energy and anxiety. Energy and balance changed similarly in both sexes after surgery. However, postoperative women tended to be more affected by facial palsy and headaches than men. Despite the greater physical impairment, general health improved equivalently or even more in female patients than in males. In conclusion, self-rated QoL in VS is significantly affected by sex and surgery. This should be taken into account when counseling VS patients regarding observation, radiotherapy, and surgery.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, 72074 Tuebingen, Germany
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Li X, Liang J, Song G, Jiao H. Using a Facial Nerve Stimulator to Record the Auditory Nerve Compound Action Potential to Locate the Auditory Nerve During Vestibular Schwannoma Resection. World Neurosurg 2023; 175:e582-e592. [PMID: 37030482 DOI: 10.1016/j.wneu.2023.03.146] [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: 03/13/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Improved technology in vestibular neuroma resection and facial nerve protection has become more sophisticated, and the protection of hearing during vestibular schwannoma resection is crucial. Currently, brainstem auditory evoked potential (BAEP), cochlear electrography, and cochlear nerve compound action potential (CNAP) are frequently used. The CNAP waveform is stable; however, the recording electrode can easily affect the procedure and cannot map the auditory nerve. The purpose of the study was to explore a simple method to record the CNAP and map the auditory nerve. METHODS In this study, CNAP was recorded using a facial nerve bipolar stimulator to localize and protect the auditory nerve. The BAEP click stimulation mode was used. A bipolar stimulator was used as the recording electrode to record CNAP and locate anatomical displacement of the auditory nerve. The CNAP of 40 patients was monitored. Pure tone audiometry, speech discrimination score, and auditory evoked potential (BAEP) evaluations were performed on all patients before and after surgery. RESULTS Of the 40 patients, 30 patients obtained CNAP during surgery, and the rate of CNAP obtained was significantly higher than that of BAEP. The sensitivity and specificity of decrease in CNAP in predicting significant hearing loss were 88.9% and 66.7%, respectively. The sensitivity and specificity of the disappearance of CNAP in predicting significant hearing loss were 52.9% and 92.3%, respectively. CONCLUSIONS The bipolar facial nerve stimulator can locate and protect the auditory nerve by recording a stable potential. The CNAP obtained rate was significantly higher than that of BAEP. The disappearance of BAEP during acoustic neuroma monitoring can be used as a standard alert for the surgeon, and decrease in CNAP is an alert for the operator.
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Affiliation(s)
- Xiaoyu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China.
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hanyi Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
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Vasilijic S, Atai NA, Hyakusoku H, Worthington S, Ren Y, Sagers JE, Sahin MI, Fujita T, Landegger LD, Lewis R, Welling DB, Stankovic KM. Identification of Immune-Related Candidate Biomarkers in Plasma of Patients with Sporadic Vestibular Schwannoma: Candidate Plasma Biomarkers in Vestibular Schwannoma. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.525436. [PMID: 36747696 PMCID: PMC9900840 DOI: 10.1101/2023.01.24.525436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vestibular schwannoma (VS) is intracranial tumor arising from neoplastic Schwann cells, causing hearing loss in about 95% of patients. The traditional belief that hearing deficit is caused by physical expansion of the VS, compressing the auditory nerve, does not explain the common clinical finding that patients with small tumors can have profound hearing loss, suggesting that tumor-secreted factors could influence hearing ability in VS patients. Here, we conducted profiling of patients' plasma for 67 immune-related factors on a large cohort of VS patients (N>120) and identified candidate biomarkers associated with tumor growth (IL-16 and S100B) and hearing (MDC). We identified the 7-biomarker panel composed of MCP-3, BLC, S100B, FGF-2, MMP-14, eotaxin, and TWEAK that showed outstanding discriminatory ability for VS. These findings revealed possible therapeutic targets for VS-induced hearing loss and provided a unique diagnostic tool that may predict hearing change and tumor growth in VS patients and may help inform the ideal timing of tumor resection to preserve hearing.
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Affiliation(s)
- Sasa Vasilijic
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, US
| | - Nadia A. Atai
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Hiroshi Hyakusoku
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otorhinolaryngology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Steven Worthington
- Harvard Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Yin Ren
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Jessica E. Sagers
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Mehmet I Sahin
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Takeshi Fujita
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Lukas D. Landegger
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Richard Lewis
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Neurology, Harvard Medical School, Boston, MA, US
| | - D. Bradley Welling
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Konstantina M. Stankovic
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, US
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, US
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, US
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Ilyalov SR, Ryzhova MV, Galkin MV, Banov SM, Golanov AV, Usachev DY. [Expression of estrogen and progesterone receptors in vestibular schwannomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:44-48. [PMID: 36763552 DOI: 10.17116/neiro20238701144] [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: 02/11/2023]
Abstract
INTRODUCTION Stereotactic radiosurgery is one of the main treatments for vestibular schwannomas (VS). Their feature is frequent post-radiation pseudoprogression. This may be due to hormonal status of patients. OBJECTIVE To analyze expression of progesterone and estrogen receptors in women and men with VS. MATERIAL AND METHODS Immunohistochemical analysis of expression of progesterone (PR) and estrogen receptors (ER) after biopsy was performed in 240 patients with VS between 2018 and 2021. ER/PR expression was assessed in men (n=120) and women (n=120) in 3 age subgroups: young age (18-44 years), middle age (45-59 years) and old age (60-79 years). Each subgroup included 40 patients. Statistical analysis was performed using the Mann-Whitney test and MedCalc software. RESULTS ER expression is not typical for VS (men - 1 (0.01%), women - 3 (2.5%)). At the same time, PR expression was found in 29 (24.2%) men and 21 (17.5%) women. We found no significant difference in expression of ER and PR between men and women. However, variability in PR expression was revealed, i.e. predominance of this indicator in young women (p=0.0463) and middle-aged men (p=0.0110). Expression of PR was similar in elderly patients (p=0.2382). CONCLUSION The established incidence of PR expression may be one of the probable causes affecting development and duration of VS pseudoprogression after radiosurgery without clear relationship between sex and age. Further prospective research is needed to predict the risks of pseudoprogression.
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Affiliation(s)
- S R Ilyalov
- Gamma Clinic center of high precision radiology (Gamma Medtechnology LLC), Obninsk, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S M Banov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Identification of key biomarkers and immune infiltration in sporadic vestibular schwannoma basing transcriptome-wide profiling. World Neurosurg 2022; 160:e591-e600. [PMID: 35092815 DOI: 10.1016/j.wneu.2022.01.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vestibular schwannoma (VS) is a common intracranial tumor, with 95% of the cases being sporadic vestibular schwannoma (SVS). The purposed of this study was identifying genes responsible for inflammation in SVS and clarifying its underlying immune mechanisms. METHODS Transcriptional sequencing datasets (GSE141801 and GSE108237) from the Gene Expression Omnibus (GEO) database were used in this study. The candidate modules closely related to SVS and hub genes were screened out by weighted gene co-expression network analysis. Τhe sensitivity and specificity of the hub genes for SVS prediction were evaluated by ROC curve analysis. The CIBERSORT algorithm was subsequently applied to analyze the immune infiltration between SVS and controls. Finally, biological signaling pathways involved in the hub genes were identified via gene set enrichment analysis. RESULTS A total of 39 significantly enriched in myelination and collagen-containing extracellular matrix DEGs were identified at the screening step. Three hub genes (MAPK8IP1, SLC36A2, and OR2AT4) were identified, which mainly enriched in pathways of melanogenesis, GnRH, and calcium signaling pathways. Compared with normal nerves, SVS tissue contained a higher proportion of T cells, monocytes and activated dendritic cells, whereas proportions of M2 macrophages were lower. CONCLUSIONS The intergrated analysis revealed the pattern of immune cell infiltration in SVS and provided a crucial molecular foundation to enhance understanding of SVS. Hub genes MAPK8IP1, SLC36A2 and OR2AT4 are potential biomarkers and therapeutic targets to facilitate the accurate diagnosis, prognosis and therapy of SVS.
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Audio-vestibular disorders and pregnancy: A systematic review. Am J Otolaryngol 2021; 42:103136. [PMID: 34182351 DOI: 10.1016/j.amjoto.2021.103136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders. MATERIALS AND METHODS A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database. RESULTS After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo. CONCLUSIONS According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.
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Abstract
OBJECTIVE To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS). STUDY DESIGN Retrospective cohort study. SETTING The Surveillance, Epidemiology, and End Results (SEER) tumor registry. PATIENTS The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed. RESULTS A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio [OR] 1.417; p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935; p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery. CONCLUSIONS The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.
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Epidemiology and Diagnostic Characteristics of Vestibular Schwannomas-Does Gender Matter? Otol Neurotol 2021; 41:e1372-e1378. [PMID: 33492815 DOI: 10.1097/mao.0000000000002936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A number of epidemiological studies have reported data on, e.g., tumor size and hearing at diagnosis for patients with a vestibular schwannoma (VS), whereas only a few have touched upon the potential significance of sex. The aim of this report is thus to present gender-specific data on incidence and age, tumor localization, tumor size, and hearing loss at diagnosis. MATERIAL AND METHODS Since 1976, various data for all patients diagnosed with a sporadic VS in Denmark have been entered prospectively into a national database. Data on sex, incidence, age, tumor localization, tumor size, and hearing (discrimination) were extracted for the period 1976 to 2015. RESULTS Over the 40 years, 3,637 cases were diagnosed, of which 1,804 were women (50%) and 1,833 men (50%). For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age was increasing and hearing at diagnosis was increasingly better.Previously, women had more extrameatal and thus larger tumors. During the most recent decade, more tumors were found in men and hearing at diagnosis was better for women, whereas age and tumor size were comparable. CONCLUSION The data on gender-specific epidemiology and diagnostic characteristics show varying trends over the 40-year-period spanned. For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age is increasing and hearing at diagnosis is increasingly better. More extrameatal and thus larger tumors were previously found in women. Contemporarily, more vestibular schwannomas are found in men and diagnostic hearing is better in women.
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Early S, Rinnooy Kan CE, Eggink M, Frijns JHM, Stankovic KM. Progression of Contralateral Hearing Loss in Patients With Sporadic Vestibular Schwannoma. Front Neurol 2020; 11:796. [PMID: 33013614 PMCID: PMC7461819 DOI: 10.3389/fneur.2020.00796] [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: 04/08/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Introduction: Vestibular schwannomas (VSs) are the most common tumors of the cerebellopontine angle, typically presenting unilaterally with ipsilateral sensorineural hearing loss (SNHL). The mechanism of tumor-induced hearing loss has recently been shown to be related to secreted tumor factors, in addition to mechanical compression of the adjacent auditory nerve, and these factors may percolate through CSF or blood to affect contralateral hearing as well. Methods: This is a retrospective study of medical records for patients treated for VS at Mass Eye and Ear from January 1994 through October 2018. Included patients had unilateral VS and sequential audiometry allowing for longitudinal assessment of hearing over time. Mass Eye and Ear's audiology database was used to select age- and sex-matched case controls, also with sequential audiometry, from the non-VS population. Subgroup analysis was performed by age, sex, baseline hearing, and tumor size at initial diagnosis. Hearing loss progression was performed using Kaplan-Meier analysis to account for variable follow-up times. Results: A total of 661 patients were identified with VS and sequential audiometry. The population was predominantly female vs. male (368 vs. 293, p = 0.0035), driven primarily by younger patients with Koos 4 tumors (76 female vs. 49 male, p = 0.016). Patients with normal baseline hearing bilaterally (N = 241) demonstrated no significant difference in hearing loss progression in VS-contralateral vs. control ears. Patients with abnormal baseline VS-ipsilateral hearing (N = 190), however, demonstrated significantly higher likelihood of reaching moderate SNHL in VS-contralateral ears. Subgroup analysis by age, sex, and baseline tumor size did not yield any subgroup-specific trends for hearing loss progression. Discussion and Conclusion: This is the largest study to date tracking long-term bilateral hearing outcomes in patients with VS, and demonstrates that, in patients with abnormal hearing in the VS-ipsilateral ear, there exists a long-term risk of progression to moderate hearing loss in the contralateral ear as well. Combined with the absence of significant changes in word understanding in the affected ears, these findings may provide clues to the nature of tumor-secreted factors involved in VS-associated hearing loss. Female predominance within the VS patient population is confirmed, driven mostly by younger female patients with Koos 4 tumors.
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Affiliation(s)
- Samuel Early
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Charlotte E Rinnooy Kan
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Leiden University Medical Center, Leiden, Netherlands
| | - Maura Eggink
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,University Medical Center Groningen, Groningen, Netherlands
| | - Johan H M Frijns
- Leiden University Medical Center, Leiden, Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States.,Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, United States
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Loures FH, Conceição LG, Amorim RL, Nobrega J, T. Neto R, Costa EP, Silva FFE. Progesterone and estrogen receptor expression by canine cutaneous soft tissue sarcomas. PESQUISA VETERINARIA BRASILEIRA 2020. [DOI: 10.1590/1678-5150-pvb-6103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT: Canine soft tissue sarcomas (STS) comprise a heterogeneous group of malignancies that share similar histopathological features, a low to moderate recurrence rate and low metastatic potential. In human medicine, the expression of estrogen receptors (ER) and progesterone receptors (PR) in sarcomas has been studied to search for prognostic factors and new treatment targets. Similar studies have yet to be conducted in veterinary medicine. The objective of this study was therefore to investigate by immunohistochemistry (IHC) the ER and PR expression in a series of 80 cutaneous and subcutaneous sarcomas in dogs with histopathological features of peripheral nerve sheath tumor (PNST) and perivascular wall tumor (PWT). All cases were positive for PR and negative for ER. Tumors of high malignancy grade (grade III) exhibited higher PR expression than low-grade tumors (grade I). Tumors with mitotic activity greater than 9 mitotic figures/10 high power fields also exhibited higher PR expression. In addition, there was a positive correlation between cell proliferation (Ki67) and PR expression. Therefore, it is possible that progesterone plays a greater role than estrogen in the pathogenesis of these tumors. Future studies should explore the potential for selective progesterone receptor modulators as therapeutic agents in canine STS, as well as evaluating PR expression as a predictor of prognosis.
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Affiliation(s)
| | | | | | | | - Rafael T. Neto
- VetMol Consultoria e Diagnóstico em Patologia Molecular Veterinária e Pesquisa, Brazil
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Kapitanov DN, Shimansky VN, Kolycheva MV, Shevchenko KV, Lebedeva MA, Chernikova NA, Shelesko EV. [The causes of late diagnostics of vestibular shwannomas]. Vestn Otorinolaringol 2019; 84:36-41. [PMID: 30938340 DOI: 10.17116/otorino20198401136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The objective of the present study was to elucidate the causes of late diagnostics of vestibular shwannomas based on the results of the analysis of the medical histories of the patients admitted to the Academician N.N. Burdenko National Medical Research Centre of Neurosurgery for the management of this condition. MATERIAL AND METHODS We undertook the retrospective review of a series of 192 cases of vestibular shwannomas in the patients treated based at the N.N. Burdenko National Medical Research Centre of Neurosurgery in 2015. The study included the analysis of demographic characteristics of the patients as well as their anamnestic and clinical data. RESULTS AND DISCUSSION A total of 55 (29%) patients were found to have small tumours (Samii T1-T3) whereas 137 (71%) ones presented with giant neoplasms including T4a and T4b tumours (in accordance with the Samii classification) in 63 (33%) and 74 (38%) patients respectively. The duration of the disease from the appearance of its first clinical symptoms up to the establishment of the definitive diagnosis was 41 months on the average. 37 (19%) patients appeared to have paid no attention to the unilateral impairment of hearing. 46 (24%) patients applied for the medical assistance to the therapists and neurologists. 56 (29%) patients had remained for a long time under the supervision of the ENT specialists and surdologists based at the local outpatient facilities. CONCLUSION More than 2/3 of the examined patients presenting with vestibular shwannomas apply for the medical assistance at the late stages of the disease. Such situation can be attributed to the low level of oncological alertness among the general population and health providers, the poor awareness of the general practitioners and otorhinolaryngologists about this pathology, the unavailability or inefficient application of the modern neurovisualization technologies, in the first place magnetic resonance imaging. The problems encountered in connection with the performance of screening studies give evidence of the necessity of the introduction of up-to-date otoneurological and audiological investigations as well as the neurovisualization techniques into the everyday clinical practice for the comprehensive examination of all the patients suffering from unilateral hearing loss.
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Affiliation(s)
- D N Kapitanov
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - V N Shimansky
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - M V Kolycheva
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - K V Shevchenko
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - M A Lebedeva
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - N A Chernikova
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - E V Shelesko
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
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Rosahl S, Bohr C, Lell M, Hamm K, Iro H. Diagnostics and therapy of vestibular schwannomas - an interdisciplinary challenge. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc03. [PMID: 29279723 PMCID: PMC5738934 DOI: 10.3205/cto000142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vestibular schwannomas (VS) expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100,000 vestibular schwannoma represent 6-7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function. Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options - watchful waiting, microsurgery and stereotactic radiation - should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several articles and reviews have been published on the topic of vestibular schwannoma. On the occasion of the 88th annual meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck surgery a special volume of the journal "HNO" will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases that outline examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after the case presentations. Important criteria for decision making are size and growth rate of the tumor, hearing of the patient and the probability of total tumor resection with preservation of hearing and facial nerve function, age and comorbidity of the patient, best possible control of vertigo and tinnitus and last but not least the patient's preference and choice. In addition to this, the experience and the results of a given center with each treatment modality will figure in the decision making process. We will discuss findings that are reported in the literature regarding facial nerve function, hearing, vertigo, tinnitus, and headache and reflect on recent studies on their influence on the patient's quality of life. Vertigo plays an essential role in this framework since it is an independent predictor of quality of life and a patient's dependence on social welfare. Pathognomonic bilateral vestibular schwannomas that occur in patients suffering from neurofibromatosis typ-2 (NF2) differ from spontaneous unilateral tumors in their biologic behavior. Treatment of neurofibromatosis type-2 patients requires a multidisciplinary team, especially because of the multitude of separate intracranial and spinal lesions. Off-label chemotherapy with Bevacizumab can stabilize tumor size of vestibular schwannomas and even improve hearing over longer periods of time. Hearing rehabilitation in NF2 patients can be achieved with cochlear and auditory brainstem implants.
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Affiliation(s)
- Steffen Rosahl
- Department of Neurosurgery, Helios Hospital of Erfurt, Germany
| | - Christopher Bohr
- Department of Otolaryngology, University Hospital of Erlangen, Germany
| | - Michael Lell
- Institute for Radiology and Nuclear Medicine, Hospital of Nuremberg, Germany
| | - Klaus Hamm
- Cyberknife Center of Central Germany, Erfurt, Germany
| | - Heinrich Iro
- Department of Neurosurgery, Helios Hospital of Erfurt, Germany
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Landegger LD, Sagers JE, Dilwali S, Fujita T, Sahin MI, Stankovic KM. A Unified Methodological Framework for Vestibular Schwannoma Research. J Vis Exp 2017. [PMID: 28654042 DOI: 10.3791/55827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Vestibular schwannomas are the most common neoplasms of the cerebellopontine angle, making up 6-8% percent of all intracranial growths. Though these tumors cause sensorineural hearing loss in up to 95% of affected individuals, the molecular mechanisms underlying this hearing loss remain elusive. This article outlines the steps established in our laboratory to facilitate the collection and processing of various primary human tissue samples for downstream research applications integral to the study of vestibular schwannomas. Specifically, this work describes a unified methodological framework for the collection, processing, and culture of Schwann and schwannoma cells from surgical samples. This is integrated with parallel processing steps now considered essential for current research: the collection of tumor and nerve secretions, the preservation of RNA and the extraction of protein from collected tissues, the fixation of tissue for the preparation of sections, and the exposure of primary human cells to adeno-associated viruses for application to gene therapy. Additionally, this work highlights the translabyrinthine surgical approach to collect this tumor as a unique opportunity to obtain human sensory epithelium from the inner ear and perilymph. Tips to improve experimental quality are provided and common pitfalls highlighted.
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Affiliation(s)
- Lukas D Landegger
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Department of Otolaryngology, Harvard Medical School; Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna
| | - Jessica E Sagers
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Program in Speech and Hearing Bioscience and Technology, Harvard Medical School
| | - Sonam Dilwali
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Program in Speech and Hearing Bioscience and Technology, Harvard Medical School
| | - Takeshi Fujita
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Department of Otolaryngology, Harvard Medical School
| | - Mehmet I Sahin
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Department of Otolaryngology, Harvard Medical School
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear; Department of Otolaryngology, Harvard Medical School; Program in Speech and Hearing Bioscience and Technology, Harvard Medical School;
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Shah KJ, Chamoun RB. Large Vestibular Schwannomas Presenting during Pregnancy: Management Strategies. J Neurol Surg B Skull Base 2014; 75:214-20. [PMID: 25072015 DOI: 10.1055/s-0034-1370784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022] Open
Abstract
Objective Large vestibular schwannomas rarely present in pregnant women. Diagnosis and management of these tumors during pregnancy present a therapeutic challenge. Methods A 20-year-old primigravida woman at 26 weeks' gestation was transferred to our facility with gait imbalance, left facial weakness, left ear hearing loss, and recent nausea and vomiting. Magnetic resonance imaging revealed a large left cerebellopontine angle mass with extension into the left internal auditory canal and compression of the fourth ventricle resulting in mild hydrocephalus. The patient was admitted with a plan for early delivery at 32 weeks followed by tumor resection. One week later, the patient's headache and neurologic symptoms worsened due to increased hydrocephalus; a ventriculoperitoneal shunt was placed. The next day, an emergent cesarean delivery was performed due to worsening respiratory status. Four days later, a tracheostomy and percutaneous endoscopic gastrostomy tube were placed due to dysphagia. Eight days after the delivery, the mass was resected with a left retrosigmoid approach without complications. Immunohistochemistry confirmed vestibular cellular schwannoma on cranial nerve VIII showing unusually high mitotic activity. Results The patient was discharged to inpatient rehabilitation on postoperative day 12 without new neurologic deficit. At 1 month, the patient was swallowing without aspiration. Her facial sensation had returned, her facial weakness remained stable, and her gait was significantly improved. Conclusion If the patient is neurologically stable, the best option is to delay resection until after delivery. If resection is necessary during pregnancy, the optimal time is during the second trimester.
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Affiliation(s)
- Kushal J Shah
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Roukoz B Chamoun
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
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Abstract
OBJECTIVE To assess the association of sex and age with presenting symptoms and size of vestibular schwannoma at clinical presentation to our clinics. STUDY DESIGN Retrospective chart review. SETTING Academic medical center. PATIENTS Approximately 1,269 subjects diagnosed with unilateral vestibular schwannoma between 1997 and 2010. INTERVENTION Demographic information, tumor characteristics, and treatment strategy were recorded. MAIN OUTCOME MEASURE Tumor size, patient-reported presence of hearing loss or dizziness at presentation. RESULTS Male subjects had significantly larger tumors than female subjects at presentation (18.23 versus 16.81 mm, p = 0.031); this difference was particularly pronounced in patients younger than 40 years. Patient-reported symptoms at baseline also differed by sex: the prevalence of hearing loss was 95.1% in male subjects versus 90.3% in female subjects (p = 0.001), and the frequency of dizziness was 74.3% in female subjects versus 59.0% in male subjects (p<0.0001). In multivariate analyses, male subjects continued to have a borderline significant positive association with tumor size (p = 0.066) and were 2-fold more likely to have hearing loss (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.300-3.336) but half as likely to have dizziness (OR, 0.501; 95% CI, 0.387-0.649) than female subjects. Additionally, for every 1-mm increase in tumor size, patients were more likely to report hearing loss by 14.7% (OR, 1.147; 95% CI, 1.106-1.191) and dizziness by 2.8% (OR, 1.028; 95% CI, 1.016-1.041). CONCLUSION We observed significant sex differences in the presentation and size of unilateral vestibular schwannomas. As management and treatment strategies are predicated on presenting symptoms and patient factors, these observations merit further study to further understand tumor biology, improve risk stratification, and optimize tumor management.
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