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Guerrero-Pérez F, Vidal N, López-Vázquez M, Sánchez-Barrera R, Sánchez-Fernández JJ, Torres-Díaz A, Vilarrasa N, Villabona C. Sarcomas of the sellar region: a systematic review. Pituitary 2021; 24:117-129. [PMID: 32785833 DOI: 10.1007/s11102-020-01073-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE AND METHODS Sarcomas of the sellar region are uncommon and unexpected tumors. Here, we review the cases reported in literature via a systematic search. RESULTS Ninety-four patients, 58.5% male with mean age of 39.2 ± 17.2 years were included. Fifty-seven (62%) had soft tissue sarcomas (STS) and 35 (38%) bone sarcomas (BS). Sarcoma was a primary tumor in 66%, developed after radiotherapy in 31.9% and 7.4% were metastatic. Median time between radiotherapy and sarcoma development was 10.5 (11) years. Main presentation symptoms were visual disorders (87.9%), headache (61.5%) and III cranial nerve palsy (24.1%). After surgery, sarcoma persisted or recurred in 82.3% and overall mortality reported was 44.6% with 6.5 (14) months of median survival. Tumor appeared earlier in BS compared to STS (34.4 ± 15.1 vs. 42.6 ± 17.6 years), p = 0.034 and complete tumor resection was achieved more often (41.3% vs. 4.4%), p = < 0.001. Condrosarcoma and rhabdomyosarcoma were more frequent subtypes among primary tumors while fibrosarcoma was among post-radiation sarcomas. Tumor size was larger in radiation associated sarcomas (mean maximum diameter 46.3 ± 9.3 vs. 29.1 ± 8.0 mm, p = 0.004) and persistency/recurrence was similar in both groups (70.1 vs. 73.3%, p = 0.259). CONCLUSION Sarcomas appear as mass effect symptoms in the middle aged population, mainly as primary tumors, but one third is associated with radiotherapy. Surgery is commonly not curative, mortality rate is high and death ensues shortly after diagnosis.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Macarena López-Vázquez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Reinaldo Sánchez-Barrera
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Juan José Sánchez-Fernández
- Institut de Diagnòstic Per La Imatge, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Alberto Torres-Díaz
- Department of Neurosurgery, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Gupta S, Iorgulescu JB, Hoffman S, Catalino M, Bernstock JD, Chua M, Segar DJ, Fandino LB, Laws ER, Smith TR. The diagnosis and management of primary and iatrogenic soft tissue sarcomas of the sella. Pituitary 2020; 23:558-572. [PMID: 32613388 DOI: 10.1007/s11102-020-01062-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Soft tissue sarcoma (STS) of the sella is exceptionally rare. We conducted a case series, literature review, and nationwide analysis of primary and iatrogenic (radiation-associated) STS of the sella to define the clinical course of this entity. METHODS This study employed a multi-institutional retrospective case review, literature review, and nationwide analysis using the National Cancer Database (NCDB). RESULTS We report five patients who were diagnosed at three institutions with malignant STS of the sella. All patients presented with symptoms related to mass effect in the sellar region. All tumors extended to the suprasellar space, with the majority displaying extension into the cavernous sinus. All patients underwent an operation via a transsphenoidal approach with a goal of maximal safe tumor resection in four patients and biopsy for 1 patient. Histopathologic evaluation demonstrated STS in all patients. Post-operative adjuvant radiotherapy and chemotherapy were given to 2 and 1 out of 4 patients with known post-operative clinical course, respectively. The 1-year and 5-year overall survival rates were 100% (5/5) and 25% (1/4). Twenty-two additional reports of primary, non-iatrogenic STS of the sella were identified in the literature. Including the three cases from our series, treatment included resection in all cases, and adjuvant radiotherapy and chemotherapy were utilized in 50% (12/24) and 17% (4/24) of cases, respectively. The national prevalence of malignant STS is estimated to be 0.01% among all pituitary and sellar tumors within the NCDB. CONCLUSIONS We report the prevalence and survival rates of STS of the sella. Multimodal therapy, including maximal safe resection, chemotherapy, and radiotherapy are necessary to optimize outcomes for this uncommon pathology.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - J Bryan Iorgulescu
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115, USA
| | - Samantha Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Catalino
- Department of Neurosurgery, University of North Carolina Medical Center, Chapel Hill, NC, 27599, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Melissa Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - David J Segar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Luis Bradley Fandino
- Department of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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Yamanaka R, Abe E, Sato T, Hayano A, Takashima Y. Secondary Intracranial Tumors Following Radiotherapy for Pituitary Adenomas: A Systematic Review. Cancers (Basel) 2017; 9:cancers9080103. [PMID: 28786923 PMCID: PMC5575606 DOI: 10.3390/cancers9080103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 02/02/2023] Open
Abstract
Pituitary adenomas are often treated with radiotherapy for the management of tumor progression or recurrence. Despite the improvement in cure rates, patients treated by radiotherapy are at risk of development of secondary malignancies. We conducted a comprehensive literature review of the secondary intracranial tumors that occurred following radiotherapy to pituitary adenomas to obtain clinicopathological characteristics. The analysis included 48 neuroepithelial tumors, 37 meningiomas, and 52 sarcomas which were published between 1959–2017, although data is missing regarding overall survival and type of irradiation in a significant proportion of the reports. The average onset age for the pituitary adenoma was 37.2 ± 14.4 years and the average latency period before the diagnosis of the secondary tumor was 15.2 ± 8.7 years. Radiotherapy was administered in pituitary adenomas at an average dose of 52.0 ± 19.5 Gy. The distribution of pituitary adenomas according to their function was prolactinoma in 10 (7.2%) cases, acromegaly in 37 (27.0%) cases, Cushing disease in 4 (2.9%) cases, PRL+GH in 1 (0.7%) case, non-functioning adenoma in 57 (41.6%) cases. Irradiation technique delivered was lateral opposing field in 23 (16.7%) cases, 3 or 4 field technique in 27 (19.6%) cases, rotation technique in 10 (7.2%) cases, radio surgery in 6 (4.3%) cases. Most of the glioma or sarcoma had been generated after lateral opposing field or 3/4 field technique. Fibrosarcomas were predominant before 1979 (p < 0.0001). The median overall survival time for all neuroepithelial tumors was 11 months (95% confidence intervals (CI), 3–14). Patients with gliomas treated with radiotherapy exhibited a non-significant positive trend with longer overall survival. The median overall survival time for sarcoma cases was 6 months (95% CI, 1.5–9). The median survival time in patients with radiation and/or chemotherapy for sarcomas exhibited a non-significant positive trend with longer overall survival. In patients treated with radiotherapy for pituitary adenomas, the risk of secondary tumor incidence warrants a longer follow up period. Moreover, radiation and/or chemotherapy should be considered in cases of secondary glioma or sarcoma following radiotherapy to the pituitary adenomas.
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Affiliation(s)
- Ryuya Yamanaka
- Laboratory of Molecular Target Therapy for Cancer, Graduate School for Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Eisuke Abe
- Division of Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8122, Japan.
| | - Toshiteru Sato
- Department of Radiology, Nagaoka Chuo General Hospital, Nagaoka 940-8653, Japan.
| | - Azusa Hayano
- Laboratory of Molecular Target Therapy for Cancer, Graduate School for Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Yasuo Takashima
- Laboratory of Molecular Target Therapy for Cancer, Graduate School for Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
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Yamanaka R, Hayano A. Radiation-Induced Sarcomas of the Central Nervous System: A Systematic Review. World Neurosurg 2017; 98:818-828.e7. [DOI: 10.1016/j.wneu.2016.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Alireza M, Amelot A, Chauvet D, Terrier LM, Lot G, Bekaert O. Poor Prognosis and Challenging Treatment of Optic Nerve Malignant Gliomas: Literature Review and Case Report Series. World Neurosurg 2017; 97:751.e1-751.e6. [DOI: 10.1016/j.wneu.2016.10.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 10/20/2022]
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6
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Yamanaka R, Hayano A, Kanayama T. Radiation-induced gliomas: a comprehensive review and meta-analysis. Neurosurg Rev 2016; 41:719-731. [DOI: 10.1007/s10143-016-0786-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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Pivonello R, De Leo M, Cozzolino A, Colao A. The Treatment of Cushing's Disease. Endocr Rev 2015; 36:385-486. [PMID: 26067718 PMCID: PMC4523083 DOI: 10.1210/er.2013-1048] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/13/2015] [Indexed: 12/23/2022]
Abstract
Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Monica De Leo
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Alessia Cozzolino
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
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8
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Elsamadicy AA, Babu R, Kirkpatrick JP, Adamson DC. Radiation-Induced Malignant Gliomas: A Current Review. World Neurosurg 2015; 83:530-42. [DOI: 10.1016/j.wneu.2014.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/30/2014] [Accepted: 12/09/2014] [Indexed: 01/07/2023]
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9
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Abboud SE, Wolansky LJ, Manjila SV, Lo SS, Arafah BM, Selman WR, Couce ME, Rogers LR. Histologically Proven Radiation-Induced Brainstem Glioma 93 Months After External Beam Radiotherapy for Pituitary Macroadenoma: Radiation Treatment Dose and Volume Correlation. J Neuroimaging 2014; 25:674-6. [PMID: 25345677 DOI: 10.1111/jon.12181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/16/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Patient is a 29-year-old with a history of recurrent growth hormone-secreting pituitary macroadenoma diagnosed 12 years prior to presentation. Eight years prior to current presentation, the patient underwent re-resection and received 50.4 Gy external beam radiotherapy (EBRT) in 28 fractions of 1.8 Gy each. Serial postradiation MRIs demonstrated regression in pituitary tumor size. Patient presented with new headaches 7.5 years after completing EBRT. Brain MRI demonstrated new FLAIR hyperintensity and contrast enhancement within the pons and medulla, corresponding to the 36 Gy isodose line of each radiation dose fraction. Differential diagnosis included radiation necrosis and radiation-induced glioma (RIG). The patient's neurologic exam worsened over the following 4 months. MRI showed progressive increase in mass effect, extent of FLAIR hyperintensity, and contrast enhancement in the brainstem. Stereotactic-assisted biopsy showed infiltrating astrocytoma with moderate atypia. A PubMed search showed this is the first case of histologically verified brainstem RIG correlated with 3-dimensional conformational radiation therapy dose and volume planning following EBRT for a pituitary adenoma. The rare occurrence of brainstem RIG after radiation therapy for pituitary tumor supports the need for long-term imaging monitoring of such patients.
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Affiliation(s)
- Salim E Abboud
- Department of Radiology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Leo J Wolansky
- Department of Radiology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Sunil V Manjila
- Department of Neurological Surgery, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH.,Department of Neurology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Simon S Lo
- Department of Radiation Oncology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Baha M Arafah
- Department of Medicine-Endocrinology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Warren R Selman
- Department of Neurological Surgery, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH.,Department of Neurology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Marta E Couce
- Department of Pathology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
| | - Lisa R Rogers
- Department of Pathology, University Hospitals Case Medical Center and Seidman Cancer Center, 11100 Euclid Avenue, Cleveland, OH
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Ecemis GC, Atmaca A, Meydan D. Radiation-associated secondary brain tumors after conventional radiotherapy and radiosurgery. Expert Rev Neurother 2013; 13:557-65. [PMID: 23621312 DOI: 10.1586/ern.13.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although there is not enough strong molecular evidence for radiation to be a causal factor for the development of secondary brain tumors, a relationship has still been found. There is a slight but significant 2-2.7% increased risk of secondary brain tumors after conventional radiotherapy. However, this risk is small and should not preclude the use of radiotherapy as an effective treatment for uncontrolled pituitary tumors. The risk of radiosurgery-associated secondary brain tumors has not been precisely determined. Taking into account the considerable number of patients who received radiosurgery worldwide and the small number of secondary brain tumors, radiosurgery seems to be a safe treatment modality. This review summarizes the pathogenesis, prevalence and characteristics of secondary brain tumors after conventional radiotherapy and stereotactic radiosurgery for pituitary adenomas.
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Affiliation(s)
- Gulcin Cengiz Ecemis
- Dr. I Sevki Atasagun Government Hospital, Clinic of Endocrinology, Nevsehir, Turkey.
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11
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Sarkar S, Rajaratnam S, Backianathan S, Chacko G, Chacko AG. Radiation-induced opticochiasmatic glioblastoma multiforme following conventional radiotherapy for Cushing's disease. Br J Neurosurg 2013; 28:510-2. [DOI: 10.3109/02688697.2013.841850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Mamlouk MD, Handwerker J, Ospina J, Hasso AN. Neuroimaging findings of the post-treatment effects of radiation and chemotherapy of malignant primary glial neoplasms. Neuroradiol J 2013; 26:396-412. [PMID: 24007728 PMCID: PMC4202820 DOI: 10.1177/197140091302600405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 06/30/2013] [Indexed: 01/24/2023] Open
Abstract
Post-treatment radiation and chemotherapy of malignant primary glial neoplasms present a wide spectrum of tumor appearances and treatment-related entities. Radiologic findings of these post-treatment effects overlap, making it difficult to distinguish treatment response and failure. The purposes of this article are to illustrate and contrast the imaging appearances of recurrent tumor from necrosis and to discuss other radiologic effects of cancer treatments. It is critical for radiologists to recognize these treatment-related effects to help direct clinical management.
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Affiliation(s)
- M D Mamlouk
- Department of Radiology, University of California; Irvine, Orange, CA, USA -
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13
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Guo F, Song L, Meng Y. Malignant peripheral nerve sheath tumour following radiotherapy for pituitary adenoma. J Clin Neurosci 2013; 21:184-5. [PMID: 23830587 DOI: 10.1016/j.jocn.2013.02.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/14/2013] [Accepted: 02/23/2013] [Indexed: 11/29/2022]
Abstract
Intracranial malignant peripheral nerve sheath tumour (MPNST) is an extremely rare lesion. We report a patient with an MPNST in the sellar region following radiotherapy for pituitary adenoma.
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Affiliation(s)
- Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, No 1, Zhengzhou, HeNan Province 450052, China.
| | - Laijun Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, No 1, Zhengzhou, HeNan Province 450052, China
| | - Yanju Meng
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, No 1, Zhengzhou, HeNan Province 450052, China
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15
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Fraser CL, Biousse V, Newman NJ. Visual outcomes after treatment of pituitary adenomas. Neurosurg Clin N Am 2012; 23:607-19. [PMID: 23040747 DOI: 10.1016/j.nec.2012.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pituitary adenomas frequently manifest with neuro-ophthalmic symptoms and signs. The location of the pituitary gland makes involvement of both the visual pathways and the ocular motor cranial nerves likely when there is adenomatous expansion. A sudden expression of visual loss or diplopia commonly accompanies pituitary apoplexy. Several preoperative neuro-ophthalmic indicators help predict posttreatment outcomes and help determine the best intervention. Treatments themselves may also cause neuro-ophthalmic complications. The current literature and avenues of future research are reviewed.
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Affiliation(s)
- Clare Louise Fraser
- Department of Neuro-Ophthalmology, Emory Eye Center, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
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16
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Kang JJ, Hou JH, Bui KM, Michals E, Valyi-Nagy T, Koshy M, Munson T, Charbel FT, Villano JL, Moss HE. De novo malignant optic chiasm glioma with initial clinical response to steroids. Neuroophthalmology 2012; 36:59-63. [PMID: 24031101 DOI: 10.3109/01658107.2012.658594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malignant optic nerve glioma (MONG) is a rare but uniformly fatal disease that remains poorly understood. We describe a notable case of this rare disease occurring in the optic chiasm. Normal brain imaging and normal ophthalmic examination two years prior to diagnosis provide evidence for de novo genesis of MONG in our patient. Early response to steroids highlights the degree to which MONG can initially mimic inflammatory optic neuropathies and chiasmal syndromes. Our case also demonstrates a poor outcome with MONG even with current advanced therapy for glioblastoma including radiotherapy plus concomitant and adjuvant temozolomide (the EORTC/NCIC regimen) and bevacizumab.
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Affiliation(s)
- Joann J Kang
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Lemm D, de Oliveira FH, Bernays RL, Kockro RA, Kollias S, Fischer I, Rushing EJ. Rare suprasellar glioblastoma: report of two cases and review of the literature. Brain Tumor Pathol 2012; 29:216-20. [PMID: 22350669 DOI: 10.1007/s10014-012-0086-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/31/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND IMPORTANCE The suprasellar and hypothalamic/chiasmatic regions can harbor a broad range of pathologic conditions, both neoplastic and nonneoplastic; however, malignant gliomas are extremely rare in those regions. CLINICAL PRESENTATIONS Patient 1 was a 70 year-old man with weight loss and rapidly progressive visual impairment. A mass centered in the hypothalamus was detected on magnetic resonance (MR) imaging. The second patient, a 45 year-old woman, complained of visual symptoms and headaches. MR imaging revealed a combined intra- and suprasellar mass. In both instances, the preoperative differential diagnosis favored craniopharyngioma. Histological examination confirmed the diagnosis of glioblastoma. CONCLUSION We report two rare adult cases of hypothalamic/chiasmatic glioblastoma. The authors review the literature, highlighting the importance of considering this rare entity in the differential diagnosis of suprasellar and hypothalamic lesions.
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Affiliation(s)
- Doreen Lemm
- Institute of Neuropathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland.
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Nakamura H, Makino K, Ushio Y, Arima R, Kuratsu JI. Therapy-associated secondary tumors in patients with non-germinomatous malignant germ cell tumors. J Neurooncol 2011; 105:359-64. [PMID: 21533838 DOI: 10.1007/s11060-011-0597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 04/20/2011] [Indexed: 11/30/2022]
Abstract
We report three patients with non-germinomatous malignant germ cell tumor (NGMGCT) who developed therapy-associated secondary tumors. They were diagnosed as having NGMGCT by elevated serum levels of α-fetoprotein (AFP), human chorionic gonadotropin (HCG), or β-HCG. Preoperatively, all patients received a combination of etoposide and platinum-based chemotherapy and radiotherapy; neo-adjuvant therapy (NAT) was followed by complete excision of the residual tumor. Postoperatively, all underwent maintenance chemotherapy and all remained free of NGMGCT without recurrence. However, they developed therapy-associated secondary tumors, i.e. glioblastoma, meningioma, or cavernous angioma after 10.1, 9.8, and 8.2 years, respectively. The patient with glioblastoma died one year after its detection. The other two patients are currently alive; the meningioma was completely removed and the cavernous angioma is being monitored without additional treatment. To the best of our knowledge, therapy-associated secondary tumors in patients treated for NGMGCT are rare.
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Affiliation(s)
- Hideo Nakamura
- Department of Neurosurgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Moritani S, Ichihara S, Hasegawa M, Takada S, Takahashi T, Kato E, Mii S, Iwakoshi A. Dedifferentiation and progression of an intracranial solitary fibrous tumor: Autopsy case of a Japanese woman with a history of radiation therapy of the head during infancy. Pathol Int 2010; 61:143-9. [DOI: 10.1111/j.1440-1827.2010.02627.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Growth Inhibition and Induction of Apoptosis in SHG-44 Glioma Cells by Chinese Medicine Formula "Pingliu Keli". EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 2011. [PMID: 20953401 PMCID: PMC2952337 DOI: 10.1155/2011/958243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/01/2010] [Accepted: 06/30/2010] [Indexed: 02/06/2023]
Abstract
The present study was carried out to evaluate the effects of the water extract of Chinese medicine “Pingliu Keli” (PK) on human glioma cell viability and apoptosis and to investigate its mechanisms of action in SHG-44 cells. MTT assay showed that PK had a strong cytotoxic effect on SHG-44 cells. The number of live cells was less than 20% after exposure to 90 μg/mL PK for 24 h. PK increased cytotoxicity of SHG-44 cells in a dose-dependent manner. PK caused arrest of SHG-44 cells in G1 phase at low concentration and in G2 phase at high concentration. The percentage of apoptotic cells by flow cytometric analysis of the DNA-stained cells increased to 38% and 52% after treatment with 72 and 108 μg/mL PK, respectively. In addition, PK increased the expression of proapoptotic protein (Bax) and decreased antiapoptotic protein (Bcl-2), with a concomitant increase in the levels of cleaved caspase-3, cleaved caspase-9 and cleaved poly-ADP-ribose polymerase (PARP). These results suggest that PK has a significant apoptosis inducing effect on SHG-44 glioma cells in vitro and caspase-3 may act as a potential mediator in the process.
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