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Yuen CA, Bao S, Pekmezci M, Mo F, Kong XT. Pembrolizumab in an HIV-infected patient with glioblastoma. Immunotherapy 2024; 16:803-811. [PMID: 38889068 PMCID: PMC11457652 DOI: 10.1080/1750743x.2024.2362566] [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: 11/10/2023] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
Persons living with human immunodeficiency virus (PLWH) carry increased risk for developing malignancies, including glioblastoma. Despite extensive investigations, both human immunodeficiency virus (HIV) and glioblastoma are incurable. Treatment for a patient with combined glioblastoma and HIV remains an unexplored need. Preliminary evidence suggests that immunotherapy may be effective for the simultaneous treatment of both HIV and cancer by reversing HIV latency and T cell exhaustion. We present a case of glioblastoma in a PLWH who was treated with pembrolizumab. Treatment was well tolerated and safe with a mixed response. Our patient did not develop any opportunistic infections, immune-related adverse events, or worsening of his immunodeficiency. To our knowledge, this is the first reported case of a PLWH and glioblastoma treated with immunotherapy.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA 92868, USA
| | - Silin Bao
- Department of Internal Medicine, Neurosciences Division, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Fan Mo
- Department of Internal Medicine, Neurosciences Division, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Xiao-Tang Kong
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA 92868, USA
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Transdural Skull Base Infiltration by Glioblastoma: Case Report and Review of the Literature. Case Rep Otolaryngol 2023; 2023:4727288. [PMID: 36742066 PMCID: PMC9891834 DOI: 10.1155/2023/4727288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/22/2022] [Accepted: 12/10/2022] [Indexed: 01/27/2023] Open
Abstract
We report the rare occurrence of a temporal glioblastoma multiforme (GBM) showing transdural tumor extension into adjacent mastoid cells. As the dura mater provides a barrier to intraaxial tumors, GBM seldom penetrates into the skull base, even though it is a high-grade astrocytoma with a tendency to spread. Yet, some mechanisms of GBM-induced skull invasion have been identified, making this entity a very rare but nonetheless relevant differential diagnosis in otherwise ambiguous cases of an intracerebral tumor extending into the skull base. In addition, imaging markers that may assist in distinguishing extra- from intraaxial tumor infiltration of the temporal bone are described.
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Coca-Pelaz A, Bishop JA, Zidar N, Agaimy A, Gebrim EMMS, Mondin V, Cohen O, Strojan P, Rinaldo A, Shaha AR, de Bree R, Hamoir M, Mäkitie AA, Kowalski LP, Saba NF, Ferlito A. Cervical Lymph Node Metastases from Central Nervous System Tumors: A Systematic Review. Cancer Manag Res 2022; 14:1099-1111. [PMID: 35300060 PMCID: PMC8921675 DOI: 10.2147/cmar.s348102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Lymph node metastasis (LNM) from primary tumors of the central nervous system (CNS) is an infrequent condition, and classically it was thought that CNS tumors could not spread via the lymphatic route. Recent discoveries about this route of dissemination make its knowledge necessary for surgeons and pathologists to avoid delays in diagnosis and unnecessary treatments. The aim of this paper is to review the literature and to discuss the relevant pathogenetic mechanism and the cytologic features along with recommendations for surgical treatment of these cervical LNM. Materials and Methods Using PRISMA guidelines, we conducted a systematic review of the literature published from 1944 to 2021, updating the comprehensive review published in 2010 by our group. Results Our review includes data of 143 articles obtaining 174 patients with LNM from a primary CNS tumor. The mean age of the patients was 31.9 years (range, 0.1–87) and there were 61 females (35.1%) and 103 males (59.2%), and in 10 cases (5.7%) the gender was not specified. The more frequent sites of distant metastasis were bones (23%), lungs (11.5%) and non-cervical lymph nodes (11%). Conclusion Cervical LNM from CNS tumors is infrequent. Pathologic diagnosis can be obtained by fine-needle aspiration cytology in most cases, giving surgeons the option to plan the appropriate surgical treatment. Given the poor prognosis of these cases, the most conservative possible cervical dissection is usually the treatment of choice.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo (Asturias), Spain
- Correspondence: Andrés Coca-Pelaz, Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Avenida de Roma s/n, Oviedo (Asturias), 33011, Spain, Email
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Eloisa Maria Mello Santiago Gebrim
- Otorhinolaryngology Department, National Institute of Rehabilitation, Mexico City, Mexico
- Radiology Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Vanni Mondin
- ENT Clinic, Policlinico Città di Udine, Udine, Italy
| | - Oded Cohen
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The NetherlAnds
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Zhang X, Katsakhyan L, LiVolsi VA, Roth JJ, Rassekh CH, Bagley SJ, Nasrallah MP. TP53 Mutation and Extraneural Metastasis of Glioblastoma: Insights From an Institutional Experience and Comprehensive Literature Review. Am J Surg Pathol 2021; 45:1516-1526. [PMID: 34366423 DOI: 10.1097/pas.0000000000001762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extraneural metastases of glioblastoma (GBM), although rare, are becoming an increasingly recognized occurrence. Currently, the biological mechanism underlying this rare occurrence is not understood. To explore the potential genomic drivers of extraneural metastasis in GBM, we present the molecular features of 4 extraneural metastatic GBMs, along with a comprehensive review and analysis of previously reported cases that had available molecular characterization. In addition to our 4 cases, 42 patients from 35 publications are reviewed. To compare the molecular profiles between GBM cases with extraneural metastasis and the general GBM population, genomic data from GBM samples in The Cancer Genome Atlas (TCGA) database were also analyzed. We found that 64.5% (20/31) of the cases with extraneural metastasis that were tested for TP53 changes had at least 1 TP53 pathogenic variant detected in either 1 or both primary and metastatic tumors. In contrast, TP53 mutation was significantly less frequent in the unselected GBM from TCGA (22.6%, 56/248) (P=0.000). In addition, O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation was more common in unselected TCGA GBM cases (48.6%, 170/350) than in cases with extraneural metastasis (31.8%, 7/22), although not statistically significant. Although isocitrate dehydrogenase (IDH) mutation is a rare occurrence in high-grade astrocytomas, IDH-mutant grade 4 astrocytomas are at least as likely to metastasize as IDH wild-type GBMs; 3 metastatic cases definitively harbored an IDH1 (p.R132H) mutation in our analysis. Our findings not only provide potential biomarkers for earlier screening of extraneural metastasis, but could also suggest clues to understanding biological mechanisms underlying GBM metastasis, and for the development of therapeutic modalities.
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Affiliation(s)
| | | | | | | | | | - Stephen J Bagley
- Hematology Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Rossi J, Giaccherini L, Cavallieri F, Napoli M, Moratti C, Froio E, Serra S, Fraternali A, Ghadirpour R, Cozzi S, Ciammella P, Iaccarino C, Pascarella R, Valzania F, Pisanello A. Extracranial metastases in secondary glioblastoma multiforme: a case report. BMC Neurol 2020; 20:382. [PMID: 33087049 PMCID: PMC7579923 DOI: 10.1186/s12883-020-01959-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
Background Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution. Case presentation We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion. Conclusions Our case highlights that grade II Astrocytoma may evolve to a GBM and rarely lead to a secondary metastatic diffusion, which can progress quite rapidly; any symptoms referable to a possible systemic involvement should be carefully investigated.
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Affiliation(s)
- Jessica Rossi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Giaccherini
- Radiation Oncology Unit, Oncological Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Manuela Napoli
- Neuroradiology Service, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Service, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Froio
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Serra
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Fraternali
- Nuclear Medicine Service, Oncology Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Reza Ghadirpour
- Neurosurgery Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Unit, Oncological Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Oncological Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Iaccarino
- Neurosurgery Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Service, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Anna Pisanello
- Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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