Adult pilocytic astrocytoma of conus medullaris: clinical considerations and review of the literature

Analysis of Spinal Pilocytic Astrocytoma in 12 Case Reports and Literature Review

Spinal pilocytic astrocytoma (PA) is a rare disorder with atypical, clinical and imaging characteristics, and generally limited to case reports. We analysed the clinical manifestations, imaging findings, treatment and prognostic follow-up of 12 patients with spinal PA admitted from January 2010 to July 2021, and reviewed the relevant literature. Radiological assessment, especially magnetic resonance imaging, can help to provide effective diagnostic information. The diagnosis and differentiation of this disease is discussed in an attempt to contribute to a more comprehensive preoperative assessment.

Pilocytic Astrocytoma Arising from the Conus Medullaris in an Adult: A Case Report

Low-grade, sporadic, pilocytic astrocytomas (PAs) are rare spinal cord tumors diagnosed in adult patients. Their localization to the conus medullaris is exceedingly rare, having only been described in a limited number of case reports. Here, we describe a case of a 22-year-old female presenting with back pain, lower extremity weakness, hypoesthesia, and urinary incontinence. Imaging studies demonstrated a cystic lesion of the conus medullaris that was treated with subtotal resection and cyst-subarachnoid shunt placement. Final pathology report confirmed PA from the histology of surgical specimens. We discuss the current literature of conus medullaris lesions and their differential diagnosis.

Multicentric Spinal Pilocytic Astrocytoma Presenting with Syringomyelia

Pilocytic spinal cord astrocytomas make up 21% of intramedullary tumors. Only 20% of those tumors are associated with syringomyelia. To our knowledge, this is the first report of an adult presenting with multiple spinal pilocytic astrocytomas associated with syringomyelia. We report a case of a 27-year-old woman who had neck and arm pain for months. She underwent cervical magnetic resonance imaging (MRI) that demonstrated a syrinx from C2 and extending to C6. A coronal view of the MRI showed multiple mural nodules. Total excision of multicentric nodules within a cyst was performed with an uneventful intraoperative and postoperative period and the patient was discharged home with moderate right-hand numbness.

Sterically stabilized recombined HDL composed of modified apolipoprotein A-I for efficient targeting toward glioma cells

Reconstituted high density lipoprotein (rHDL) has been regarded as a promising brain-targeting vehicle for anti-glioma drugs under the mediation of apolipoprotein A-I (apoA-I). However, some stability issues relating to drug leakage and consequent reduced targeting efficiency in the course of discoidal rHDL (d-rHDL) circulating in blood hinder its broad application. The objective of the study was to develop a novel stabilized d-rHDL by replacing cholesterol and apoA-I with mono-cholesterol glutarate (MCG) modified apoA-I (termed as mA) and to evaluate its allosteric behavior and glioma targeting. MCG was synthesized through esterifying the hydroxyl of cholesterol with glutaric anhydride and characterized by FI-IR and 1H NMR. d-rHDL assembled with mA (termed as m-d-rHDL) presented similar properties such as minute particle size and disk-like appearance resembling nascent HDL. Morphological transformation observation and in vitro release plots convinced that the modification of cholesterol could effectively inhibit the remolding of d-rHDL. The uptake of m-d-rHDL by LCAT-pretreated bEND.3 cells was significantly higher than that of d-rHDL, thereby serving as another proof for the capability of m-d-rHDL in enhancing targeting property. Besides, apoA-I anchoring into m-d-rHDL played a critical role in the endocytosis process into bEND.3 cells and C6 cells, which implied the possibility of traversing blood brain barrier and accumulating in the brain and glioma. These results suggested that the modification toward cholesterol to improve the stability of d-rHDL is advantageous, and that this obtained m-d-rHDL revealed great potential for realization of suppressing the remolding of d-rHDL in the brain-targeted treatment of glioma for drug delivery.

Efficacy of surgery for the treatment of astrocytoma: A protocol of systematic review and meta-analysis

BACKGROUND

This study will assess the efficacy of surgery for the treatment of patients with astrocytoma.

METHODS

We will undertake searches for randomized controlled trials from the following databases: MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and China National Knowledge Infrastructure. We will search all these databases from their inception to the March 1, 2020. No language limitation and publication status will be imposed in this study. Two authors will independently carry out study selection, data extraction, and study quality assessment. We will invite another author to solve any divergences between 2 authors. We will use RevMan 5.3 software to conduct statistical analysis.

RESULTS

This study will present synthesis of most recent evidence of surgery for the treatment of patients with astrocytoma.

CONCLUSION

The findings of this study will provide helpful reference for the efficacy and complications of surgery for the treatment of patients with astrocytoma to the clinicians and future researchers.

STUDY REGISTRATION

INPLASY202040194.