1
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Jia F, Kang Y, Wang Z. Case report: A 53-year-old woman with synchronous WHO classification II and IV gliomas. Front Oncol 2024; 14:1308497. [PMID: 38919539 PMCID: PMC11196406 DOI: 10.3389/fonc.2024.1308497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Glioma is the most common primary intracranial neoplasm with a relatively poor prognosis. Case presentation Here, we present a unique case of a 53-year-old woman with two histopathologically distinct gliomas at the initial diagnosis. She presented with headaches and left limb weakness before admission, and magnetic resonance imaging (MRI) showed right frontal and basal ganglia area involvement combined with hemorrhage. The patient underwent a navigation-guided craniotomy for tumor removal. Pathological examination revealed the right frontal lobe lesion as a WHO grade II IDH-NOS astrocytoma, but the right parietal lobe lesion was a WHO grade IV IDH-mutant diffuse astrocytoma. Molecular detection of the parietal lesion revealed a point mutation at the R132 locus of the IDH1 gene, no mutation in the TERT promoter, amplification of the epidermal growth factor receptor, and a non-homozygous CDKN2A/B deletion. Discussion In-depth epigenomic analysis and molecular examination revealed that one patient had two different brain tumors, underscoring the importance of performing a comprehensive brain tumor workup. Conclusion This unique case confirms that adjacent astrocytomas may have different molecular pathogenesis and provides novel insights into the development of gliomas.
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Affiliation(s)
| | | | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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2
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Duffau H. A Personalized Longitudinal Strategy in Low-Grade Glioma Patients: Predicting Oncological and Neural Interindividual Variability and Its Changes over Years to Think One Step Ahead. J Pers Med 2022; 12:jpm12101621. [PMID: 36294760 PMCID: PMC9604939 DOI: 10.3390/jpm12101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Diffuse low-grade glioma (LGG) is a rare cerebral cancer, mostly involving young adults with an active life at diagnosis. If left untreated, LGG widely invades the brain and becomes malignant, generating neurological worsening and ultimately death. Early and repeat treatments for this incurable tumor, including maximal connectome-based surgical resection(s) in awake patients, enable postponement of malignant transformation while preserving quality of life owing to constant neural network reconfiguration. Due to considerable interindividual variability in terms of LGG course and consecutive cerebral reorganization, a multistage longitudinal strategy should be tailored accordingly in each patient. It is crucial to predict how the glioma will progress (changes in growth rate and pattern of migration, genetic mutation, etc.) and how the brain will adapt (changes in patterns of spatiotemporal redistribution, possible functional consequences such as epilepsy or cognitive decline, etc.). The goal is to anticipate therapeutic management, remaining one step ahead in order to select the optimal (re-)treatment(s) (some of them possibly kept in reserve), at the appropriate time(s) in the evolution of this chronic disease, before malignization and clinical worsening. Here, predictive tumoral and non-tumoral factors, and their ever-changing interactions, are reviewed to guide individual decisions in advance based on patient-specific markers, for the treatment of LGG.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av. Augustin Fliche, 34295 Montpellier, France; ; Tel.: +33-4-67-33-66-12; Fax: +33-4-67-33-69-12
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors”, National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France
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3
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Yan Y, Dai W, Mei Q. Multicentric Glioma: An Ideal Model to Reveal the Mechanism of Glioma. Front Oncol 2022; 12:798018. [PMID: 35747806 PMCID: PMC9209746 DOI: 10.3389/fonc.2022.798018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
As a special type of glioma, multicentric glioma provides an ideal pathological model for glioma research. According to the stem-cell-origin theory, multiple lesions of multicentric glioma share the same neuro-oncological origin, both in gene level and in cell level. Although the number of studies focusing on genetic evolution in gliomas with the model of multicentric gliomas were limited, some mutations, including IDH1 mutations, TERTp mutations and PTEN deletions, are found to be at an early stage in the process of genetic aberrance during glioma evolution based on the results of these studies. This article reviews the clinical reports and genetic studies of multicentric glioma, and intends to explain the various clinical phenomena of multicentric glioma from the perspective of genetic aberrance accumulation and tumor cell evolution. The malignant degree of a glioma is determined by both the tumorigenicity of early mutant genes, and the stemness of early suffered cells.
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Affiliation(s)
- Yong Yan
- Departmentof Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Dai
- Departmentof Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qiyong Mei
- Departmentof Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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4
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Agopyan-Miu AHCW, Banu MA, Miller ML, Troy C, Hargus G, Canoll P, Wang TJC, Feldstein N, Haggiagi A, McKhann GM. Synchronous supratentorial and infratentorial oligodendrogliomas with incongruous IDH1 mutations, a case report. Acta Neuropathol Commun 2021; 9:160. [PMID: 34587990 PMCID: PMC8482672 DOI: 10.1186/s40478-021-01265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 12/13/2022] Open
Abstract
Infratentorial oligodendrogliomas, a rare pathological entity, are generally considered metastatic lesions from supratentorial primary tumors. Here, we report the case of a 23-year-old man presenting with a histopathologically confirmed right precentral gyrus grade 2 oligodendroglioma and a concurrent pontine grade 3 oligodendroglioma. The pontine lesion was biopsied approximately a year after the biopsy of the precentral lesion due to disease progression despite 4 cycles of procarbazine-CCNU-vincristine (PCV) chemotherapy and stable supratentorial disease. Histology and genetic analysis of the pontine biopsy were consistent with grade 3 oligodendroglioma, and comparison of the two lesions demonstrated common 1p/19q co-deletions and TERT promoter mutations but distinct IDH1 mutations, with a non-canonical IDH1 R132G mutation identified in the infratentorial lesion and a R132H mutation identified in the cortical lesion. Initiation of Temozolomide led to complete response of the supratentorial lesion and durable disease control, while Temozolomide with subsequent radiation therapy of 54 Gy in 30 fractions resulted in partial response of the pontine lesion. This case report supports possible distinct molecular pathogenesis in supratentorial and infratentorial oligodendrogliomas and raises questions about the role of different IDH1 mutant isoforms in explaining treatment resistance to different chemotherapy regimens. Importantly, this case suggests that biopsies of all radiographic lesions, when feasible and safe, should be considered in order to adequately guide management in multicentric oligodendrogliomas.
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5
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Das KK, Singh A, Khatri D, Gosal JS, Bhaisora K, Mehrotra A, Gogoi S, Behari S. The Dilemma of Multifocality in Insular Tumors: Multicentricity versus Metastasis. Asian J Neurosurg 2021; 16:72-77. [PMID: 34211870 PMCID: PMC8202396 DOI: 10.4103/ajns.ajns_458_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: Multifocality and metastasis from insular glioma are extremely rare. Pathological insights and elaboration of the clinical course of this condition will contribute to their better understanding. Materials and Methods: Among 123 consecutively operated insular gliomas, 5 patients (4.2%) presented with a multifocal tumor. The clinico-radiological, histo-molecular, and treatment outcomes were noted and compared with the unifocal insular glioma cohort. Results: Among the five patients, all were males and involved the right insular lobe. Three patients presented with synchronous tumors, while two patients developed metachronous multifocal tumors. The histology of the insular tumor was Grade I glioma in 1, Grade II astrocytoma with p53 mutation in 2, and anaplastic astrocytoma and glioblastoma in one patient each. Histological confirmation of the second lesion was performed in two patients, showing the same histology of the insular tumor. Interconnection between the tumors was apparent through cerebrospinal fluid pathways in four patients, while no such connection could be established in one patient. Barring the patient of Grade I glioma, the rest of the patients died within months of the diagnosis. Conclusion: Multifocal insular glioma is rare and probably represents a biologically more aggressive tumor. Insular glioma that touches the ventricle appears a common denominator for multifocality. True multicentricity is rare. The prognosis in insular glioma with multifocality is poor in non-Grade I gliomas.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amanjot Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Khatri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kamlesh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudarsana Gogoi
- Department of Pathology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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6
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The landscape of postsurgical recurrence patterns in diffuse low-grade gliomas. Crit Rev Oncol Hematol 2019; 138:148-155. [PMID: 31092371 DOI: 10.1016/j.critrevonc.2019.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
Early and maximal safe surgical resection optionally followed by adjuvant treatment is currently recommended in diffuse low-grade glioma (DLGG). Although this management delays malignant transformation (MT), recurrence will most often occur. Because this relapse usually arises locally, reoperation can be considered, with possible further chemotherapy/radiotherapy. However, due to a prolonged overall survival, a large spectrum of unusual recurrence patterns begins to emerge during long-term follow-up, beyond the classical slow and local tumor re-growth. We review various atypical patterns of DLGG relapse, we discuss their pathophysiological mechanisms and how to adapt the treatment(s). Those patterns include very diffuse, ipsi- or bilateral gliomatosis-like progression, multicentric recurrence with emergence of remote low-grade or high-grade glioma, leptomeningeal dissemination, acute (early or delayed) local MT or bulky relapse into the operating cavity. This landscape of recurrence patterns may allow physicians to elaborate new tailored therapeutic strategies and scientists to develop original hypotheses for basic research.
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7
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Hayes J, Yu Y, Jalbert LE, Mazor T, Jones LE, Wood MD, Walsh KM, Bengtsson H, Hong C, Oberndorfer S, Roetzer T, Smirnov IV, Clarke JL, Aghi MK, Chang SM, Nelson SJ, Woehrer A, Phillips JJ, Solomon DA, Costello JF. Genomic analysis of the origins and evolution of multicentric diffuse lower-grade gliomas. Neuro Oncol 2019; 20:632-641. [PMID: 29077933 DOI: 10.1093/neuonc/nox205] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Rare multicentric lower-grade gliomas (LGGs) represent a unique opportunity to study the heterogeneity among distinct tumor foci in a single patient and to infer their origins and parallel patterns of evolution. Methods In this study, we integrate clinical features, histology, and immunohistochemistry for 4 patients with multicentric LGG, arising both synchronously and metachronously. For 3 patients we analyze the phylogeny of the lesions using exome sequencing, including one case with a total of 8 samples from the 2 lesions. Results One patient was diagnosed with multicentric isocitrate dehydrogenase 1 (IDH1) mutated diffuse astrocytomas harboring distinct IDH1 mutations, R132H and R132C; the latter mutation has been associated with Li-Fraumeni syndrome, which was subsequently confirmed in the patient's germline DNA and shown in additional cases with The Cancer Genome Atlas data. In another patient, phylogenetic analysis of synchronously arising grade II and grade III diffuse astrocytomas demonstrated a single shared mutation, IDH1 R132H, and revealed convergent evolution via non-overlapping mutations in ATRX and TP53. In 2 cases, there was divergent evolution of IDH1-mutated and 1p/19q-codeleted oligodendroglioma and IDH1-mutated and 1p/19q-intact diffuse astrocytoma, occurring synchronously in one case and metachronously in a second. Conclusions Each tumor in multicentric LGG cases may arise independently or may diverge very early in their development, presenting as genetically and histologically distinct tumors. Comprehensive sampling of these lesions can therefore significantly alter diagnosis and management. Additionally, somatic IDH1 R132C mutation in either multicentric or solitary LGG identifies unsuspected germline TP53 mutation, validating the limited number of published cases.
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Affiliation(s)
- Josie Hayes
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Yao Yu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Llewellyn E Jalbert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Tali Mazor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Lindsey E Jones
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Matthew D Wood
- Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Kyle M Walsh
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Henrik Bengtsson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Chibo Hong
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Stefan Oberndorfer
- Department of Neurology, University Hospital of St Poelten, St Poelten, Austria
| | - Thomas Roetzer
- Institute of Neurology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ivan V Smirnov
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jennifer L Clarke
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,UCSF Brain Tumor Center, Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,UCSF Brain Tumor Center, Division of Neuro-Oncology, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Adelheid Woehrer
- Institute of Neurology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - David A Solomon
- Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Costello
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
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8
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Wang T, Niu X, Gao T, Zhao L, Li J, Gan Y, Liu Y, Mao Q. Prognostic Factors for Survival Outcome of High-Grade Multicentric Glioma. World Neurosurg 2018; 112:e269-e277. [DOI: 10.1016/j.wneu.2018.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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9
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Vaubel RA, Kollmeyer TM, Caron AA, Barr Fritcher EG, Voss JS, Liang H, Jenkins RB, Giannini C, Kipp BR. Synchronous gemistocytic astrocytoma IDH-mutant and oligodendroglioma IDH-mutant and 1p/19q-codeleted in a patient with CCDC26 polymorphism. Acta Neuropathol 2017; 134:317-319. [PMID: 28550371 DOI: 10.1007/s00401-017-1727-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Rachael A Vaubel
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Alissa A Caron
- Department of Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Jesse S Voss
- Department of Molecular Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Haohai Liang
- Anatomic Pathology, WellStar Kennestone Hospital, Marietta, GA, USA
| | - Robert B Jenkins
- Department of Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Benjamin R Kipp
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA.
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10
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Corrivetti F, Herbet G, Moritz-Gasser S, Duffau H. Prosopagnosia Induced by a Left Anterior Temporal lobectomy Following a Right Temporo-occipital Resection in a Multicentric Diffuse Low-Grade Glioma. World Neurosurg 2017; 97:756.e1-756.e5. [DOI: 10.1016/j.wneu.2016.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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11
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Bette S, Gempt J, Huber T, Delbridge C, Meyer B, Zimmer C, Kirschke JS, Boeckh-Behrens T. FLAIR signal increase of the fluid within the resection cavity after glioma surgery: generally valid as early recurrence marker? J Neurosurg 2016; 127:417-425. [PMID: 27767397 DOI: 10.3171/2016.8.jns16752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Recent studies have indicated that a signal intensity increase of the fluid within the resection cavity on FLAIR images may predict tumor recurrence after glioma surgery. The aim of this study was to assess the increase in FLAIR signal intensity in a large patient cohort and in subgroups to assess its prognostic value for early tumor recurrence in glioma patients. METHODS A total of 212 patients (213 cases) who had undergone surgery for an intracranial glioma (WHO Grade IV [n = 103], WHO Grade III [n = 57], and WHO Grade II [n = 53]) were included in this retrospective study. FLAIR signal within the resection cavity at the time of tumor recurrence/last contact and on the previous MRI study was assessed qualitatively and quantitatively. Appearance of FLAIR signal increase was studied over time using Kaplan-Meier estimates in subgroups. RESULTS Patients with WHO Grade II glioma and connection of the resection cavity to CSF who did not undergo radiotherapy did not regularly develop this sign and were excluded from further analysis. For the remaining 87 cases, FLAIR signal intensity increase was observed in 27 cases. Recurrent disease was found in 26 of these 27 cases, resulting in a specificity of 80.0%, a sensitivity of 31.7%, and positive and negative predictive values of 96.3% and 6.7%, respectively. In 4 cases this sign had been observed prior (range 2.8-8.5 months) to tumor recurrence defined by standard criteria. Quantitative analysis underlined the results of qualitative analysis, but it did not add a diagnostic value. CONCLUSIONS Signal intensity increase of the fluid within the resection cavity on FLAIR images is a rare but highly specific and early sign for tumor recurrence/tumor progression in completely and incompletely resected high-grade glioma without connection of the resection cavity to CSF and with radiotherapy.
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Affiliation(s)
| | | | | | - Claire Delbridge
- Neuropathology, Klinikum rechts der Isar, Technische Universität München, Germany
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12
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Lasocki A, Gaillard F, Tacey MA, Drummond KJ, Stuckey SL. The incidence and significance of multicentric noncontrast-enhancing lesions distant from a histologically-proven glioblastoma. J Neurooncol 2016; 129:471-478. [DOI: 10.1007/s11060-016-2193-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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13
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Sridharan V, Urbanski LM, Bi WL, Thistle K, Miller MB, Ramkissoon S, Reardon DA, Dunn IF. Multicentric Low-Grade Gliomas. World Neurosurg 2015; 84:1045-50. [DOI: 10.1016/j.wneu.2015.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/09/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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14
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Gkekas N, Vyziotis A, Dimitriadi A, Koutsonikas G, Georgakoulias N. Multifocal low-grade gliomas: Adapting the optimal therapeutic management. Br J Neurosurg 2014; 29:94-96. [PMID: 25215562 DOI: 10.3109/02688697.2014.957156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors report the rare and first documented case in the literature of a surgically treated patient with multifocal low-grade glioma comprising left frontotemporoinsular ganglioglioma of World Health Organization (WHO) grade I and right temporal lobe astrocytoma of WHO grade II.
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Affiliation(s)
- Nikolaos Gkekas
- a Department of Neurosurgery , Athens General Hospital G.Gennimatas , Athens , Greece
| | - Alexandros Vyziotis
- a Department of Neurosurgery , Athens General Hospital G.Gennimatas , Athens , Greece
| | - Anastasia Dimitriadi
- b Department of Pathology , Athens General Hospital G.Gennimatas , Athens , Greece
| | - Georgios Koutsonikas
- b Department of Pathology , Athens General Hospital G.Gennimatas , Athens , Greece
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15
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di Russo P, Perrini P, Pasqualetti F, Meola A, Vannozzi R. Management and outcome of high-grade multicentric gliomas: a contemporary single-institution series and review of the literature. Acta Neurochir (Wien) 2013; 155:2245-51. [PMID: 24105045 DOI: 10.1007/s00701-013-1892-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/17/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Multicentric malignant gliomas are well-separated tumours in different lobes or hemispheres, without anatomical continuity between lesions. The purpose of this study was to explore the clinical features, the pathology and the outcome according to the management strategies in a consecutive series of patients treated at a single institution. In addition, an analysis of the existing literature is presented. METHODS For the institutional analysis, a retrospective review of all patients who underwent treatment for multicentric gliomas in the last 7 years was performed. For the analysis of the literature, a MEDLINE search with no date limitations was accomplished for surgical treatment of multicentric malignant gliomas. RESULTS Two hundred and thirty-nine patients with glioma were treated in our department. Eighteen patients (7.5 %) with a mean age of 64 years (age range, 37-78 years) presented multicentric malignant gliomas. Thirteen patients (72 %) underwent surgical resection of at least one lesion that was followed by adjuvant treatment in all but one case. Five patients (28 %) underwent stereotactic biopsy and thereafter received chemotherapy. A survival advantage was associated with resection of at least one lesion followed by adjuvant treatment (median overall survival 12 months) compared with 4 months for stereotactic biopsy followed by chemotherapy. Similar results were obtained from the review of the literature. CONCLUSIONS Resection of at least one lesion seems to play a significant role in the management of selected patients with multicentric malignant gliomas. Multi-institutional studies on larger series are warranted to define how aggressively the patients with malignant multicentric gliomas should be treated.
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Affiliation(s)
- Paolo di Russo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
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16
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Alvarez de Eulate-Beramendi S, Rigau V, Taillandier L, Duffau H. Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults. J Neurosurg 2013; 120:833-9. [PMID: 24286144 DOI: 10.3171/2013.10.jns131512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECT Diffuse WHO Grade II glioma (diffuse low-grade glioma [DLGG]) is an infiltrative brain tumor that usually migrates along the white matter fibers. The delayed CSF dissemination of supratentorial DLGGs is an exceptional complication and is rarely described in adults. Here, the authors report outcomes in a surgical series of 9 patients with DLGGs with subsequent leptomeningeal and/or subependymal seeding (LMSS) following multiple incomplete resections. METHODS The authors performed a retrospective review of patients who underwent surgery for histopathologically confirmed WHO Grade II gliomas between 1998 and 2012 and experienced a secondary CSF spread. Information regarding clinical features, surgical procedures, histopathological results, adjuvant treatment, and clinical outcomes was collected and analyzed. RESULTS Nine consecutive patients were included in this study. There were 6 men and 3 women whose mean age was 35.5 years (range 22-59 years) at the time of initial symptom onset. All patients underwent surgery with the aid of intraoperative mapping, with incomplete tumor removal because of invasion of eloquent structures. The neuropathological examination diagnosed a DLGG in all cases (7 oligodendrogliomas, 1 astrocytoma, and 1 oligoastrocytoma). Five patients had a 1p19q codeletion. Because of tumor regrowth, the 9 patients underwent reoperation (2 surgeries in 6 cases and 3 surgeries in 3 cases), again with incomplete resection. There were no surgical complications. Adjuvant therapy (radiotherapy and chemotherapy) was administered in all patients because of progression to a higher grade of malignancy that was histopathologically confirmed in all tumors. The patients suddenly worsened, and the diagnosis of LMSS was made with a mean delay of 77 months (range 27-140 months) after the initial symptom onset. Six patients benefited from salvage chemotherapy while palliative care was chosen in 3 cases. The median survival in the 6 patients who underwent LMSS treatment was significantly longer than that in the 3 patients who did not receive salvage chemotherapy (p = 0.03). Indeed, all patients died, with a mean delay between the diagnosis of LMSS and death of 11 months (range 2-38 months) and with a mean delay between the initial symptom onset and death of 88 months (range 34-144 months). CONCLUSIONS Cerebrospinal fluid dissemination of DLGG is a rare but possible event. It can occur throughout the progression of WHO Grade II oligodendrogliomas, oligoastrocytomas, and astrocytomas, regardless of 1p19q status. This complication seems to appear in patients who have undergone multiple incomplete resections. Salvage therapy can be considered in patients with good neurological status. However, LMSS is associated with a decreased overall survival. Therefore, this rare entity deserves further multicenter studies to better understand its pathophysiology and to adapt therapeutic strategies.
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