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Cler SJ, Skidmore A, Yahanda AT, Mackey K, Rubin JB, Cluster A, Perkins S, Gauvain K, King AA, Limbrick DD, McEvoy S, Park TS, Smyth MD, Mian AY, Chicoine MR, Dahiya S, Strahle JM. Genetic and histopathological associations with outcome in pediatric pilocytic astrocytoma. J Neurosurg Pediatr 2022; 29:504-512. [PMID: 35148515 DOI: 10.3171/2021.9.peds21405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pilocytic astrocytomas (PAs) have a generally favorable prognosis; however, progression or recurrence after resection is possible. The prognostic value of histopathological qualifiers (defined below) or BRAF alterations is not well understood. The aim of this study was to identify the prognostic value of genetic and histopathological features of pediatric PAs. METHODS Patients treated for a WHO grade I PA at a single institution were analyzed for histopathological and genetic features and outcomes. "Histopathological qualifier" refers to designations such as "WHO grade I PA with increased proliferative index." BRAF alterations include gene fusions and point mutations. Patients with neurofibromatosis type 1 were excluded. RESULTS A total of 222 patients were analyzed (51% female, mean age 9.6 years). Tumors were located in the cerebellum/fourth ventricle (51%), optic pathway/hypothalamus (15%), brainstem (12%), and cerebral cortex (11%). BRAF alterations were screened for in 77 patients and identified in 56 (73%). Histopathological qualifiers were present in 27 patients (14%). Resection was performed in 197 patients (89%), 41 (21%) of whom displayed tumor progression or recurrence after resection. Tumor progression or recurrence was not associated with histopathologic qualifiers (p = 0.36) or BRAF alterations (p = 0.77). Ki-67 proliferative indices were not predictive of progression or recurrence (p = 0.94). BRAF alterations, specifically KIAA1549 fusions, were associated with cerebellar/fourth ventricular tumor location (p < 0.0001) and younger patient age (p = 0.03). Patients in whom gross-total resection was achieved had lower rates of progression and recurrence (p < 0.0001). CONCLUSIONS Histopathological features/qualifiers and BRAF alterations were not associated with tumor recurrence/progression in pediatric PAs. The extent of resection was the only factor analyzed that predicted outcome.
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Affiliation(s)
- Samuel J Cler
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alexander Skidmore
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alexander T Yahanda
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Joshua B Rubin
- 3Department of Neuroscience, Washington University School of Medicine, St. Louis.,4Department of Pediatrics, Washington University School of Medicine, Division of Hematology and Oncology, St. Louis
| | - Andrew Cluster
- 4Department of Pediatrics, Washington University School of Medicine, Division of Hematology and Oncology, St. Louis
| | - Stephanie Perkins
- 4Department of Pediatrics, Washington University School of Medicine, Division of Hematology and Oncology, St. Louis.,5Department of Radiation Oncology, Washington University School of Medicine, St. Louis
| | - Karen Gauvain
- 4Department of Pediatrics, Washington University School of Medicine, Division of Hematology and Oncology, St. Louis
| | - Allison A King
- 4Department of Pediatrics, Washington University School of Medicine, Division of Hematology and Oncology, St. Louis
| | - David D Limbrick
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sean McEvoy
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tae Sung Park
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Smyth
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ali Y Mian
- 6Department of Radiology, Washington University School of Medicine, St. Louis; and
| | - Michael R Chicoine
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sonika Dahiya
- 7Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer M Strahle
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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Candido MF, Baldissera GC, Medeiros M, Umezawa K, Brassesco MS. NF-кB inhibition by DHMEQ: in vitro antiproliferative effects on pilocytic astrocytoma and concise review of the current literature. Childs Nerv Syst 2020; 36:2675-2684. [PMID: 32385563 DOI: 10.1007/s00381-020-04625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pilocytic astrocytoma (PA) is the most common brain tumor that affects the pediatric population. Even though PA is benign and treatment only involves surgery, recurrent or unresectable tumors require chemo- and radiotherapy. Besides BRAF, CDKN2A, or IDH mutations, the hyperactivation of the nuclear factor NF-κB contributes to tumor growth and survival. METHODS In the present study, we used publicly available data for the in silico analysis of NF-κB subunits (RELA, RELB, REL, NF-κB1, and NF-κB2) expression in PA samples. Besides, in vitro assays were performed to evaluate proliferation, migration, cell death, on the PA cell line Res286 comparing to human primary astrocytes. Sensitization to radiation therapy and temozolomide (TMZ) was also assayed. RESULTS Our results showed that all the members of the NF-kB family are upregulated in PA datasets compared to normal brain tissues. Moreover, DHMEQ treatment significantly reduced cell growth and motility, while sensitized cells to ionizing radiation and TMZ, as previously seen in high-grade gliomas. CONCLUSIONS This drug presents a potential application in clinical practice for the treatment of recurrent or inoperable PA. Moreover, its use might assist adjuvant chemotherapy and reduce irradiation doses to avoid toxicity to the surrounding tissues.
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Affiliation(s)
- M F Candido
- Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - G C Baldissera
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - M Medeiros
- Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - K Umezawa
- Department of Molecular Target Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - María Sol Brassesco
- Departamento de Biologia, FFCLRP-USP, Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirao Preto, SP, CEP 14040-901, Brazil.
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Moussalem C, Ftouni L, Mrad ZA, Amine A, Hamideh D, Baassiri W, Bali B, Najjar M. Pediatric posterior fossa tumors outcomes: Experience in a tertiary care center in the Middle East. Clin Neurol Neurosurg 2020; 197:106170. [PMID: 32861036 DOI: 10.1016/j.clineuro.2020.106170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among all childhood cancers, brain tumors are second only to leukemia in incidence and are the most common solid pediatric tumors. More than 60 % of pediatric brain tumors are infra-tentorial. The first-line treatment for most infra-tentorial tumors in pediatric patients is surgical resection, with the goal of gross-total resection, relief of symptoms and hydrocephalus, and increased survival. The proximity to the fourth ventricle, and therefore, the cerebrospinal fluid (CSF) pathways, predisposes children with posterior fossa tumors to the development of obstructive hydrocephalus and multiple other co-morbidities pre and post-surgery. OBJECTIVES This study aims to present our series of pediatric posterior fossa tumor surgeries in the Neurosurgical Department at the American University of Beirut Medical Center(AUBMC) and perform internal quality control for our single-institution consecutive series as one of the largest referral and tertiary care centers in the region. The second purpose of this retrospective study is to weigh the risks of surgery against the presumed advantages and to have specific knowledge about the complication rates, especially those related to the CSF pathway, comparing our results to those in the literature. METHODS All pediatric patients (< 18 years of age), referred to our center from different regions in the middle east, and surgically treated for a posterior fossa tumor from June 2006 to June 2018 at the American University of Beirut Medical Center were included. A thorough review of all medical charts was performed to validate all the database records. RESULTS The patient sample consisted of 64 patients having a mean age of 6.19 ± 4.42 years and 59.37 % of whom were males. The most common tumor pathology was pilocytic astrocytoma (40.62 %) followed by medulloblastoma (35.93 %) and ependymoma. The most common type of tumor that was seen in patients that developed mutism postoperatively (n = 6, 9.37 %) was medulloblastoma (n = 4, 66.66 %). In this patient sample, 12.28 % (n = 7) of the patients developed hydrocephalus postoperatively.Midline tumors were more associated with the development of mutism(OR = 4.632, p = 0.306) and hydrocephalus (OR = 5.056, p = 0.135) postoperatively, albeit not statistically significantly.The presence of a preoperative shunt was shown to be protective against the development of CSF leak (OR = 0.636, p = 0.767), as none of the patients that came in with CSF diversion developed a CSF leak after their surgery. CONCLUSION This study from a single center experience accompanied by a thorough literature review sheds light on the complications frequently encountered after posterior fossa tumor surgery in children. These included transient cerebellar mutism, CSF leak, and hydrocephalus as seen in some of our patients. Our findings highlight the need for prospective studies with well-defined protocols directed at assessing novel ways and approaches to minimize the risk of these complications.
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Affiliation(s)
- Charbel Moussalem
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon
| | - Louna Ftouni
- Faculty of Medecine, Beirut Arab University, Lebanon
| | - Zaki Abou Mrad
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon
| | - Ali Amine
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon
| | - Dima Hamideh
- Department of pediatrics and adolescent medicine, American University of Beirut Medical Center, Lebanon
| | - Wassim Baassiri
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon
| | - Bassel Bali
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon
| | - Marwan Najjar
- Neurosurgery Department, American university of Beirut Medical Center, Lebanon.
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Maharaj A, Manoranjan B, Verhey LH, Fleming AJ, Farrokhyar F, Almenawer S, Singh SK, Yarascavitch B. Predictive measures and outcomes of extent of resection in juvenile pilocytic astrocytoma. J Clin Neurosci 2019; 70:79-84. [PMID: 31466905 DOI: 10.1016/j.jocn.2019.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The present study aims to determine the tumor-related, clinical, and demographic factors associated with extent of resection (EOR) and post-operative outcomes in JPA patients. METHODS All patients with JPA, identified from a single-center brain tumour data base, were included in this retrospective analysis. Pre-operative MRI scans were reviewed by a single neurosurgeon blinded to the EOR. JPA cases that exhibited no residual tumor post-operatively were assigned to the GTR group, all other tumors were assigned to the <GTR group. Tumor-related, clinical and demographic variables as well as perioperative morbidities were compared between both groups. RESULTS Of the 28 patients included, 15 had a GTR (46% male; median age: 7.5 years; range: 1.16-14.9) and 13 had <GTR (69.2% male; median age: 10.6 years; range: 0.66-17.68). Tumor location reached statistical significance, as there were significantly more cerebellar tumors in the GTR group (86.7%) compared to the <GTR group (38.5%) (p = 0.016). GTR cases had a significantly longer average follow-up interval (6.6 months) than <GTR cases (4.5 months) (p = 0.031). All demographic variables, clinical variables and tumor-related factors showed no significant differences between the two groups. There were no differences between GTR and <GTR cases in terms of perioperative outcomes. CONCLUSIONS This study shows other than location of the lesion in the cerebellum, demographic, clinical and tumor-related variables are not associated with EOR in children with JPA. GTR was associated with an extended follow-up interval but not with increased perioperative morbidities compared to those with <GTR.
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Affiliation(s)
- Arjuna Maharaj
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Branavan Manoranjan
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Leonard H Verhey
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Adam J Fleming
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Paediatrics, Division of Hematology and Oncology, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Saleh Almenawer
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada
| | - Sheila K Singh
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Blake Yarascavitch
- McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada; Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada.
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Matsumoto H, Yoshida Y. De novo cerebellar malignant glioma: A case report. Int J Surg Case Rep 2016; 22:28-31. [PMID: 27017277 PMCID: PMC4844666 DOI: 10.1016/j.ijscr.2016.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 12/02/2022] Open
Abstract
Gliomas of the cerebellum are rare in adults, and their natural history and clinical behavior are not well known. We describe a case of de novo cerebellar anaplastic astrocytoma in which the developmental process was detected on magnetic resonance imaging. Cerebellar malignant glioma may show few signs characteristic of tumor on magnetic resonance imaging in the initial stage.
Introduction Gliomas of the cerebellum are rare in adults, and their natural history and clinical behavior are not well known. Because cerebellar glioma is not usually diagnosed until clinical symptoms have appeared, no reports have described the developmental process of new cerebellar gliomas. We describe a case of de novo cerebellar anaplastic astrocytoma in which the developmental process was detected on magnetic resonance imaging (MRI). Presentation of case A 78-year-old man with a history of cerebral infarction was undergoing follow-up MRI every 6 months. This follow-up revealed a small abnormality in the left cerebellar hemisphere without clinical symptoms. Subsequent MRI showed lesion growth accompanying clinical symptoms. As cerebellar tumor was suspected, the lesion was extirpated. The histological diagnosis was anaplastic astrocytoma. Local recurrence developed and the patient died 20 months postoperatively. Discussion Cerebellar gliomas sometimes do not exhibit the common MRI findings of supratentorial gliomas, leading to difficulty with preoperative diagnosis. In this case, we initially diagnosed asymptomatic cerebellar infarction because the lesion was small and asymptomatic. The abnormal lesion gradually grew and clinical symptoms appeared. Cerebellar glioma may show few signs characteristic of tumor on MRI in the initial stages. Conclusion When MRI detects a new, faint abnormality in the cerebellum, close follow-up of clinical symptoms and MRI on suspicion of glioma is warranted
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Affiliation(s)
| | - Yasuhisa Yoshida
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
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Aquilina K, Daniels DJ, Spoudeas H, Phipps K, Gan HW, Boop FA. Optic pathway glioma in children: does visual deficit correlate with radiology in focal exophytic lesions? Childs Nerv Syst 2015; 31:2041-9. [PMID: 26277358 DOI: 10.1007/s00381-015-2855-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/28/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Unlike pilocytic astrocytomas in other parts of the brain, optic pathway gliomas (OPG) are usually diffuse lesions involving the anterior optic pathways and hypothalamus. Their infiltrative nature often precludes complete surgical resection. We sought to determine whether careful magnetic resonance (MR) analysis, correlated with visual deficits, could be sufficient to identify those focal lesions that may be amenable to more aggressive surgical resection at presentation. METHODS We retrospectively reviewed the medical records of patients from two sites: children under 20 years of age treated for OPG between 1985 and 2009 at St Jude's Children's Research Hospital and children under 16 years of age treated at Great Ormond Street Hospital, London, UK, between 1984 and 2011. Patients with isolated optic nerve tumors were excluded. Visual acuity and visual field data at presentation were reviewed and correlated with MR characteristics, including extent of optic pathway involvement, symmetry, and lateral extension. RESULTS Two hundred and one children were treated for OPG between 1984 and 2011 in the two institutions; 74 had neurofibromatosis 1 (NF1). At presentation, visual loss was symmetrical in 132 patients and asymmetrical in 69. Potential correlation between pattern of visual loss and tumor characteristics on routine MRI was found in only 13 patients with asymmetrical vision. There was no difference between patients with and without NF1. CONCLUSION The decision for aggressive surgical resection for optic pathway gliomas should be based on clinical criteria, particularly in children with good vision in one eye and poor vision in the other, as current MRI results do not reliably predict visual field deficits.
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Affiliation(s)
- Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - David J Daniels
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Helen Spoudeas
- Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, University College London Institute of Child Health, London, UK
| | - Kim Phipps
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Hoong-Wei Gan
- Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, University College London Institute of Child Health, London, UK
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA. .,Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, TN, USA. .,Semmes Murphey Clinic, 6325 Humphreys Blvd., Memphis, TN, 38120, USA.
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Abstract
Intracranial tumors are the most common solid tumors in children. The infratentorial compartment will be the primary site for 60% to 70% of these tumors, including astrocytomas, medulloblastomas, and ependymomas. Several technological advancements have increased our knowledge of the cell biology of pediatric brain tumors, facilitated earlier diagnosis, and improved neurosurgical resections while minimizing neurological deficits. These in turn have not only improved the survival of children with brain tumors but also their quality of life. Current management strategies in most cases rely on surgery coupled with adjuvant therapies, including radiation therapy and chemotherapy. The vulnerability of the immature brain to adjuvant therapies creates many challenges for the treating physician. We review current diagnostic and therapeutic approaches and outcome for children harboring the most common pediatric brain tumors: astrocytomas (low-grade and high-grade glioma), ependymoma, medulloblastoma, and craniopharyngioma. The emphasis will be on the neurosurgical management of children with these tumors.
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Affiliation(s)
- Farideh Nejat
- Department of Neurosurgery, Children’s Hospital Medical Center, Medical Sciences/University of Tehran, Tehran, Iran
| | - Mostafa El Khashab
- Department of Neurosurgery, Hackensack University Medical Center, New Jersey, United States
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
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Abstract
Primary brain tumors are the most common solid neoplasms of childhood. The diagnosis of brain tumors in the general pediatric population remains challenging. Nevertheless, it is clear that refinements in imaging, surgical technique, and adjunctive therapies have led to longer survival and an improving quality of life in children with brain tumors.
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Affiliation(s)
- Cormac O Maher
- Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Fernandez C, Figarella-Branger D, Girard N, Bouvier-Labit C, Gouvernet J, Paz Paredes A, Lena G. Pilocytic astrocytomas in children: prognostic factors--a retrospective study of 80 cases. Neurosurgery 2003; 53:544-53; discussion 554-5. [PMID: 12943571 DOI: 10.1227/01.neu.0000079330.01541.6e] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2002] [Accepted: 05/14/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pilocytic astrocytomas (PA) are Grade I brain tumors characterized by an excellent prognosis. In some cases, however, the patient has a bad outcome. The aim of our study was to search for the clinicopathological factors underlying the prognosis for patients with this disease. METHODS We reviewed the clinical, neuroradiological, and histopathological features of 80 PAs (33 cerebellar, 18 optochiasmatic, 16 brainstem, 7 spinal cord, 3 thalamic, 2 optic nerve, and 1 hemispheric) in pediatric patients. RESULTS Pathological examination revealed 58 classic PAs and 20 pilomyxoid astrocytomas, which are a histological variant of PAs. Two cases remained unclassified. The mean overall follow-up period was 58 months, the 5-year progression-free survival rate was 75%, and the 5-year survival rates were 100 and 92% after total and partial removal. Univariate statistical analysis revealed that partial resection, optochiasmatic PA localization, and pilomyxoid variant were associated with a worse prognosis, but the latter two parameters were too closely related to the extent of resection to be independent prognostic factors in multivariate analysis. Among the patients who underwent partial surgical removal, only invasion of the surrounding structures was related to prognosis. CONCLUSION PAs are benign tumors, but some clinicopathological factors, such as partial resection, optochiasmatic location, invasion of surrounding structures, and the pilomyxoid variant, have a worse prognosis.
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Affiliation(s)
- Carla Fernandez
- Service d'Anatomie Pathologique et de Neuropathologie, Hôpital de la Timone, Marseille, France
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Burkhard C, Di Patre PL, Schüler D, Schüler G, Yaşargil MG, Yonekawa Y, Lütolf UM, Kleihues P, Ohgaki H. A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 2003; 98:1170-4. [PMID: 12816259 DOI: 10.3171/jns.2003.98.6.1170] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The incidence of pilocytic astrocytomas and the rate of patient survival were analyzed in a population-based study in the canton of Zürich, Switzerland. METHODS Between 1980 and 1994, 987 astrocytic and oligodendroglial tumors were diagnosed, of which 55 (5.5%) were pilocytic astrocytomas. The incidence rate, adjusted to the World Standard Population, was 4.8 per 1 million per year. The mean age at clinical diagnosis was 19.6 +/- 12.7 years, and the male/female ratio was 1.12. The most frequent tumor sites were the cerebellum (40%), followed by supratentorial locations (35%), the optic pathway and hypothalamus (11%), and the brainstem (9%). The mean follow-up period was 12 years. Observed survival rates were 100% at 5 years and 95.8% at 10 years after diagnosis (relative survival rate at 10 years: 96.8%). Seven patients (13%) received postoperative radiotherapy, but this did not significantly affect survival. In all patients the tumors were histologically classified as WHO Grade I, except in two patients who had anaplastic pilocytic astrocytoma (Grade III), one of whom died after 7 years, whereas the other was still alive after 10 years. CONCLUSIONS This population-based study shows that, because of the benign biological behavior of pilocytic astrocytomas and advances in microneurosurgery, the survival rates for patients with these tumors are excellent, regardless of postoperative radiotherapy.
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Abstract
Pilocytic astrocytoma is an infrequently encountered, generally low-grade neoplasm. No study has extensively looked at both cyclin D1 and MIB-1 labeling indices in pilocytic astrocytoma and their relation to clinical outcome. This study retrospectively examines the clinicopathologic features of 48 patients with pilocytic astrocytoma including MIB-1 (cell proliferation marker) and cyclin D1 (protein that regulates progression from G1 to S phase of the cell cycle) immunohistochemistry. Of 48 patients (27 females and 21 males; mean age, 12.7 years; age range, 2 to 57 years), 26 initially underwent gross total resection; 17, subtotal resection; four, biopsy alone; in one patient, the extent of tumor resection was unknown. Histological features observed included Rosenthal fibers (83.3%), granular bodies (75%), vascular sclerosis (56.2%), vascular proliferation (56.2%), prominent nuclear pleomorphism (14.6%), necrosis (10.4%), and identifiable mitotic figures (2.1%). MIB-1 labeling indices (n=45) (positive staining tumor nuclei per 1,000 nuclei evaluated) ranged from 0 to 3.5% (mean, 0.6%); seven tumors had a labeling index greater than 1.0%. Cyclin D1 labeling indices (n=45) ranged from 0 to 0.8% (mean, 0.1%). Most tumors (N=29, 66.7%) had no immunostaining. At last known follow-up, 27 patients were alive with no evidence of disease (mean, 49.2 months), 17 patients were alive with evidence of disease (mean, 36.8 months), three died with tumor at 2, 22, and 156 months, and one patient was lost to follow-up. Eight patients had at least one tumor recurrence requiring additional surgery; seven of these patients had an initial subtotal resection. In summary, MIB-1 labeling indices were generally low (mean, 0.6%) and are reflective of the slow growth of the tumors. Cyclin D1 immunostaining does not appear to be significantly increased in pilocytic astrocytoma. Adverse outcome in patients with pilocytic astrocytoma may be related to extent of surgical resection and does not seem to correlate with histology, MIB-1 labeling indices, or cyclin D1 immunoreactivity.
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Affiliation(s)
- S K Machen
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA
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Nishigaya K, Kaneko M, Nagaseki Y, Nukui H. Palatal myoclonus induced by extirpation of a cerebellar astrocytoma. Case report. J Neurosurg 1998; 88:1107-10. [PMID: 9609309 DOI: 10.3171/jns.1998.88.6.1107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 45-year-old woman developed a rare case of palatal myoclonus with no other neurological signs after undergoing extirpation of a small cerebellar low-grade astrocytoma that was located in the right dentate nucleus. The palatal myoclonus has persisted for 4 years after the operation. Magnetic resonance T2-weighted imaging revealed a high-intensity lesion in the left inferior olive. Palatal myoclonus associated with the removal of cerebellar tumors is unusual but may easily be overlooked.
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Affiliation(s)
- K Nishigaya
- Iwata Neurosurgical Hospital, Shizuoka, Japan
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