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Auricchio AM, Pennisi G, Menna G, Olivi A, Gessi M, Gielen GH, Gaudino S, Montano N, Papacci F. H3 K27-Altered Diffuse Glioma of the Spinal Cord in Adult Patients: A Qualitative Systematic Review and Peculiarity of Radiological Findings. J Clin Med 2024; 13:2972. [PMID: 38792513 PMCID: PMC11122636 DOI: 10.3390/jcm13102972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Primary spinal cord diffuse gliomas (SpDG) are rare tumors that may harbor, like diffuse intrinsic pontine gliomas (DIPG), H3K27M mutations. According to the WHO (2021), SpDGs are included in diffuse midline H3K27-altered gliomas, which occur more frequently in adults and show unusual clinical presentation, neuroradiological features, and clinical behavior, which differ from H3 G34-mutant diffuse hemispheric glioma. Currently, homogeneous adult-only case series of SpDG, with complete data and adequate follow-up, are still lacking. Methods: We conducted a qualitative systematic review, focusing exclusively on adult and young adult patients, encompassing all studies reporting cases of primitive, non-metastatic SpDG with H3K27 mutation. We analyzed the type of treatment administered, survival, follow-up duration, and outcomes. Results: We identified 30 eligible articles published between 1990 and 2023, which collectively reported on 62 adult and young adult patients with primitive SpDG. Postoperative outcomes were assessed based on the duration of follow-up, with outcomes categorized as either survival or mortality. Patients who underwent surgery were followed up for a mean duration of 17.37 months, while those who underwent biopsy had a mean follow-up period of 14.65 months. Among patients who were still alive, the mean follow-up duration was 18.77 months. The radiological presentation of SpDG varies widely, indicating its lack of uniformity. Conclusion: Therefore, we presented a descriptive scenario where SpDG was initially suspected to be a meningioma, but was later revealed to be a malignant SpDG with H3K27M mutation.
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Affiliation(s)
- Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
- Department of Neurosurgery, F. Spaziani Hospital, 03100 Frosinone, Italy
| | - Grazia Menna
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
| | - Marco Gessi
- Department of Pathology, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy;
| | - Gerrit H. Gielen
- Department of Neuropathology, Universitätsklinikum Bonn, 53127 Bonn, Germany;
| | - Simona Gaudino
- Department of Radiology, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy;
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
| | - Fabio Papacci
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
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Ying Y, Liu X, Li X, Mei N, Ruan Z, Lu Y, Yin B. Distinct MRI characteristics of spinal cord diffuse midline glioma, H3 K27-altered in comparison to spinal cord glioma without H3 K27-alteration and demyelination disorder. Acta Radiol 2024; 65:284-293. [PMID: 38115811 DOI: 10.1177/02841851231215803] [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] [Indexed: 12/21/2023]
Abstract
BACKGROUND An applicable magnetic resonance imaging (MRI) biomarker for diffuse midline glioma (DMG), H3 K27-altered of the spinal cord is important for non-invasive diagnosis. PURPOSE To evaluate the efficacy of conventional MRI (cMRI) in distinguishing between DMGs, H3 K27-altered, gliomas without H3 K27-alteration, and demyelinating lesions in the spinal cord. MATERIAL AND METHODS Between January 2017 and February 2023, patients with pathology-confirmed spinal cord gliomas (including ependymomas) with definite H3 K27 status and demyelinating diseases diagnosed by recognized criteria were recruited as the training set for this retrospective study. Morphologic parameter assessment was performed by two neuroradiologists on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted imaging. Variables with high inter- and intra-observer agreement were included in univariable correlation analysis and multivariable logistic regression. The performance of the final model was verified by internal and external testing sets. RESULTS The training cohort included 21 patients with DMGs (13 men; mean age = 34.57 ± 13.489 years), 21 with wild-type gliomas (10 men; mean age = 46.76 ± 17.017 years), and 20 with demyelinating diseases (5 men; mean age = 49.50 ± 18.872 years). A significant difference was observed in MRI features, including cyst(s), hemorrhage, pial thickening with enhancement, and the maximum anteroposterior diameter of the spinal cord. The prediction model, integrating age, age2, and morphological characteristics, demonstrated good performance in the internal and external testing cohort (accuracy: 0.810 and 0.800, specificity: 0.810 and 0.720, sensitivity: 0.872 and 0.849, respectively). CONCLUSION Based on cMRI, we developed a model with good performance for differentiating among DMGs, H3 K27-altered, wild-type glioma, and demyelinating lesions in the spinal cord.
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Affiliation(s)
- Yinwei Ying
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xiujuan Liu
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Zhuoying Ruan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
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Zhao Z, Song Z, Wang Z, Zhang F, Ding Z, Fan T. Advances in Molecular Pathology, Diagnosis and Treatment of Spinal Cord Astrocytomas. Technol Cancer Res Treat 2024; 23:15330338241262483. [PMID: 39043042 PMCID: PMC11271101 DOI: 10.1177/15330338241262483] [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: 02/17/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
Spinal cord astrocytoma (SCA) is a rare subtype of astrocytoma, posing challenges in diagnosis and treatment. Low-grade SCA can achieve long-term survival solely through surgery, while high-grade has a disappointing prognosis even with comprehensive treatment. Diagnostic criteria and standard treatment of intracranial astrocytoma have shown obvious limitations in SCA. Research on the molecular mechanism in SCA is lagging far behind that on intracranial astrocytoma. In recent years, huge breakthroughs have been made in molecular pathology of astrocytoma, and novel techniques have emerged, including DNA methylation analysis and radiomics. These advances are now making it possible to provide a precise diagnosis and develop corresponding treatment strategies in SCA. Our aim is to review the current status of diagnosis and treatment of SCA, and summarize the latest research advancement, including tumor subtype, molecular characteristics, diagnostic technology, and potential therapy strategies, thus deepening our understanding of this uncommon tumor type and providing guidance for accurate diagnosis and treatment.
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Affiliation(s)
- Zijun Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zihan Song
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fan Zhang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Ze Ding
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tao Fan
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Liu Y, Sun P, Zhou M, Du J, Zeng G. Pediatric spinal cord diffuse midline glioma with H3 K27M-alteration with leptomeningeal dissemination: a rare case with intracranial hypertension onset and no spinal cord-related symptom. Childs Nerv Syst 2023; 39:1663-1666. [PMID: 36759369 DOI: 10.1007/s00381-023-05851-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Spinal cord diffuse midline glioma (DMG) with H3 K27-alteration is a group of spinal cord high-grade glioma with poor outcome. We present a case with rare onset symptom pattern of pediatric spinal DMG, contributing to the understanding of the clinical presentations and natural history of pediatric spinal cord DMG. METHODS AND RESULTS A 7-year-old boy was admitted due to symptoms of intracranial hypertension without obvious spinal cord-related symptoms. Head radiological examinations, blood and cerebral spinal fluid tests did not support intracranial lesion, infection, or autoimmune diseases. Spinal magnetic resonance imaging revealed intraspinal occupying lesion with leptomeningeal dissemination. Pathology of the lesion verified DMG with H3 K27M-alteration. CONCLUSION Pediatric DMG with leptomeningeal dissemination could present with initial symptoms of intracranial hypertension without obvious spinal cord-related symptoms. Spinal cord examinations in cases of intracranial hypertension with negative head radiological examination results could be valuable in finding the etiology.
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Affiliation(s)
- Yutong Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mading Zhou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianxin Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gao Zeng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Serrallach BL, Tran BH, Bauer DF, Mohila CA, Adesina AM, McGovern SL, Lindsay HB, Huisman TAGM. Pediatric spinal cord diffuse midline glioma, H3 K27-altered with intracranial and spinal leptomeningeal spread: A case report. Neuroradiol J 2022; 35:634-639. [PMID: 34989626 PMCID: PMC9513925 DOI: 10.1177/19714009211067402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary spinal cord high-grade gliomas, including those histologically identified as glioblastoma (GBM), are a rare entity in the pediatric population but should be considered in the differential diagnosis of intramedullary lesions. Pediatric spinal cord high-grade gliomas have an aggressive course with poor prognosis. The aim of this case report is to present a 15-year-old female adolescent with histopathologically confirmed spinal cord GBM with H3F3A K27 M mutation consistent with a diffuse midline glioma (DMG), H3 K27-altered, CNS WHO grade 4 with leptomeningeal seeding on initial presentation. As imaging features of H3 K27-altered DMGs are non-specific and may mimic more frequently encountered neoplastic diseases as well as demyelinating disorders, severe neurological deficits at presentation with short duration, rapid progression, and early leptomeningeal seeding should however raise the suspicion for a pediatric-type diffuse high-grade glioma like DMG, H3 K27-altered.
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Affiliation(s)
- Bettina L Serrallach
- Edward B. Singleton Department of
Radiology, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - Brandon H Tran
- Edward B. Singleton Department of
Radiology, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - David F Bauer
- Department of Neurosurgery, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - Carrie A Mohila
- Department of Pathology and Immunology, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - Adekunle M Adesina
- Department of Pathology and Immunology, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
- Proton Therapy Center, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
| | - Holly B Lindsay
- Division of Pediatric Hematology and
Oncology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
| | - Thierry AGM Huisman
- Edward B. Singleton Department of
Radiology, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, USA
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Liang XY, Chen YP, Li Q, Zhou ZW. Atypical imaging features of the primary spinal cord glioblastoma: A case report. World J Clin Cases 2022; 10:7950-7959. [PMID: 36158493 PMCID: PMC9372862 DOI: 10.12998/wjcc.v10.i22.7950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/29/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary spinal cord (PSC) glioblastoma (GB) is an extremely rare but fatal primary tumor of the central nervous system and associated with a poor prognosis. While typical tumor imaging features are generally easy to recognize, glioblastoma multiforme can have a wide range of imaging findings. Atypical GB is often misdiagnosed, which usually delays the optimal time for treatment. In this article, we discuss a clinical case of pathologically confirmed PSC GB under the guise of benign tumor imaging findings, as well as the most recent literature pertaining to PSC GB.
CASE SUMMARY A 70-year-old female complained of limb weakness lasting more than 20 d. Irregular masses were observed inside and outside the left foramina of the spinal canal at C7-T1 on medical imaging. Based on the imaging features, radiologists diagnosed the patient with schwannoma. Tumor resection was performed under general anesthesia. The final histopathological findings revealed a final diagnosis of PSC GB, world health organization Grade IV. The patient subsequently underwent a 4-wk course of radiotherapy (60 Gy in 20 fractions) combined with temozolomide chemotherapy. The patient was alive at the time of submission of this manuscript.
CONCLUSION Atypical GB presented unusual imaging findings, which led to misdiagnosis. Therefore, a complete recognition of imaging signs may facilitate early accurate diagnosis.
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Affiliation(s)
- Xin-Yu Liang
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Yao-Ping Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Qiao Li
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Ze-Wang Zhou
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
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Darbari S, Manjunath N, Doddamani RS, Meena R, Nambirajan A, Sawarkar D, Singh PK, Garg K, Chandra PS, Kale SS. Primary spinal cord glioblastoma multiforme: a single-center experience. Br J Neurosurg 2022:1-7. [PMID: 35441567 DOI: 10.1080/02688697.2022.2064427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/14/2021] [Accepted: 04/06/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Primary spinal glioblastoma (GBM) are very rare tumors of the spinal cord, with dismal prognosis and their exact management is controversial. We attempt to formulate treatment guidelines for these extremely rare tumors based on our institutional experience and a comprehensive review of the literature. MATERIALS AND METHODS In this retrospective study from 2008 to 2020, all the patients diagnosed with primary spinal GBM who underwent surgery at our institution were included. Clinical data were retrieved from case files, outpatient records and telephonic follow-up. Data on postoperative chemoradiation was noted in all the patients. The final diagnosis of spinal GBM was confirmed as per the histopathology reports. Patients who could not be followed up and those with prior history of cranial GBM were excluded from the study. RESULTS Nine patients were followed up and a median survival of 11 months was noted. Chemotherapy with TMZ and radiotherapy to the whole craniospinal axis significantly improved survival in these patients. The extent of surgical resection was not shown to be significant. Intracranial metastasis was the leading cause of mortality in such patients. Three patients developed documented intracranial metastasis during the course of the disease. CONCLUSIONS Low threshold must be kept in mind in diagnosing patients with high-grade spinal cord intramedullary tumors in view of the rapidly progressing nature of the disease. In case of positive histopathological diagnosis of spinal GBM, the whole craniospinal axis should be imaged and any cranial metastasis which was originally missed during initial workup could be given appropriate radiotherapy.
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Affiliation(s)
- Shaurya Darbari
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nivedita Manjunath
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Sharanappa Doddamani
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aruna Nambirajan
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Dattaraj Sawarkar
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery and Neuropathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Hohm A, Karremann M, Gielen GH, Pietsch T, Warmuth-Metz M, Vandergrift LA, Bison B, Stock A, Hoffmann M, Pham M, Kramm CM, Nowak J. Magnetic Resonance Imaging Characteristics of Molecular Subgroups in Pediatric H3 K27M Mutant Diffuse Midline Glioma. Clin Neuroradiol 2021; 32:249-258. [PMID: 34919158 PMCID: PMC8894220 DOI: 10.1007/s00062-021-01120-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Purpose Recent research identified histone H3 K27M mutations to be associated with a dismal prognosis in pediatric diffuse midline glioma (pDMG); however, data on detailed MRI characteristics with respect to H3 K27 mutation status and molecular subgroups (H3.1 and H3.3 K27M mutations) are limited. Methods Standardized magnetic resonance imaging (MRI) parameters and epidemiologic data of 68 pDMG patients (age <18 years) were retrospectively reviewed and compared in a) H3 K27M mutant versus H3 K27 wildtype (WT) tumors and b) H3.1 versus H3.3 K27M mutant tumors. Results Intracranial gliomas (n = 58) showed heterogeneous phenotypes with isointense to hyperintense signal in T2-weighted images and frequent contrast enhancement. Hemorrhage and necrosis may be present. Comparing H3 K27M mutant to WT tumors, there were significant differences in the following parameters: i) tumor localization (p = 0.001), ii) T2 signal intensity (p = 0.021), and iii) T1 signal homogeneity (p = 0.02). No significant imaging differences were found in any parameter between H3.1 and H3.3 K27M mutant tumors; however, H3.1 mutant tumors occurred at a younger age (p = 0.004). Considering spinal gliomas (n = 10) there were no significant imaging differences between the analyzed molecular groups. Conclusion With this study, we are the first to provide detailed MR imaging data on H3 K27M mutant pDMG with respect to molecular subgroup status in a large patient cohort. Our findings may support diagnosis and future targeted therapeutic trials of pDMG within the framework of the radiogenomics concept. Supplementary Information The online version of this article (10.1007/s00062-021-01120-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Hohm
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
- Current address: Division of Pediatric Stem Cell Transplantation and Immunology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Monika Warmuth-Metz
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Lindsey A Vandergrift
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigitte Bison
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Current address: Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Department of Neuroradiology, University Augsburg, Faculty of Medicine, Augsburg, Germany
| | - Annika Stock
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Marion Hoffmann
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirko Pham
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Nowak
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany.
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany.
- SRH Poliklinik Gera GmbH, Radiology Gotha, Gotha, Germany.
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Vadhan JD, Eichberg DG, Di L, Manzano G, Ivan M, Komotar RJ. Primary Low-Grade Astrocytoma of the Spine With Secondary Cerebral Metastasis: A Case Report and Comprehensive Review of the Literature. Cureus 2020; 12:e10030. [PMID: 32983723 PMCID: PMC7515806 DOI: 10.7759/cureus.10030] [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] [Indexed: 11/23/2022] Open
Abstract
An astrocytoma is a subclassification of glioma, with primary spinal manifestations accounting for less than 10% of all spinal cord tumors, with the majority encompassing low-grade features. It is even more uncommon for such lesions to demonstrate intracerebral metastasis. We report such an occurrence in a 39-year-old female who initially presented with an intramedullary and intradural mass from T10-L1, as well as secondary metastasis to the mesial right temporal lobe and cerebellum upon clinical follow-up. Surgical resection of the spine and subsequent temporal lobe biopsy confirmed high-grade glioma. Given the rarity and poor prognosis of spinal gliomas with cerebral metastasis, we also summarize all previously reported cases to date. We recommend that physicians maintain an index of suspicion for spinal gliomas in young patients with cord compression related symptoms outside the event of traumatic injury.
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Affiliation(s)
- Jason D Vadhan
- Osteopathic Medicine, Nova Southeastern University, Miami, USA
| | - Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Glen Manzano
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Michael Ivan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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10
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Yang K, Man W, Jing L, Sun Z, Liang P, Wang J, Wang G. Clinical Features and Outcomes of Primary Spinal Cord Glioblastoma: A Single-Center Experience and Literature Review. World Neurosurg 2020; 143:e157-e165. [PMID: 32688042 DOI: 10.1016/j.wneu.2020.07.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aim to elucidate the clinical characteristics of patients with primary spinal cord glioblastoma (PSC GBM) and prognostic factors for their outcomes. METHODS A cohort of 11 patients with pathologically diagnosed PSC GBM from our center were retrospectively reviewed. The clinical, radiologic, operative, and molecular information were recorded, and univariate analysis was performed to identify prognostic factors. RESULTS The patient cohort included 5 males (45.5%) and 6 females (54.5%) with a median age of 26 years (range, 9-69 years). The median duration of the preoperative symptoms was 4.0 months (range, 0.5-120 months). Subtotal resection was achieved in 8 patients (72.7%) and partial resection in 3 (27.3%). Two patients (18.2%) underwent postoperative adjuvant chemoradiotherapy, 2 patients underwent (27.3%) chemotherapy only, and 6 patients (54.5%) neither. Two patients underwent additional therapy with bevacizumab. After a mean follow-up of 12.4 months (range, 1-33 months), Kaplan-Meier plot showed that the median progression-free survival and overall survival were 6.0 (range, 0.5-12.0) months and 12.0 (range, 1.0-33.0) months, respectively, and 1-year survival was 31.8%. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors of progression-free survival and overall survival in univariate analysis (P < 0.05). CONCLUSIONS Despite aggressive treatment, PSC GBM still has a dismal prognosis and leads to severe neurologic deficit. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors, yet the role of adjuvant radiochemotherapy and extent of resection are still unclear, necessitating further research.
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Affiliation(s)
- Kaiyuan Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weitao Man
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Linkai Jing
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhenxing Sun
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ping Liang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Buch K. Invited Commentary: A Framework for the Differential Diagnosis of Benign and Malignant Intramedullary Tumors. Radiographics 2020; 40:1146-1147. [DOI: 10.1148/rg.2020200059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Buch
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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