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Mulhem A. Primary glioblastoma multiform (GBM) of the optic nerve and chiasma: A case report and systematic review of the literature. Clin Case Rep 2024; 12:e8636. [PMID: 38515994 PMCID: PMC10954565 DOI: 10.1002/ccr3.8636] [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: 12/28/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Abstract
Key Clinical Message Primary GBM of the optic nerve and chiasma should be included in the differential diagnosis of progressive lesions despite initial treatment; clinicians should avoid delay in confirming the histology to initiate proper treatment and improve prognosis. Abstract Primary GBM of the optic nerve or chiasma is very rare. The characteristics of this condition have not been well-described, which poses difficulties in establishing the correct diagnosis, affecting the treatment and the prognosis. We present a case of GBM of the optic chiasma diagnosed through an open biopsy at our centre. Following the PRISMA statement, we also conducted a systematic review after protocol registration in PROSPERO (CRD42021285855). We searched Medline and Embase through Ovid from inception until December 31, 2021. Two reviewers independently screened the studies. Studies were eligible for inclusion if they reported cases of primary GBM confined to the optic nerve or chiasma as the initial radiological diagnosis. A 77-year-old female was referred for progressive visual loss lasting 8 weeks. MRI revealed a suspected lesion in the left chiasma. The patient's vision deteriorated further despite initially diagnosing an inflammatory process and empirical treatment with corticosteroids. Subsequently, the patient underwent an open biopsy and surgical debulking. Histology, including epigenetic analysis, confirmed GBM grade IV. Radiochemotherapy was administered. The patient died 19 months after surgery. We identified 45 similar cases (22 female) reported in 35 studies between 1949 and 2020. The mean age of the cases was 61 (SD = 14.6). Most cases were misdiagnosed and mistreated accordingly, so there was a median delay of 8 weeks (IQR: 5-14 weeks) in obtaining histological confirmation of the diagnosis, delaying the initiation of appropriate treatment. Five cases became no treatment since the patients died shortly after the delayed histologic diagnosis. The Kaplan-Meier estimate indicated that most patients died within 20 months of presentation, with a 1-year survival rate of 50%, and untreated cases had very low survival rates compared to treated cases. Primary GBM of the optic nerve and chiasma is a rare condition primarily affecting adults. The rarity of this condition contributes to initial misdiagnosis, mistreatment, and delays in confirming the histology and initiating appropriate treatment. The prognosis remains poor, but treatment, including surgery and radiochemotherapy, improves survival.
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Affiliation(s)
- Ali Mulhem
- Department of NeurosurgeryVivantes Klinikum im FriedrichshainBerlinGermany
- Department of Continuing Education, MSc Program in Evidence‐Based Health CareUniversity of OxfordOxfordUK
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2
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Dung LT, Hung ND, Hung NK, Khuong NH, Thien LQ, Duy NQ, Duc NM. Magnetic resonance imaging characteristics of glioblastoma of the optic pathway during adulthood. Radiol Case Rep 2023; 18:2628-2632. [PMID: 37273722 PMCID: PMC10238590 DOI: 10.1016/j.radcr.2023.05.010] [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: 03/01/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Glioma has been previously known as the most common adult brain tumor. Glioma of the optic pathway is predominated by low-grade neoplasms. High-grade glioma in adults is extremely rare. In this study, we present the case of a 46-year-old male patient who developed glioblastoma of the optic chiasm extending along the optic tract. This study aims to discuss several common differential diagnoses of nontumor diffuse lesions in the optic pathway and their clinical symptoms and magnetic resonance imaging findings, which could help navigate management.
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Affiliation(s)
- Le Thanh Dung
- Department of Radiology, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
- Department of Radiology, Viet Duc Hospital, Hanoi, Viet Nam
| | - Nguyen Duy Hung
- Department of Radiology, Viet Duc Hospital, Hanoi, Viet Nam
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen Khac Hung
- Department of Radiology, Hanoi Obstetrics and Gynecology, Hanoi, Viet Nam
| | - Nguyen Ha Khuong
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
| | - Le Quy Thien
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
| | - Ngo Quang Duy
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
- Department of Radiology, Ha Giang General Hospital, Ha Giang, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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3
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Merchancano-Esquivel LF, Marín-Díaz CF, Mejía-Quiñones V, Granados-Sánchez AM. Glioblastoma in the optic chiasm: A case report. Radiol Case Rep 2022; 17:729-734. [PMID: 35003470 PMCID: PMC8717424 DOI: 10.1016/j.radcr.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
Malignant optic gliomas are an uncommon pathology, with around 67 cases reported worldwide in the literature. We present the case of a 77-year-old-male with a two-month history of progressive vision loss, ultimately leading to bilateral blindness. The initial clinical suspicion was a non-inflammatory ischemic optic neuropathy. Stereotactic biopsy was performed on the optic chiasm, and the histopathological diagnosis was confirmed as Glioblastoma.
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4
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Tsunogae M, Yoshimura H, Matsuzaki M, Yokota S, Kawamoto M. Localised chiasmal optic neuritis in neuromyelitis optica spectrum disorder. Pract Neurol 2021; 22:154-155. [PMID: 34675122 DOI: 10.1136/practneurol-2021-003120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Marie Tsunogae
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hajime Yoshimura
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | | | - Michi Kawamoto
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
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5
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Siedler DG, Beechey JC, Jessup PJ, Thani NB. Infantile Optic Pathway Glioblastoma. World Neurosurg 2019; 129:172-175. [PMID: 31158532 DOI: 10.1016/j.wneu.2019.05.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic pathway gliomas and glioblastomas remain a rare entity within the infant population. CASE DESCRIPTION We outline the case of a 6-month-old female who presented with failure to thrive, nystagmus and features of raised intracranial pressure. Subsequent magnetic resonance imaging demonstrated an infiltrating tumor radiating from the optic nerves bilaterally. She underwent emergent ventriculoperitoneal shunting and biopsy. Histology confirmed a World Health Organization grade IV glioblastoma. CONCLUSIONS The patient remained clinically and radiologically stable at 1 year. Optic pathway glioblastoma in this population is a previously undescribed entity that requires multidisciplinary input to guide ongoing therapy.
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Affiliation(s)
- Declan G Siedler
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jessica C Beechey
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Peter J Jessup
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nova B Thani
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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6
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Hidalgo ET, McQuinn MW, Wisoff JH. Regression after subtotal resection of an optic pathway glioma in an adult without adjuvant therapy: case report. J Neurosurg 2018; 130:2005-2008. [PMID: 29999469 DOI: 10.3171/2017.12.jns172188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/19/2017] [Indexed: 11/06/2022]
Abstract
Optic pathway gliomas (OPGs) are relatively common and benign lesions in children; however, in adults these lesions are nearly always malignant and hold a very poor prognosis. In this report the authors present the case of an adult patient with a benign OPG who underwent subtotal resection without adjuvant therapy and has had no tumor progression for more than 20 years. A 50-year-old woman presented with a 2-year history of personality changes, weight gain, and a few months of visual disturbances. Ophthalmological evaluation showed incomplete right homonymous hemianopsia. MRI demonstrated a 2.5 × 2.5 × 2.5-cm enhancing left-sided lesion involving the hypothalamus with extension into the suprasellar cistern, extending along the left optic tract and anterior to the level of the optic chiasm. A biopsy procedure revealed a juvenile pilocytic astrocytoma. A subtotal resection of approximately 80% of the tumor was performed. Postoperatively, the patient experienced complete resolution of her personality changes, and her weight decreased back to baseline. Ophthalmological examination showed increased right homonymous hemianopsia. In the years following her surgery, there was a spontaneous decrease in tumor size without adjuvant therapy. The patient continues to have an excellent quality of life despite a visual field defect, and no further tumor growth has been observed.
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7
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Primary Gliosarcoma of the Optic Nerve: A Unique Adult Optic Pathway Glioma. Ophthalmic Plast Reconstr Surg 2017; 33:e88-e92. [PMID: 27792048 DOI: 10.1097/iop.0000000000000798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 90-year-old woman presented with 1-year history of right-sided progressive proptosis, neovascular glaucoma, blindness, and worsening ocular pain. No funduscopic examination was possible because of a corneal opacity. Head CT scan without contrast demonstrated a heterogeneous 4.1 cm (anterior-posterior) by 1.7 cm (transverse) cylindrical mass arising in the right optic nerve and extending from the retrobulbar globe to the optic canal. She underwent palliative enucleation with subtotal resection of the orbital optic nerve and tumor. Pathological examination showed effacement of the optic nerve by an infiltrative high-grade glial neoplasm with biphasic sarcomeric differentiation. Invasion into the uvea and retina was present. The neoplasm was negative for melan-A, HMB45, tyrosinase, synaptophysin, smooth muscle actin, and epithelial membrane antigen. The glioma had strongly intense, but patchy immunopositivity for glial fibrillary acidic protein. Multiple foci of neoplastic cells had pericellular reticulin staining. The overall features were diagnostic of a gliosarcoma (World Health Organization grade IV) of the optic nerve. Postoperative MRI demonstrated postsurgical changes and residual gliosarcoma with extension into the optic chiasm. The patient died 2 and a half months after her enucleation surgery at her nursing home. Autopsy was unavailable due to the caregiver wishes, making a definitive cause of death unknown. Gliosarcoma is a rare variant of glioblastoma, and this is the first documented case presenting as a primary neoplasm of the optic nerve.
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8
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Mastorakos P, Hays MA, Caruso JP, Chen CJ, Ding D, Taylor DG, Beatriz Lopes M, Shaffrey ME. Transtentorial dissemination of optic nerve glioblastoma: case report. J Neurosurg 2017; 128:406-413. [PMID: 28298017 DOI: 10.3171/2016.10.jns161443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optic nerve glioblastoma is a rare entity that usually presents with rapidly progressive vision loss, which eventually results in blindness and, ultimately, death. As with malignant gliomas in other anatomical locations, local recurrence is common. Isolated rapid changes in vision, atypical neuroimaging findings, and the rarity of optic nerve glioblastoma may render diagnosis challenging and, thus, delay treatment. The authors present a case of optic nerve glioblastoma that was treated with subtotal resection followed by adjuvant radiation therapy and temozolomide. One year following the initial diagnosis, the patient developed a right cerebellar lesion, which was histopathologically consistent with glioblastoma. This case represents the first report of transtentorial dissemination of an optic nerve glioblastoma. In addition, the authors reviewed the literature regarding optic nerve glioblastomas. Of the 73 previously reported cases of malignant optic nerve gliomas, 32 were histologically confirmed glioblastomas. The mean age at diagnosis was 62 years, and 56% were male; the median survival was 7 months. A malignant glioma of the optic nerve should be considered in the differential diagnosis of a patient with rapidly progressive visual loss. However, the incidence of optic nerve glioblastoma is exceedingly low.
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Affiliation(s)
| | - Michael A Hays
- 2Division of Neuropathology, University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Dale Ding
- 1Department of Neurological Surgery and
| | | | - M Beatriz Lopes
- 1Department of Neurological Surgery and.,2Division of Neuropathology, University of Virginia Health System, Charlottesville, Virginia
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9
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Alireza M, Amelot A, Chauvet D, Terrier LM, Lot G, Bekaert O. Poor Prognosis and Challenging Treatment of Optic Nerve Malignant Gliomas: Literature Review and Case Report Series. World Neurosurg 2017; 97:751.e1-751.e6. [DOI: 10.1016/j.wneu.2016.10.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 10/20/2022]
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10
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Lyapichev KA, Bregy A, Cassel A, Handfield C, Velazquez-Vega J, Kay MD, Basil G, Komotar RJ. Glioblastoma multiforme of the optic chiasm: A rare case of common pathology. Surg Neurol Int 2016; 7:S485-7. [PMID: 27512611 PMCID: PMC4960928 DOI: 10.4103/2152-7806.185783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/24/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Malignant optic and chiasmatic gliomas are extremely rare, and are classified pathologically as anaplastic astrocytoma or glioblastoma multiforme (GBM). Approximately 40 cases of optic GBM in adults have been reported in the literature, and only five of them were described to originate from the optic chiasm. CASE DESCRIPTION An 82-year-old male patient with a past medical history of diabetes mellitus type 2, melanoma, and bladder cancer presented with gradual vision loss of the left eye in a period of 1 month. After neuro-ophthalmological examination, the decision of thither magnetic resonance imaging (MRI) studies was made. It showed a contrast enhancing mass in the region of the optic chiasm. In this case, imaging study was not enough to establish an accurate diagnosis and a left pterional craniotomy for biopsy and resection of the optic chiasmal mass was performed. After histological evaluation of the mass tissue, the diagnosis of GBM was made. Taking into account the patient's poor condition and unfavorable prognosis he was moved to inpatient hospice. The patient deceased within 2 months after surgery. CONCLUSION Chiasmal GBM is an extremely rare condition where a biopsy is necessary for accurate diagnosis and optimal treatment. Differential diagnosis for such lesions can be very difficult and include demyelinating optic neuritis and non-demyelinating inflammatory optic neuropathy (e.g., sarcoid), vascular lesions (e.g., cavernoma), compressive lesions of the optic apparatus, metastatic malignancy, and primary tumors of the anterior optic pathway. The role of chemotherapy and radiotherapy including novel stereotaxic radiosurgery methods is still unclear and will need to be evaluated.
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Affiliation(s)
- Kirill A Lyapichev
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amade Bregy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Adrienne Cassel
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Chelsea Handfield
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jose Velazquez-Vega
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Gregory Basil
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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11
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Malignant optic glioma – the spectrum of disease in a case series. Graefes Arch Clin Exp Ophthalmol 2015; 253:1187-94. [DOI: 10.1007/s00417-015-3045-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/24/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022] Open
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12
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Deng S, Li Y, Guan Y, Xu S, Chen J, Zhao G. Gliomas in the Sellar Turcica Region: A Retrospective Study Including Adult Cases and Comparison with Craniopharyngioma. Eur Neurol 2014; 73:135-43. [DOI: 10.1159/000369794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/09/2014] [Indexed: 11/19/2022]
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Shofty B, Constantini S, Bokstein F, Ram Z, Ben-Sira L, Freedman S, Vainer G, Kesler A. Optic pathway gliomas in adults. Neurosurgery 2014; 74:273-9; discussion 279-80. [PMID: 24335817 DOI: 10.1227/neu.0000000000000257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optic pathway gliomas (OPGs) are considered relatively benign pediatric tumors. Adult patients with OPG can be divided into 2 groups: adult patients with tumors diagnosed in childhood and adult patients diagnosed during adulthood. OBJECTIVE To characterize the clinical course of adult patients with OPG. METHODS We retrospectively collected clinical and imaging data of all adult OPG patients monitored in our medical center between 1990 and 2012. RESULTS Twenty-two adult patients were included. Age at diagnosis varied widely (6 months-66 years), as did age at last follow-up (18-74 years). Ten patients were diagnosed at adulthood and 12 in childhood. Of the patients diagnosed at childhood, 6 had radiological progression during childhood, and 3 of those patients suffered visual impairment. From this group, 1 patient had further progression during adulthood accompanied by additional visual decline, and 2 patients had additional visual decline during adulthood despite no signs of progression. Of the 6 patients whose tumors were stable during childhood, all 6 remained stable during adulthood. Of 10 patients diagnosed at adulthood, 6 patients suffered visual deterioration; in 5 of them, a concomitant progression was noted. Two patients were diagnosed with high-grade gliomas. CONCLUSION OPGs may be active during childhood or adulthood. Those patients who experienced anatomic activity during childhood are prone to continue experiencing active disease during adulthood. A significant percentage of patients diagnosed with low-grade OPG at adulthood may suffer progression, visual decline, or both. ABBREVIATIONS NF1, neurofibromatosis 1OPG, optic pathway gliomas.
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Affiliation(s)
- Ben Shofty
- *Division of Neurosurgery, ‡Gilbert Israeli Neurofibromatosis Center, §Neuro-Oncology Service, ¶Pediatric Radiology Unit, ‖Pathology, and #Neuro-Ophthalmology Unit, Tel-Aviv Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Nagaishi M, Sugiura Y, Takano I, Tanaka Y, Suzuki K, Yokoo H, Hyodo A. Clinicopathological and molecular features of malignant optic pathway glioma in an adult. J Clin Neurosci 2014; 22:207-9. [PMID: 25150758 DOI: 10.1016/j.jocn.2014.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
Malignant gliomas of the optic pathway are rare, and their genetic alterations are poorly understood. We describe a 64-year-old woman with anaplastic astrocytoma originating from the optic pathway, together with the molecular features. She presented with progressive visual field loss, and a biopsy sample was obtained from the lesion in the optic chiasm. She underwent radiosurgery concomitant with temozolomide chemotherapy, and subsequently remained stable for 10 months after initial presentation. Molecular analysis indicated that the mass may have shared common molecular genetic features with conventional primary astrocytic gliomas but not pilocytic gliomas, which supported the morphologic diagnosis of anaplastic astrocytoma. Molecular analysis of malignant optic pathway gliomas in adults is useful for distinguishing between high-grade gliomas and anaplastic pilocytic astrocytomas, and for determining further therapy.
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Affiliation(s)
- Masaya Nagaishi
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan.
| | - Yoshiki Sugiura
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan
| | - Issei Takano
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan
| | - Yoshihiro Tanaka
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama 343-8555, Japan
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15
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Abstract
Chiasmal dysfunction produces a characteristic clinical picture, regardless of the mechanism. In most cases a compressive lesion is the cause. In occasional cases, however, no such extrinsic mass is found and other possible etiologies must be explored. In some of these cases, the pathologic process is identifiable with appropriate neuroimaging. For example, inflammation, infiltrative tumors, and radiation necrosis produce intrinsic chiasmal enhancement. Chiasmal ischemia may require specialized magnetic resonance (MR) sequences for diagnosis. Chiasmal hemorrhage, trauma and chiasmal herniation typically produce distinctive changes on noncontrasted imaging. In cases of metabolic insult, either toxic or hereditary, radiographic changes are typically absent. In each of these, the correct diagnosis can usually be made with a combination of clinical and radiographic features.
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Affiliation(s)
- Valerie A Purvin
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, IN, USA
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16
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Kang EM, Kwon KY, Choi MJ, Kim CY, Seong GJ, Hong S. Optic Neuritis Mimicking Ischemic Optic Neuropathy and Optic Glioma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.11.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Min Kang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kye Yoon Kwon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jung Choi
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Samin Hong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Optic nerve and visual pathways primary glioblastoma treated with radiotherapy and temozolomide chemotherapy. Eur J Ophthalmol 2013; 24:637-40. [PMID: 24366773 DOI: 10.5301/ejo.5000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE Primary malignant gliomas of the optic nerves are rare tumors of adulthood, progressing rapidly to blindness and to death within several months, regardless of the type of treatment. Recently, treatments associating radiotherapy and temozolomide have been used in other types of glioblastomas, but their impact on optic nerve malignant gliomas is not known. METHODS This was a retrospective case series of 2 patients diagnosed with primary optic nerve and chiasm glioblastoma (GBM), treated with radiotherapy and concomitant temozolomide. RESULTS A 74-year-old man presented with visual loss caused by an infiltrative and enhancing lesion, affecting the left optic nerve and the chiasm, subsequently confirmed as GBM World Health Organization (WHO) grade IV. The patient was treated with external conformal radiotherapy (54 Gy over 42 days) and concomitant chemotherapy with temozolomide (75 mg/m2/day), followed by 6 monthly cycles of adjuvant treatment (250 mg/day for 5 days). The second patient was a 74-year-old woman diagnosed with bilateral visual loss due to pathologically confirmed GBM (WHO grade IV). She was treated with temozolomide (220 mg/day) for 1 month, followed by radiotherapy (54 Gy over 42 days) and temozolomide chemotherapy (75 mg/m2/day). There was no adjuvant regimen. This treatment resulted in disease stabilization and partial preservation of vision during 12 months for patient 1, 8 months for patient 2. Survival after first examination was 15 and 11 months, respectively. CONCLUSIONS Combined radiotherapy and temozolomide may be an alternative treatment in optic nerve and visual pathways primary GBM, potentially providing a longer survival.
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18
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Fadzli F, Ramli N, Ramli NM. MRI of optic tract lesions: review and correlation with visual field defects. Clin Radiol 2013; 68:e538-51. [PMID: 23932674 DOI: 10.1016/j.crad.2013.05.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/14/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
Abstract
Visual field defects are a conglomerate of patterns of visual impairment derived from diseases affecting the optic nerve as it extends from the globe to the visual cortex. They are complex signs requiring perimetry or visual confrontation for delineation and are associated with diverse aetiologies. This review considers the chiasmatic and post-chiasmatic causes of visual disturbances, with an emphasis on magnetic resonance imaging (MRI) techniques. Newer MRI sequences are considered, such as diffusion-tensor imaging. MRI images are correlated with perimetric findings in order to demonstrate localization of lesions in the visual pathway. This may serve as a valuable reference tool to clinicians and radiologists in the early diagnostic process of differentiating causes of various visual field defects in daily practice.
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Affiliation(s)
- F Fadzli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Malaysia.
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19
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Kang JJ, Hou JH, Bui KM, Michals E, Valyi-Nagy T, Koshy M, Munson T, Charbel FT, Villano JL, Moss HE. De novo malignant optic chiasm glioma with initial clinical response to steroids. Neuroophthalmology 2012; 36:59-63. [PMID: 24031101 DOI: 10.3109/01658107.2012.658594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malignant optic nerve glioma (MONG) is a rare but uniformly fatal disease that remains poorly understood. We describe a notable case of this rare disease occurring in the optic chiasm. Normal brain imaging and normal ophthalmic examination two years prior to diagnosis provide evidence for de novo genesis of MONG in our patient. Early response to steroids highlights the degree to which MONG can initially mimic inflammatory optic neuropathies and chiasmal syndromes. Our case also demonstrates a poor outcome with MONG even with current advanced therapy for glioblastoma including radiotherapy plus concomitant and adjuvant temozolomide (the EORTC/NCIC regimen) and bevacizumab.
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Affiliation(s)
- Joann J Kang
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Lemm D, de Oliveira FH, Bernays RL, Kockro RA, Kollias S, Fischer I, Rushing EJ. Rare suprasellar glioblastoma: report of two cases and review of the literature. Brain Tumor Pathol 2012; 29:216-20. [PMID: 22350669 DOI: 10.1007/s10014-012-0086-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/31/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND IMPORTANCE The suprasellar and hypothalamic/chiasmatic regions can harbor a broad range of pathologic conditions, both neoplastic and nonneoplastic; however, malignant gliomas are extremely rare in those regions. CLINICAL PRESENTATIONS Patient 1 was a 70 year-old man with weight loss and rapidly progressive visual impairment. A mass centered in the hypothalamus was detected on magnetic resonance (MR) imaging. The second patient, a 45 year-old woman, complained of visual symptoms and headaches. MR imaging revealed a combined intra- and suprasellar mass. In both instances, the preoperative differential diagnosis favored craniopharyngioma. Histological examination confirmed the diagnosis of glioblastoma. CONCLUSION We report two rare adult cases of hypothalamic/chiasmatic glioblastoma. The authors review the literature, highlighting the importance of considering this rare entity in the differential diagnosis of suprasellar and hypothalamic lesions.
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Affiliation(s)
- Doreen Lemm
- Institute of Neuropathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland.
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21
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Diagnosis and management of optic nerve glioma. J Clin Neurosci 2011; 18:1585-91. [DOI: 10.1016/j.jocn.2011.09.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/10/2011] [Indexed: 11/30/2022]
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22
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Matloob S, Fan JC, Danesh-Meyer HV. Multifocal malignant optic glioma of adulthood presenting as acute anterior optic neuropathy. J Clin Neurosci 2011; 18:974-7. [DOI: 10.1016/j.jocn.2010.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/19/2010] [Indexed: 11/15/2022]
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Dumas-Stoeckel S, Gambrelle J, Cornut P, El Chehab H, Vighetto A, Denis P. Occlusion vasculaire mixte de la veine et de l’artère centrale de la rétine liée à l’envahissement intraoculaire d’un gliome anaplasique optochiasmatique. J Fr Ophtalmol 2010; 33:564-7. [DOI: 10.1016/j.jfo.2010.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
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Arai A, Morishita A, Hanada Y, Aihara H. Solitary metastatic tumor within the optic chiasm--case report. Neurol Med Chir (Tokyo) 2010; 50:158-61. [PMID: 20185885 DOI: 10.2176/nmc.50.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 61-year-old female, previously treated for lung cancer, presented with a rare case of metastasis directly to the optic chiasm manifesting as visual deficits. Magnetic resonance imaging revealed a suprasellar mass similar to an optic glioma. At surgery, the optic chiasm appeared swollen with hypervascularity over the surface. The bilateral optic nerves and the pituitary stalk appeared normal. A small incision was made on the superior surface of the chiasm and biopsy specimens were taken. The histological diagnosis was adenocarcinoma, which was consistent with the primary lung cancer. She received whole brain irradiation, resulting in mild improvement of her vision. Suprasellar metastatic tumors to the pituitary gland, pituitary stalk, and hypothalamus are well documented, but solitary metastasis within the optic chiasm should be considered as one of several differential diagnoses of suprasellar tumors, in patients with or without a history of treated cancer.
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Affiliation(s)
- Atsushi Arai
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo
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Zoeller GK, Brathwaite CD, Sandberg DI. Malignant transformation of an optic pathway glioma without prior radiation therapy. J Neurosurg Pediatr 2010; 5:507-10. [PMID: 20433265 DOI: 10.3171/2009.12.peds09173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optic pathway gliomas (OPGs) arise from the optic nerves, optic chiasm, and/or hypothalamus and most commonly occur in childhood. Although these tumors can be quite challenging to manage, they are typically low-grade astrocytomas histologically, most commonly pilocytic astrocytomas. The few previously reported cases of malignant degeneration of an OPG occurred after external beam radiation therapy. The authors report the first case in the English literature of an OPG that transformed from a low-grade astrocytoma, with features most consistent with a pilocytic astrocytoma, to a malignant glioma without any exposure to radiation therapy.
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Affiliation(s)
- Garrett K Zoeller
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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