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Nafari A, Ghaffary EM, Shaygannejad V, Mirmosayyeb O. Concurrent glioma and multiple sclerosis: A systematic review of case reports. Mult Scler Relat Disord 2024; 84:105455. [PMID: 38330723 DOI: 10.1016/j.msard.2024.105455] [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: 10/20/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND It is uncommon for individuals with demyelinating disease, notably multiple sclerosis (MS), to be diagnosed with intracranial gliomas. It has been debated whether or not the concurrence of these two disorders is accidental. Clinically, it may be challenging to diagnose someone who has MS and an intracranial tumor simultaneously. We conducted this systematic review to evaluate the glioma patients following MS. METHODS We collected 63 studies from 1672 databases from January 1990 to February 2023, and our inclusion criteria involved peer-reviewed case reports/series studies reporting concurrent MS and glioma in patients, considering various types of gliomas. RESULTS We included 145 cases, 51% were women and 49 % were men, with an average age of 47.4 years. Common symptoms of glioma at admission included seizures (31.2 %), hemiparesis (15.6 %), and headache (14.3 %). 75 % of patients had primarily with relapsing-remitting MS (RRMS). MS treatments included interferon(IFN)-ß (44.6 %), glatiramer acetate (GA) (21.4 %), fingolimod (19.6 %), and natalizumab (19.6 %). The average time between MS and glioma diagnosis was 12.1 years, with various timeframes. Among the 59 reported cases, 45.8 % led to patient fatalities, while the remaining 54.2 % managed to survive. CONCLUSION This co-occurrence, though rare, suggests potential underlying shared mechanisms or vulnerabilities, possibly at a genetic or environmental level. An interdisciplinary approach, combining the expertise of neurologists, oncologists, radiologists, and pathologists, is vital to ensure accurate diagnosis and optimal management of affected individuals. Nonetheless, there is still a significant lack of information regarding this phenomenon, necessitating large-scale population-based studies and experimental research.
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Affiliation(s)
- Amirhossein Nafari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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2
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Sahm K, Kessler T, Eisele P, Ratliff M, Sperk E, König L, Breckwoldt MO, Seliger C, Mildenberger I, Schrimpf D, Herold-Mende C, Zeiner PS, Tabatabai G, Meuth SG, Capper D, Bendszus M, von Deimling A, Wick W, Sahm F, Platten M. Concurrent gliomas in patients with multiple sclerosis. COMMUNICATIONS MEDICINE 2023; 3:186. [PMID: 38110626 PMCID: PMC10728097 DOI: 10.1038/s43856-023-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/10/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Concurrent malignant brain tumors in patients with multiple sclerosis (MS) constitute a rare but paradigmatic phenomenon for studying neuroimmunological mechanisms from both molecular and clinical perspectives. METHODS A multicenter cohort of 26 patients diagnosed with both primary brain tumors and multiple sclerosis was studied for disease localization, tumor treatment-related MS activity, and molecular characteristics specific for diffuse glioma in MS patients. RESULTS MS neither predisposes nor protects from the development of gliomas. Patients with glioblastoma WHO grade 4 without isocitratdehydrogenase (IDH) mutations have a longstanding history of MS, whereas patients diagnosed with IDH-mutant astrocytoma WHO grade 2 receive multiple sclerosis diagnosis mostly at the same time or later. Concurrent MS is associated with a lesser extent of tumor resection and a worse prognosis in IDH-mutant glioma patients (PFS 32 vs. 64 months, p = 0.0206). When assessing tumor-intrinsic differences no distinct subgroup-defining methylation pattern is identified in gliomas of MS patients compared to other glioma samples. However, differential methylation of immune-related genetic loci including human leukocyte antigen locus on 6p21 and interleukin locus on 5q31 is found in MS patients vs. matched non-MS patients. In line, inflammatory disease activity increases in 42% of multiple sclerosis patients after brain tumor radiotherapy suggesting a susceptibility of multiple sclerosis brain tissue to pro-inflammatory stimuli such as ionizing radiation. CONCLUSIONS Concurrent low-grade gliomas should be considered in multiple sclerosis patients with slowly progressive, expansive T2/FLAIR lesions. Our findings of typically reduced extent of resection in MS patients and increased MS activity after radiation may inform future treatment decisions.
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Affiliation(s)
- Katharina Sahm
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany.
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tobias Kessler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Miriam Ratliff
- Department of Neurosurgery, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael O Breckwoldt
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinna Seliger
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Iris Mildenberger
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pia S Zeiner
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neurooncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sven G Meuth
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany.
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Laine G, Baldi I, Jecko V, Betancourt Z, Bertaud E, Huchet A, Menegon P, Eimer S, Chotard G, Cuny E, Gimbert E, Liguoro D, Mollier O, Monteil P, Penchet G, Vignes JR, Wavasseur T, Loiseau H, Engelhardt J. Descriptive epidemiology of ependymal tumors in Gironde, France: results from the Gironde Registry for the 2000-2018 period. Neuroepidemiology 2022; 56:250-260. [PMID: 35320802 DOI: 10.1159/000523954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Gironde Central Nervous System (CNS) Tumor Registry, in collaboration with the French National Cancer Institute, is the largest population-based registry focused exclusively on primary CNS tumors in France and represents a population of 1.62 million. This report focuses on ependymal tumors to refine current knowledge and provide up-to-date data on the epidemiology of these rare tumors. MATERIAL AND METHODS All of the ependymal tumors were extracted from the Gironde CNS Tumor Registry for the years 2000 to 2018. Demographic and clinical characteristics, incidence rates and time trends as well as survival outcomes were analyzed. RESULTS One hundred and forty-four ependymal tumors were retrieved, which represented 2.3% of all the CNS tumors recorded in the same period. Histological subtype was significantly dependent on age and topography in the CNS. The median age at diagnosis was 46 years old. The annual incidence rates varied between 0.15/100,000 (2004) and 0.96/100,000 (2016), with a significant increase over the study period by 4.67% per year. Five-year and 10-year OS rates were 87% and 80%, respectively. CONCLUSION An increase in the incidence of ependymal tumors was observed over the past two decades. Further studies are needed to confirm this result and provide etiological clues.
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Affiliation(s)
- Gaëtan Laine
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Baldi
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Zamira Betancourt
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Emilie Bertaud
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Aymeri Huchet
- Department of Radiation Oncology, CHU de Bordeaux, Bordeaux, France
| | - Patrice Menegon
- Department of Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Sandrine Eimer
- Department of Pathology, CHU de Bordeaux, Bordeaux, France
| | | | - Emmanuel Cuny
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | | | - Olivier Mollier
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Pascal Monteil
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | | | | | | | - Hugues Loiseau
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
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Dixon GA, Pérez CA. Multiple Sclerosis and the Choroid Plexus: Emerging Concepts of Disease Immunopathophysiology. Pediatr Neurol 2020; 103:65-75. [PMID: 31780202 DOI: 10.1016/j.pediatrneurol.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/11/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The coexistence of multiple sclerosis and intracranial neoplasms is very rare, and whether this occurrence can be explained by a causal relationship or by coincidence remains a matter of debate. Possible roles of the choroid plexus as a site of tumor cell invasion and lymphocyte infiltration into the central nervous system have been hypothesized in recent studies. METHODS We describe a 13-year-old boy with concurrent multiple sclerosis and choroid plexus papilloma, then review the published literature with a focus on the pathophysiologic mechanisms of neuroinflammation in multiple sclerosis and the potential role of the choroid plexus in this process. RESULTS A growing body of evidence suggests that both physical and functional dysregulation of the choroid plexus may be a common mechanism underlying the pathophysiology of central nervous system inflammation. CONCLUSIONS In multiple sclerosis, the choroid plexus could act as a gateway for lymphocyte entry from the peripheral blood into the central nervous system at its earlier stages. However, future studies are needed to identify whether structural alterations of the choroid plexus play a role in the pathophysiology of multiple sclerosis and to provide suitable models to determine their consequences.
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Affiliation(s)
- Grant A Dixon
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Carlos A Pérez
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
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Sinclair G, Al-Saffar Y, Johnstone P, Hatiboglu MA, Shamikh A. A challenging case of concurrent multiple sclerosis and anaplastic astrocytoma. Surg Neurol Int 2019; 10:166. [PMID: 31583163 PMCID: PMC6763678 DOI: 10.25259/sni_176_2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Cases of gliomas coexisting with multiple sclerosis (MS) have been described over the past few decades. However, due to the complex clinical and radiological traits inherent to both entities, this concurrent phenomenon remains difficult to diagnose. Much has been debated about whether this coexistence is incidental or mirrors a poorly understood neoplastic phenomenon engaging glial cells in the regions of demyelination. Case Description: We present the case of a 41-year-old patient diagnosed with a left-sided frontal contrast enhancing lesion initially assessed as a tumefactive MS. Despite systemic treatment, the patient gradually developed signs of mass effect, which led to decompressive surgery. The initial microscopic evaluation demonstrated the presence of MS and oligodendroglioma; the postoperative evolution proved complex due to a series of MS-relapses and tumor recurrence. An ulterior revaluation of the samples for the purpose of this report showed an MS-concurrent anaplastic astrocytoma. We describe all relevant clinical aspects of this case and review the medical literature for possible causal mechanisms. Conclusion: Although cases of concurrent glioma and MS remain rare, we present a case illustrating this phenomenon and explore a number of theories behind a potential causal relationship.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurosurgery, Bezmialem Vakif University Medical School, İstanbul, Turkey.,Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Yahya Al-Saffar
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Philippa Johnstone
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Alia Shamikh
- Department of Neuropathology, Karolinska University Hospital, Stockholm, Sweden
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6
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Abrishamchi F, Khorvash F. Coexistence of Multiple Sclerosis and Brain Tumor: An Uncommon Diagnostic Challenge. Adv Biomed Res 2017; 6:101. [PMID: 28900612 PMCID: PMC5583647 DOI: 10.4103/abr.abr_625_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonneoplastic demyelinating processes of the brain with mass effect on magnetic resonance imaging can cause diagnostic difficulties. It requires differential diagnosis between the tumefactive demyelinating lesion and the coexistence of neoplasm. We document the case of 41-year-old woman with clinical and radiological findings suggestive of multiple sclerosis. Additional investigations confirmed the coexistence of astrocytoma. This report emphasizes the importance of considering brain tumors in the differential diagnosis of primary demyelinating disease presenting with a cerebral mass lesion.
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Affiliation(s)
- Fatemeh Abrishamchi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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7
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Golombievski EE, McCoyd MA, Lee JM, Schneck MJ. Biopsy Proven Tumefactive Multiple Sclerosis with Concomitant Glioma: Case Report and Review of the Literature. Front Neurol 2015; 6:150. [PMID: 26236276 PMCID: PMC4505113 DOI: 10.3389/fneur.2015.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/22/2015] [Indexed: 12/04/2022] Open
Abstract
We report a case of pathologically confirmed tumefactive multiple sclerosis (MS) followed shortly thereafter by the diagnosis of an oligoastrocytoma. The complexity of diagnosis and management of concomitant presence of tumefactive MS and glial cell tumors is discussed.
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Affiliation(s)
- Esteban E Golombievski
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Matthew A McCoyd
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - John M Lee
- North Shore University Health System , Evanston, IL , USA
| | - Michael J Schneck
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA ; Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
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Mantero V, Balgera R, Bianchi G, Rossi G, Rigamonti A, Fiumani A, Salmaggi A. Brainstem glioblastoma in a patient with secondary progressive multiple sclerosis. Neurol Sci 2015; 36:1733-5. [DOI: 10.1007/s10072-015-2256-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
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9
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Plantone D, Renna R, Sbardella E, Koudriavtseva T. Concurrence of multiple sclerosis and brain tumors. Front Neurol 2015; 6:40. [PMID: 25788892 PMCID: PMC4349169 DOI: 10.3389/fneur.2015.00040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/17/2015] [Indexed: 12/28/2022] Open
Affiliation(s)
- Domenico Plantone
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO , Rome , Italy
| | - Rosaria Renna
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO , Rome , Italy
| | - Emilia Sbardella
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO , Rome , Italy
| | - Tatiana Koudriavtseva
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO , Rome , Italy
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10
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Genetic characterization of gliomas arising in patients with multiple sclerosis. J Neurooncol 2012; 109:261-72. [DOI: 10.1007/s11060-012-0888-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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