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Kojima K, Arakawa Y, Takeuchi Y, Terada Y, Tanji M, Mineharu Y, Haga H, Miyamoto S. Malignant transformation of central neurocytoma with dissemination 17 years after initial treatment: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21610. [PMID: 36130558 PMCID: PMC9379763 DOI: 10.3171/case21610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Central neurocytomas usually have a favorable clinical course, and gross total resection (GTR) results in long-term survival. Recurrences of central neurocytomas are usually local, and dissemination is extremely rare. OBSERVATIONS A 24-year-old man who presented with vomiting was found to have a mass in the right lateral ventricle. After GTR, he received whole-brain irradiation and chemotherapy and had remained disease-free on follow-up for years. The review of the initial tumor revealed central neurocytoma. Seventeen years later, he presented with deterioration of memory, and magnetic resonance imaging showed an enhanced lesion in the left hippocampus. The enhanced lesion was resected, and the histological examination revealed that the tumor was a disseminated atypical central neurocytoma with frequent mitoses. Although he was treated with chemotherapy, the disseminated tumor slowly grew and invaded the brain. Massive brain invasion occurred without enhanced lesions, and he died 27 months after the tumor recurrence. LESSONS In this patient, a central neurocytoma disseminated after an extremely long period of time. Once neurocytomas disseminate and show aggressive behavior, patients usually follow a poor course. Patients with central neurocytomas should be followed up for a long time.
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Affiliation(s)
| | | | - Yasuhide Takeuchi
- Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | - Hironori Haga
- Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Johnson MO, Kirkpatrick JP, Patel MP, Desjardins A, Randazzo DM, Friedman HS, Ashley DM, Peters KB. The role of chemotherapy in the treatment of central neurocytoma. CNS Oncol 2019; 8:CNS41. [PMID: 31686534 PMCID: PMC6880304 DOI: 10.2217/cns-2019-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Central neurocytoma (CN) is a rare WHO grade II central nervous system (CNS) tumor. This is an update on chemotherapeutic agents used in its treatment. Patients & methods: An institutional review board-approved, chart review of patients seen at our institution resulted in a single case treated with chemotherapy and is herein included. We proceeded with a comprehensive literature review. Results: We identified 18 citations, representing 39 cases of adult and pediatric CN treated with chemotherapy. With the addition of our single case, the total number of recurrent CN patients treated with temozolomide (TMZ) is nine. Conclusion: There exists marked heterogeneity in chemotherapy used to treat CN. TMZ is incorporated into treatment regimens in the setting of tumor recurrence: its role merits further study.
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Affiliation(s)
- Margaret O Johnson
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - John P Kirkpatrick
- Radiation Oncology, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA
| | - Mallika P Patel
- Department of Pharmacy, Duke University Hospital, Durham, NC ;27710, USA
| | - Annick Desjardins
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Dina M Randazzo
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Henry S Friedman
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David M Ashley
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
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Bui TT, Lagman C, Chung LK, Tenn S, Lee P, Chin RK, Kaprealian T, Yang I. Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma. Brain Tumor Res Treat 2017; 5:10-15. [PMID: 28516073 PMCID: PMC5433945 DOI: 10.14791/btrt.2017.5.1.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 12/11/2022] Open
Abstract
Central neurocytoma (CN) typically presents as an intraventricular mass causing obstructive hydrocephalus. The first line of treatment is surgical resection with adjuvant conventional radiotherapy. Stereotactic radiosurgery (SRS) was proposed as an alternative therapy for CN because of its lower risk profile. The objective of this systematic analysis is to assess the efficacy of SRS for CN. A systematic analysis for CN treated with SRS was conducted in PubMed. Baseline patient characteristics and outcomes data were extracted. Heterogeneity and publication bias were also assessed. Univariate and multivariate linear regressions were used to test for correlations to the primary outcome: local control (LC). The estimated cumulative rate of LC was 92.2% (95% confidence interval: 86.5-95.7%, p<0.001). Mean follow-up time was 62.4 months (range 3-149 months). Heterogeneity and publication bias were insignificant. The univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC (p<0.001). Our data suggests that SRS may be an effective and safe therapy for CN. However, the rarity of CN still limits the efficacy of a quantitative analysis. Future multi-institutional, randomized trials of CN patients should be considered to further elucidate this therapy.
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Affiliation(s)
- Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Robert K Chin
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Tania Kaprealian
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.,Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
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Nayyar M, Mayo MC, Shiroishi M, Commins D, Liu CY, Go JL, Kim PE, Zee CS, Law M, Lerner A. Atypical central neurocytoma with metastatic craniospinal dissemination: a case report. Clin Imaging 2016; 40:1108-1111. [DOI: 10.1016/j.clinimag.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
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Lee SJ, Bui TT, Chen CHJ, Lagman C, Chung LK, Sidhu S, Seo DJ, Yong WH, Siegal TL, Kim M, Yang I. Central Neurocytoma: A Review of Clinical Management and Histopathologic Features. Brain Tumor Res Treat 2016; 4:49-57. [PMID: 27867912 PMCID: PMC5114192 DOI: 10.14791/btrt.2016.4.2.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 01/24/2023] Open
Abstract
Central neurocytoma (CN) is a rare, benign brain tumor often located in the lateral ventricles. CN may cause obstructive hydrocephalus and manifest as signs of increased intracranial pressure. The goal of treatment for CN is a gross total resection (GTR), which often yields excellent prognosis with a very high rate of tumor control and survival. Adjuvant radiosurgery and radiotherapy may be considered to improve tumor control when GTR cannot be achieved. Chemotherapy is also not considered a primary treatment, but has been used as a salvage therapy. The radiological features of CN are indistinguishable from those of other brain tumors; therefore, many histological markers, such as synaptophysin, can be very useful for diagnosing CNs. Furthermore, the MIB-1 Labeling Index seems to be correlated with the prognosis of CN. We also discuss oncogenes associated with these elusive tumors. Further studies may improve our ability to accurately diagnose CNs and to design the optimal treatment regimens for patients with CNs.
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Affiliation(s)
- Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Cheng Hao Jacky Chen
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sabrin Sidhu
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - David J Seo
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - William H Yong
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Todd L Siegal
- Department of Radiology, Division of Neuroradiology, Cooper University Hospital, Camden, NJ, USA
| | - Minsu Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
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Central Versus Extraventricular Neurocytoma in Children: A Clinicopathologic Comparison and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:479-85. [PMID: 27438020 DOI: 10.1097/mph.0000000000000627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central neurocytomas (CN) are rare pediatric CNS tumors most often with a benign clinical course. Occasionally, these tumors occur outside the ventricles and are called extraventricular neurocytomas (EVN). We present a retrospective institutional analysis of children with neurocytoma with prolonged follow-up. PROCEDURE Twelve patients were diagnosed with neurocytoma at our institution between 1993 and 2004. RESULTS Six patients were male and the median age at diagnosis was 12 years (1.5 to 16 y). Seven patients had CN and 5 had EVN. Presenting symptoms included headaches (67%), vomiting (50%), nausea (33%), seizures (33%), and mental status changes (25%). Obstructive hydrocephalus was present at diagnosis in 42% of the cases. Younger age and seizures were more common in patients with EVN. Gross total resection (GTR) was achieved in 42% (5/12) of the patients. Patients with GTR received no adjuvant therapy upfront; 1 patient subsequently had recurrence with leptomeningeal disease. Patients with subtotal resection received additional treatment: 1 underwent reoperation (GTR), 2 patients received focal radiation, 2 patients received adjuvant chemotherapy, and 2 patients received craniospinal irradiation followed by chemotherapy. The 20-year overall survival for this cohort was 83% with event free survival of 56%. Overall survival for CNs was 100%, versus 40% for EVN. Event free survival for CNs was 57% and 53% for the EVNs. An MIB-1 fraction >2% was associated with worse prognosis. CONCLUSIONS Neurocytomas are rare brain tumors in children usually cured with GTR. Adjuvant focal radiation therapy and/or chemotherapy may improve disease control in cases with subtotal resection, but case-by-case analysis should be done. EVNs might be associated with worse outcome due to a higher proliferative index.
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Yamanaka K, Iwai Y, Shuto T, Kida Y, Sato M, Hayashi M, Kondo T, Hirai H, Hori R, Kubo K, Mori H, Nagano O, Serizawa T. Treatment Results of Gamma Knife Radiosurgery for Central Neurocytoma: Report of a Japanese Multi-Institutional Cooperative Study. World Neurosurg 2016; 90:300-305. [PMID: 26987638 DOI: 10.1016/j.wneu.2016.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Central neurocytoma (CN) is a rare benign neuronal tumor, and a limited number of reports have described the usefulness of radiosurgery for a relatively large group of patients. We evaluated the effectiveness and outcomes of Gamma Knife radiosurgery (GKS) for CN in a Japanese multi-institutional study. METHODS We performed retrospective analysis of 36 patients with CN who were treated with GKS in 12 institutes in Japan. All patients underwent surgery before GKS. The median tumor volume at GKS was 4.9 mL (range, 0.07-23.4 mL), and the median radiation dose prescribed to the tumor margin was 15 Gy (range, 10-20 Gy). The median follow-up period was 54.5 months (range, 3-180 months). RESULTS The local tumor progression-free survival rates at 5 and 10 years were 94% and 86%, respectively. Three patients developed distant dissemination 16-90 months later. Overall progression-free survival was unrelated to the prescribed dose (<15 Gy vs. ≥15 Gy, P = 0.62), tumor size (<6 mL vs. ≥6 mL, P = 0.46), gender (P = 0.36), age (<30 vs. ≥30 years, P = 0.37), target of GKS (residual vs. recurrence, P = 0.90), and type of enhancement (homogeneous vs. inhomogeneous, P = 0.19). Two permanent complications occurred with 1 intratumoral hemorrhage and 1 radiation injury. CONCLUSIONS GKS is effective for CN because of its high rate of long-term local tumor control. GKS may have a potential role as a primary treatment for asymptomatic, relatively small tumors in the absence of hydrocephalus without surgical resection.
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Affiliation(s)
- Kazuhiro Yamanaka
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
| | - Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Yoshihisa Kida
- Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan
| | - Mitsuya Sato
- Department of Neurosurgery, Kitanihon Neurosurgical Hospital, Gosen, Niigata, Japan
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Kondo
- Department of Neurosurgery, Shin-Suma Hospital, Kobe, Hyogo, Japan
| | - Hisao Hirai
- Department of Neurosurgery, Koto Memorial Hospital, Higashioumi, Shiga, Japan
| | - Rentaro Hori
- Department of Neurosurgery, Shiokawa Hospital, Suzuka, Mie, Japan
| | - Kenji Kubo
- Department of Neurosurgery, Koyo Hospital, Wakayama, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Osamu Nagano
- Department of Neurosurgery, Chiba Cardiovascular Center, Ichihara, Chiba, Japan
| | - Toru Serizawa
- Tsukiji Neurological Clinic, Tokyo Gamma Unit Center, Tokyo, Japan
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Yang I, Ung N, Chung LK, Nagasawa DT, Thill K, Park J, Tenn S. Clinical manifestations of central neurocytoma. Neurosurg Clin N Am 2015; 26:5-10. [PMID: 25432178 DOI: 10.1016/j.nec.2014.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central neurocytomas (CNs) are rare central nervous system tumors that occur in the lateral ventricles. They are prevalent in young adults and are typically benign with excellent prognosis following surgical resection. Because of the rarity of the disease and its similar features with more common tumors, misdiagnosis becomes an issue. Optimal treatment is achieved only when the correct tumor types are distinguished. Typical clinical manifestations include symptoms of increased intracranial pressure, although no clinical feature is pathognomonic to CN. Radiologic imaging, histology, magnetic resonance spectroscopy, and immunohistochemistry must be used to elucidate tumor characteristics and properly diagnose CN.
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Affiliation(s)
- Isaac Yang
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA.
| | - Nolan Ung
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lawrance K Chung
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel T Nagasawa
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA
| | - Kimberly Thill
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA
| | - Junmook Park
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen Tenn
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
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11
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Choudhri O, Razavi SM, Vogel H, Li G. Atypical and Rare Variants of Central Neurocytomas. Neurosurg Clin N Am 2015; 26:91-8. [DOI: 10.1016/j.nec.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Vajrala G, Jain PK, Surana S, Madigubba S, Immaneni SR, Panigrahi MK. Atypical Neurocytoma: Dilemma in diagnosis and management. Surg Neurol Int 2014; 5:183. [PMID: 25593767 PMCID: PMC4287918 DOI: 10.4103/2152-7806.147414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Central neurocytoma is an uncommon benign tumor of the central nervous system. A section of these tumors have unusual aggressiveness and are termed as “atypical central neurocytomas,” the definition of which is debated. Many studies in the available literature define them as tumors with elevated MIB-1 labeling index (MIB-1 LI) >2%, while some associate them with higher values of MIB-1 LI or those with histological atypical features. Newer parameters also have been identified and correlated with MIB-1 LI to differentiate atypical from benign neurocytoma cases. A recent analysis of the atypical neurocytoma cases with malignant behavior revealed their increased tendency of spread through the cerebrospinal fluid causing craniospinal axis dissemination. However, limited studies document the appropriate indications and usefulness of additional therapeutic modalities, such as upfront craniospinal irradiation (CSI) or adjuvant chemotherapy, in countering the aggressive behavior of such tumors. Case Description: We present two such rare cases of atypical neurocytoma with elevated MIB-1 LI, of 3% and 4%, respectively, without histological atypia. Since there is insufficient evidence documenting advantages of any additional measures in the adjuvant management of atypical cases, both patients were treated with localized cranial radiotherapy alone, as per the evidence available in the literature currently. Conclusion: We propose that future studies must aptly redefine these atypical neurocytomas with malignant potential and provide guidance to identify aggressiveness of these tumors early in the course of management. Lastly, strong evidence to provide specific adjuvant therapy is also warranted.
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Affiliation(s)
- Gangadhar Vajrala
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
| | - Piyush K Jain
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
| | - Shitalkumar Surana
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
| | - Sailaja Madigubba
- Department of Pathology, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
| | - Satish R Immaneni
- Department of Pathology, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
| | - Manas K Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, (KIMS), Secunderabad, Andhra Pradesh, India
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Abstract
The establishment and identification of central neurocytoma as a distinct disease entity are invaluable in catalyzing investigations of neuronal differentiation in central nervous system tumors. The discovery of neuronal differentiation in neuroepithelial tumors has been extended to extraventricular tumors and potentially to various glial tumors undergoing neuronal differentiation. Understanding the disease spectrum of neuronal and mixed neuronal-glial tumors is important for deciphering the mechanism of gliomagenesis.
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Chen YD, Li WB, Feng J, Qiu XG. Long-term outcomes of adjuvant radiotherapy after surgical resection of central neurocytoma. Radiat Oncol 2014; 9:242. [PMID: 25373333 PMCID: PMC4236432 DOI: 10.1186/s13014-014-0242-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background and purpose The role of adjuvant radiotherapy for central neurocytomas (CNs) is not clear. Therefore, we aimed to examine the clinical outcomes of treating histologically confirmed CNs with adjuvant RT after surgical resection. Material and methods Sixty-three CN patients were retrospectively evaluated: 24 patients underwent gross total resection (GTR); 28, subtotal resection (STR); 9, partial resection (PR), and 2, biopsy (Bx). They underwent adjuvant RT after surgery (median dose, 54 Gy). Results The median follow-up was 69 months (15–129 months). The 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 94.4% and 95% after GTR + RT, 96.4% and 100% after STR + RT, and 100% and 90.9% after PR + RT. Only three patients had tumor recurrence: at the primary site at 30 and 24 months in two GTR + PR patients, and dissemination to the spinal cord at 75 months in one STR + RT patient. Thirty-eight (63.3%) patients experienced late neurotoxicity (28, grade 1; 7, grade 2; 3, grade 3). Short-term memory impairment was the most common toxicity. Conclusions RT after incomplete resection (IR) led to OS and PFS comparable to those for GTR. Considering the excellent outcomes and limited late toxicity, adjuvant RT maybe a good option for CN patients who undergo IR.
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Affiliation(s)
| | | | | | - Xiao-Guang Qiu
- Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Monaco EA, Niranjan A, Lunsford LD. The management of central neurocytoma: radiosurgery. Neurosurg Clin N Am 2014; 26:37-44. [PMID: 25432182 DOI: 10.1016/j.nec.2014.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stereotactic radiosurgery (SRS) has evolved into a mainstay in the primary and adjuvant management of most intracranial tumors. Central neurocytomas are rare, usually benign, intraventricular tumors that can be challenging to completely resect and often recur. Adjuvant therapy has been suggested for residual or recurrent tumors, especially in the setting of atypical neurocytomas. The limited data available suggest that SRS is a highly effective treatment approach for primary and adjuvant therapy, with tumor control rates of 80% to 90%. Due to its highly conformal and selective nature, SRS avoids the inconvenience and delayed toxicity of conventional radiation therapy.
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Affiliation(s)
- Edward A Monaco
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Qiu-lin L, Xiao-dong C, Da-yun P. 30 year-old male with headaches. Brain Pathol 2013; 23:605-6. [PMID: 24137620 DOI: 10.1111/bpa.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Liao Qiu-lin
- Department of Pathology, Liuhuaqiao Hospital of Guangzhou, Guangzhou 510010, China
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Clinical Course of Central Neurocytoma with Malignant Transformation—An Indication for Craniospinal Irradiation. Pathol Oncol Res 2013; 20:319-25. [DOI: 10.1007/s12253-013-9697-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Han L, Niu H, Wang J, Wan F, Shu K, Ke C, Lei T. Extraventricular neurocytoma in pediatric populations: A case report and review of the literature. Oncol Lett 2013; 6:1397-1405. [PMID: 24179531 PMCID: PMC3813794 DOI: 10.3892/ol.2013.1583] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/20/2013] [Indexed: 11/06/2022] Open
Abstract
Extraventricular neurocytomas (EVNs) are rare neuronal tumors included in the definition of neoplasms in the 2007 World Health Organization classification of tumors of the central nervous system. Although a small case series of EVNs in adults has been previously reported, EVNs in pediatric populations are extremely rare. The current case report presents the clinicopathological features of an EVN in a 2-year-old female who presented with nausea and vomiting that had lasted for five days. In addition, an analysis of the imaging features, histology, treatment and prognosis of these reported rare lesions is presented. Immunohistochemically, EVNs are characterized by the robust expression of synaptophysin, but with a lack of oligodendrocyte transcription factor 2, isocitrate dehydrogenase enzyme isoform 1 (IDH1) R132/IDH2 R172 mutations and p53 immunoexpression. The treatment for EVNs in pediatric and adult populations is gross total resection, with post-operative radiation reserved for subtotal resection or recurrent disease. In addition, drop metastasis must be carefully avoided.
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Affiliation(s)
- Lin Han
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Patel DM, Schmidt RF, Liu JK. Update on the diagnosis, pathogenesis, and treatment strategies for central neurocytoma. J Clin Neurosci 2013; 20:1193-9. [DOI: 10.1016/j.jocn.2013.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/10/2013] [Indexed: 01/19/2023]
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Juratli TA, Geiger K, Leimert M, Schackert G, Kirsch M. Atypical Central Neurocytoma with Recurrent Spinal Dissemination over a Period of 20 Years: A Case Report and Review of the Literature. Case Rep Neurol Med 2013; 2013:925647. [PMID: 23840986 PMCID: PMC3690632 DOI: 10.1155/2013/925647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/12/2013] [Indexed: 11/17/2022] Open
Abstract
We present an unusual case of a late recurrent central neurocytoma that was rediagnosed as an ependymoma and neurocytoma in accordance with changes in histological classifications. Case Description. A 56-year-old male teacher presented with incomplete transverse syndrome due to several intradural extramedullary tumors at the level of lumbar vertebrae 1-3. The histological diagnosis at the time was atypical ependymoma. One year later, two additional tumors were removed at the L5-S1 vertebral level. For 12 years, the patient remained tumor free on followup. Fourteen years after the initial diagnosis, the patient presented with thoracic paresthesias due to two new extramedullary tumors in the C7-T1 and the T8-T9 vertebral levels. After complete removal of the tumors, a radiological survey revealed an intracranial lesion in the third ventricle. Five months later, an additional lesion recurrence was removed surgically. The most recent histological diagnosis revealed an atypical central neurocytoma. In retrospect, the previous tumors were reclassified as neurocytoma according to the additional immunohistochemistry evidence. Discussion. There is no standard adjuvant treatment regimen for atypical neurocytoma; therefore, the patient is currently under close followup. Modern histopathological diagnosis is essential in these cases. Potential routes for dissemination of the tumor should be considered upon first recurrence.
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Affiliation(s)
- Tareq A. Juratli
- Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Kathrin Geiger
- Institute of Neuropathology, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Mario Leimert
- Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Matthias Kirsch
- Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Diffuse central neurocytoma with craniospinal dissemination. J Clin Neurosci 2011; 19:163-6. [PMID: 22088950 DOI: 10.1016/j.jocn.2011.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 07/11/2011] [Indexed: 11/21/2022]
Abstract
Central neurocytomas (CN) are benign central nervous system (CNS) tumors of neuroglial origin that represent 0.25 to 0.5% of all intracranial tumors in adults and an even smaller proportion of pediatric CNS tumors. These tumors characteristically occur in the subependymal layer of the lateral ventricle near the foramen of Monro and appear as sharply demarcated, solitary lesions. Surgical resection is considered curative, as the reported recurrence rate is less than 5% for patients with localized disease. In this report, we describe the case of a three-year-old boy with a diffuse CN with craniospinal dissemination identified at the time of diagnosis. Given the extensive nature of the disease, surgical resection was not indicated and he underwent a chemotherapeutic regimen of vincristine and carboplatin. At 18 months followup, the patient has completed 6 of 8 total cycles of vincristine and carboplatin and serial imaging shows stable disease within the craniospinal axis.
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Peltier J, Baroncini M, Le Gars D, Lejeune JP. [Central neurocytomas of the lateral ventricle. A series of 35 cases with review of the literature]. Neurochirurgie 2011; 57:215-9. [PMID: 22019220 DOI: 10.1016/j.neuchi.2011.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/11/2011] [Indexed: 11/30/2022]
Abstract
Central neurocytoma is the second most frequent tumor in our series of 284 lateral ventricle tumors (12%). Mean age was 32.6 years. There was a male predominance (20/35). Most frequent clinical signs were neuropsychological disturbances and intracranial hypertension. On imaging, these tumors concentrate central calcifications in more than half of cases. Main locations were frontal horn and corpus of lateral ventricle (82%). Uneventful postoperative course was recorded in 52% of cases. Immunoreactivity against neuron-specific enolase (NSE), synaptophysin, S100 protein, Microtubul Associated Protein de type 2 (MAP2) and calcineurin confirms the neuronal nature of the neoplasm. This tumor has a good prognosis. Local control after surgery is obtained in 68% of cases. Gamma knife surgery seems to be useful in cases of little volume with tumoral remnants or recurrence, when radiological appearance is well circumscribed and round-shaped.
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Affiliation(s)
- J Peltier
- Service de neurochirurgie, hôpital Nord, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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Chen MC, Pan DHC, Chung WY, Liu KD, Yen YS, Chen MT, Wong TT, Shih YH, Wu HM, Guo WY, Shiau CY, Wang LW, Lin CW. Gamma knife radiosurgery for central neurocytoma: retrospective analysis of fourteen cases with a median follow-up period of sixty-five months. Stereotact Funct Neurosurg 2011; 89:185-93. [PMID: 21546789 DOI: 10.1159/000326780] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/12/2011] [Indexed: 11/19/2022]
Abstract
OBJECT Central neurocytoma (CN) is considered to be a benign neuronal tumor with possible atypical behavior. Microsurgery, radiation therapy (RT) and radiosurgery all have been used in treating this rare disease during the past decade. In this study, the authors present the experience with gamma knife radiosurgery (GKRS) on 14 patients with CN during a median follow-up period of 65 months and document the safety and efficacy of GKRS in the treatment of CN. METHODS Between November 1997 and December 2009, 14 patients pathologically diagnosed with CN were treated with GKRS. Follow-up magnetic resonance imaging (MRI) was performed at 6-month intervals. Tumor volume and adverse radiation effects (ARE) were documented to evaluate tumor response to GKRS. The Karnofsky Performance Scale (KPS) and neurological status were used to assess clinical outcome. The mean radiation dose prescribed to the tumor margin was 12.1 Gy (ranging from 11 to 13 Gy). The mean tumor volume was 19.6 ml (ranging from 3.5 to 48.9 ml). The mean follow-up period was 70 months (ranging from 30 to 140 months), and the median follow-up period was 65 months. RESULTS Tumor shrinkage was found in all patients at the final MRI follow-up. The mean volume reduction was 69% (ranging from 47 to 87%). No tumor progression, ARE or radiation-related toxicity developed in any of the cases. The KPS scores of all patients were the same or had increased, and the neurological functions were all stable without deterioration at the final follow-up. CONCLUSION In our observations, GKRS was found to be an effective and safe alternative as adjuvant therapy for pathology-confirmed CN. The tumor volume and functional outcome can be controlled with a favorable result in long-term observation. Compared with RT and microsurgery, GKRS plays an important role in the treatment of CN as a minimally invasive technique with low morbidity. Regular long-term MRI follow-up should be mandatory to document the tumor response and possible recurrence. Multicenter consortia should be considered for further investigation and evaluation of GKRS for such a rare tumor.
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Affiliation(s)
- Meng-Chao Chen
- Department of Neurosurgery, Taipei City Hospital, Taiwan, Republic of China
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Rhiew RB, Manjila S, Lozen A, Guthikonda M, Sood S, Kupsky WJ. Leptomeningeal dissemination of a pediatric neoplasm with 1p19q deletion showing mixed immunohistochemical features of an oligodendroglioma and neurocytoma. Acta Neurochir (Wien) 2010; 152:1425-9. [PMID: 20446099 DOI: 10.1007/s00701-010-0674-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 04/21/2010] [Indexed: 12/13/2022]
Abstract
Leptomeningeal dissemination of an oligodendroglioma is rarely reported in the neurosurgical literature, especially in cases with a classical 1p19q deletion. The authors describe a case wherein a 1p19q deletion in a disseminated tumor with mixed immunohistochemical features of oligodendroglioma and neurocytoma was encountered and treated. Stereotactic right frontal craniotomy was undertaken for obtaining definitive histological diagnosis. The results revealed a neuroectodermal neoplasm with histologic and immunohistochemical features of oligodendroglioma and neurocytoma. FISH analysis confirmed classical 1p19q deletion. The patient was treated postoperatively with chemotherapy and radiation therapy. He showed good clinical response and remains alive 16 months after diagnosis.
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Affiliation(s)
- Richard B Rhiew
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
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27
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Tran H, Medina-Flores R, Cerilli LA, Phelps J, Lee FC, Wong G, Turner P. Primary disseminated central neurocytoma: cytological and MRI evidence of tumor spread prior to surgery. J Neurooncol 2010; 100:291-8. [DOI: 10.1007/s11060-010-0165-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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Terakawa Y, Tsuruno T, Ishibashi K, Okada Y, Shimotake K, Murata T. Central neurocytoma presenting with massive hemorrhage leading to coma--case report. Neurol Med Chir (Tokyo) 2010; 50:139-43. [PMID: 20185880 DOI: 10.2176/nmc.50.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 21-year-old man presented with a hemorrhagic central neurocytoma manifesting as acute onset of disturbance of consciousness and right hemiparesis. Computed tomography (CT) demonstrated a tumor in the left lateral ventricle during the course of evaluation for mental alteration 12 days before onset, but the tumor was left untreated because the patient refused to visit a neurosurgical institution. CT on admission revealed a large mass lesion located in the body of the lateral ventricle associated with massive intratumoral and intraventricular hemorrhage. He underwent emergent surgery for evacuation of the tumor with hematoma, and his neurological symptoms gradually recovered after surgery. The present case highlights the possibility of rapid deterioration of symptoms by massive hemorrhage from central neurocytoma. Surgical intervention should thoroughly be considered, if intratumoral hemorrhage is present, as hemorrhage from the central neurocytoma may lead to serious neurological complications.
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Affiliation(s)
- Yuzo Terakawa
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka.
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29
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Matsunaga S, Shuto T, Suenaga J, Inomori S, Fujino H. Gamma Knife Radiosurgery for Central Neurocytomas. Neurol Med Chir (Tokyo) 2010; 50:107-12; disucussion 112-3. [PMID: 20185873 DOI: 10.2176/nmc.50.107] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shigeo Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa.
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30
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Buchbinder D, Danielpour M, Yong WH, Salamon N, Lasky J. Treatment of atypical central neurocytoma in a child with high dose chemotherapy and autologous stem cell rescue. J Neurooncol 2009; 97:429-37. [PMID: 19924515 PMCID: PMC2858278 DOI: 10.1007/s11060-009-0029-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/25/2009] [Indexed: 11/30/2022]
Abstract
The authors describe a 9 month old female with recurrent atypical central neurocytoma and leptomeningeal spread treated with high dose chemotherapy, autologous stem cell rescue, and adjuvant therapy. She had a complete response to therapy and was disease free at 4 years of age until a recurrence 6 months later. The use of intensive chemotherapy followed by autologous stem cell rescue for atypical neurocytoma may be considered as an adjunct to surgical therapy in young patients with atypical neurocytoma not amenable to radiation therapy.
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Affiliation(s)
- David Buchbinder
- Department of Pediatric Hematology, Children’s Hospital of Orange County, 455 S. Main Street, Orange, CA 92868 USA
| | - Moise Danielpour
- Department of Pediatric Neurosurgery, Cedars-Sinai Medical Center, 8631 W. Third St., Suite 800 E, Los Angeles, CA 90048 USA
| | - William H. Yong
- Department of Pathology and Laboratory Medicine (Neuropathology), David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
| | - Joseph Lasky
- Department of Pediatrics, Division of Hematology/Oncology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Los Angeles, CA 90502 USA
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Christov C, Adle-Biassette H, Le Guerinel C. Recurrent central neurocytoma with marked increase in MIB-1 labelling index. Br J Neurosurg 2009. [DOI: 10.1080/02688699908540626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Wong J, Teo C, Kwok B. Central neurocytoma in third and fourth ventricles with aqueductal involvement. Br J Neurosurg 2009; 20:57-62. [PMID: 16698614 DOI: 10.1080/02688690600598463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Central neurocytomas are characterized by their intraventricular locations, usually arising from the lateral ventricles and their benign clinical course. Variations in location, histology and clinical behaviour have been reported in recent years. The authors present two cases of central neurocytomas arising in the third and fourth ventricles with aqueductal involvement. The atypical features in their location and behaviour are discussed. The cases represent the extended spectrum of central neurocytomas.
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Affiliation(s)
- J Wong
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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33
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Mpairamidis E, Alexiou GA, Stefanaki K, Sfakianos G, Prodromou N. Extraventricular neurocytoma in a child: case report and review of the literature. J Child Neurol 2009; 24:491-4. [PMID: 19339288 DOI: 10.1177/0883073808324534] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurocytomas are relatively rare central nervous system tumors first described in intraventricular sites but increasingly recognized in the brain and spinal cord parenchyma. Herewith, we report a case of a 3-year-old girl with generalized seizures. Computed tomography and magnetic resonance imaging revealed a lesion in the left frontal lobe. Angiography showed minimal vascularity. The tumor was totally excised. Histopathologic examination demonstrated an extraventricular neurocytoma. On follow-up magnetic resonance imaging after 1 year, no evidence of tumor recurrence was noted. Cerebral neurocytomas are histologically low-grade tumors and radical surgery is curative; they should be included in the differential diagnosis of cerebral tumors in children.
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Muragaki Y, Chernov M, Tajika Y, Kubo O, Iseki H, Hori T, Takakura K. Coincidence of central neurocytoma and multiple glioblastomas: a rare case report. J Neurooncol 2009; 93:431-5. [PMID: 19183852 DOI: 10.1007/s11060-008-9793-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
Coincidence of parenchymal primary brain tumors of different histogenesis is extremely rare. To the best of our knowledge, the present case of simultaneous appearance of a central neurocytoma and multiple glioblastomas is the first to be reported. Multiple intraaxial brain neoplasms were disclosed in a 39-year-old man and were surgically resected. Histological diagnosis of the tumor located in the right lateral ventricle was central neurocytoma whereas two tumors of the left temporal lobe were glioblastomas. The latter were located in close proximity to the subarachnoid space, had atypical radiological appearance, and were slightly positive for synaptophysin and neurofilament protein. It can be speculated that both malignant neoplasms were, in fact, dedifferentiated central neurocytoma, which developed from distant tumor deposits. This case seems to be in agreement with the hypothesis that central neurocytoma arises from the progenitor cells with potential for both neuronal and glial differentiation. Better understanding of histogenesis of this tumor is definitely needed.
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Affiliation(s)
- Yoshihiro Muragaki
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Shinjuku-ku, Japan.
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35
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Romano A, Chibbaro S, Makiese O, Marsella M, Mainini P, Benericetti E. Endoscopic removal of a central neurocytoma from the posterior third ventricle. J Clin Neurosci 2008; 16:312-6. [PMID: 19084413 DOI: 10.1016/j.jocn.2008.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 03/21/2008] [Accepted: 03/26/2008] [Indexed: 11/17/2022]
Abstract
Central neurocytoma is a rare benign tumor that most commonly arises within the ventricular system of young adults. Its occurrence in the posterior third ventricle is one of the least reported presentations. These tumors are usually treated by a combination of either biopsy or open surgical resection, often followed by radiation (Gamma knife or Novalis) with or without chemotherapy. A 37-year-old woman with a posterior third ventricle neurocytoma presented with acute signs of aqueductal stenosis. The patient underwent endoscopic assisted gross total resection of the tumor with the aid of intraoperative laser followed by standard third ventriculostomy; no further treatment was required. The patient did not develop any subsequent neurological deficit. A 36-month follow-up was still consistent with a normal neurological examination. Serial post-operative MRIs show neither residual nor recurrent tumor. Thus, posterior third ventricle central neurocytomas are relatively benign tumors that can be successfully removed using a minimally invasive approach, thereby avoiding both the morbidity related to conventional open craniotomy and the potential toxicity of any adjuvant treatment.
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Affiliation(s)
- A Romano
- Department of Neurosurgery, Parma University Hospital, Via Gramsci 14-43100, Parma, Italy.
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36
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Poliani PL, Sperli D, Valentini S, Armentano A, Bercich L, Bonetti MF, Corriero G, Brisigotti M, Quattrone A, Lanza PL. Spinal glioneuronal tumor with neuropil-like islands and meningeal dissemination: histopathological and radiological study of a pediatric case. Neuropathology 2008; 29:574-8. [PMID: 19077041 DOI: 10.1111/j.1440-1789.2008.00988.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral and spinal location of glioneuronal tumors have been recently described as a novel type of primary CNS neoplasia. A distinctive rare form of glioneuronal tumors with neuropil-like islands (GTNI) have been reported to occur in the adult cerebrum, whereas spinal GTNI localization is extremely rare. In the present report we describe a case of a 15-month-old child with a spinal GTNI of the cervical region and meningeal dissemination. Histologically the tumor was composed of round, small neurocytic-like cells arranged around eosinophilic neuropil cores and embedded in a diffuse fibrillar glial component forming prominent "rosetted" neuropil islands displaying strong immunoreactivity for neuronal markers. Cerebral GTNI shows abundant glial components not rarely exhibiting anaplastic features that justify their inclusion within the group of diffuse astrocytomas. In contrast, including our case, spinal GTNI do not show histological evidence of anaplastic features and exhibits a significant neuronal component that may imply considering these lesions in a separate group. Nevertheless, due to their exceptional rarity, the natural history of these lesions is not yet fully understood, but spinal GTNI seems to have an unfavorable clinical course despite their benign histopathological features, which must be taken into account for appropriate treatment and follow-up of the patient.
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Kerkovský M, Zitterbart K, Svoboda K, Hrivnacká J, Skotáková J, Sprláková-Puková A, Mechl M. Central neurocytoma: the neuroradiological perspective. Childs Nerv Syst 2008; 24:1361-9. [PMID: 18516608 DOI: 10.1007/s00381-008-0655-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Central neurocytoma (CN) represents a rare, relatively recently described primary central nervous system tumor. It ranks among intraventricular tumors due to its predominant location within the lateral brain ventricles. CN occurs mostly in young adults around the 3rd decade of life; almost a fifth of the cases are children under 18 years of age. OBJECTIVES The authors present three cases of patients with histopathologically confirmed CN, emphasizing diagnostic imaging issues. A review of the literature concerning differential diagnosis and clinical and therapeutic aspects is also presented. CONCLUSION Literature reports of CN comprise most likely case reports, small cohorts of patients, and meta-analytic studies due to the generally low incidence of this tumor. In the current paper, the authors summarize up-to-date knowledge of this rare disease on the background of their own observations. CN should be included in the list for differential diagnostics of intraventricular brain tumors, especially those located in lateral ventricles.
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Affiliation(s)
- M Kerkovský
- Department of Radiology, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic.
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38
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Central neurocytoma: 9 case series and review. ACTA ACUST UNITED AC 2008; 70:204-9. [DOI: 10.1016/j.surneu.2007.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Accepted: 04/30/2007] [Indexed: 11/22/2022]
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Raja AI, Yeaney GA, Jakacki RI, Hamilton RL, Pollack IF. Extraventricular neurocytoma in neurofibromatosis Type 1: case report. J Neurosurg Pediatr 2008; 2:63-7. [PMID: 18590398 DOI: 10.3171/ped/2008/2/7/063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurocytomas are rare tumors of the central nervous system that are typically located in the ventricular system. The authors report a case of a child with neurofibromatosis Type 1 (NF1) who had a tumor of the optic nerves and chiasm with signal abnormality extending through the diencephalon, as well as an occipital lobe mass, which was presumed to be part of the visual pathway neoplasm. Because the occipital lobe lesion slowly increased in size over time, while the other areas remained stable, a biopsy was performed. Pathological evaluation revealed an extraventricular neurocytoma of extraventricular neurocytoma. To the authors' knowledge, neurocytomas have not been previously reported in patients with NF1. Because visual pathway gliomas are extremely common in children with NF1, they are often treated empirically as low-grade gliomas without histological confirmation. The importance of obtaining a biopsy in lesions that have atypical imaging features is highlighted.
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Affiliation(s)
- Ali I Raja
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA
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40
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Chen CL, Shen CC, Wang J, Lu CH, Lee HT. Central neurocytoma: a clinical, radiological and pathological study of nine cases. Clin Neurol Neurosurg 2007; 110:129-36. [PMID: 18022760 DOI: 10.1016/j.clineuro.2007.09.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 09/23/2007] [Accepted: 09/25/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Central neurocytoma is a rare intraventricular brain tumor that affects young adults and presents with increased intracranial pressure secondary to obstructive hydrocephalus. Typically, it has a favorable prognosis after adequate surgical intervention, but in some cases the clinical course is more aggressive. In this report, we describe the diagnosis and treatment of central neurocytoma in a series of patients at our institution. PATIENTS AND METHODS Our series of nine patients (M:F=2:7, mean age, 28.2 years) with ventricular tumors showed typical radiological, histologic and immunohistochemical features of central neurocytoma. Most patients received craniotomy with removal of the tumor through transcallosal or transcortical approach. The surgical and histopathologic data of these patients were reviewed and analyzed. RESULTS The prognosis is generally favorable. Although most patients were alive and well at the last follow-up, two developed recurrence. Typical histologic features of recurrent neurocytoma include high proliferative activity (MIB-1 labeling index: 2.0-6.8%), prominent vascular proliferation and remarkable synaptophysin expression. Two patients (non-recurrent) died during follow-up due to sepsis or central failure. The MIB-1 labeling indices were as high as 2.2-5.4% for these two patients. CONCLUSION Although central neurocytoma is generally a benign neoplasm, some variant forms of recurrence are also present. Complete resection provides favorable long-term prognosis in most cases. Recurrent tumors are often local and the patients seem to recover well after a second resection followed by radiotherapy. Histologic features such as tumor proliferation (MIB-1 labeling index), vascular proliferation, and synaptophysin expression are often prominent in the recurrent tumor. We recommend that these histologic features be considered for tumor recurrence during treatment and follow-up of these patients.
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Affiliation(s)
- Chun-Lin Chen
- Department of Neurosurgery, Taichung Veterans General Hospital, 160, Sec. 3, Taichung Harbor Road, Taichung 40705, Taiwan, ROC
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Abstract
Object
Although considered benign tumors, neurocytomas have various biological behaviors, histological patterns, and clinical courses. In the last 15 years, fractionated radiotherapy and radiosurgery in addition to microsurgery have been used in their management. In this study, the authors present their experience using Gamma Knife surgery (GKS) in the treatment of these tumors.
Methods
Between 1989 and 2004, the authors performed GKS in seven patients with a total of nine neurocytomas. Three patients harbored five recurrent tumors after a gross-total resection, three had progression of previous partially resected tumors, and one had undergone a tumor biopsy only. The mean tumor volume at the time of GKS ranged from 1.4 to 19.8 cm3 (mean 6.0 cm3). A mean peripheral dose of 16 Gy was prescribed to the tumor margin with the median isodose configuration of 32.5%.
Results
After a mean follow-up period of 60 months, four of the nine tumors treated disappeared and four shrank significantly. Because of secondary hemorrhage, an accurate tumor volume could not be determined in one. Four patients were asymptomatic during the follow-up period, and the condition of the patient who had residual hemiparesis from a previous transcortical resection of the tumor was stable. Additionally, the patient who experienced tumor hemorrhage required a shunt revision, and another patient died of sepsis due to a shunt infection.
Conclusions
Based on this limited experience, GKS seems to be an appropriate management alternative. It offers control over the tumor with the benefits of minimal invasiveness and low morbidity rates. Recurrence, however, is not unusual following both microsurgery and GKS. Open-ended follow-up imaging is required to detect early recurrence and determine the need for retreatment.
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Affiliation(s)
- Chun Po Yen
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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Yeh IB, Xu M, Ng WH, Ye J, Yang D, Lim CCT. Central neurocytoma: typical magnetic resonance spectroscopy findings and atypical ventricular dissemination. Magn Reson Imaging 2007; 26:59-64. [PMID: 17574365 DOI: 10.1016/j.mri.2007.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 04/05/2007] [Accepted: 04/21/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Central neurocytomas (CNCs) are rare neuronal tumors that have a favorable prognosis and lower rate of recurrence compared with other intraventricular neoplasms. Although it may be difficult to distinguish CNC on conventional neuroimaging, typical MR spectroscopy (MRS) features have been reported. We describe the MRI and MRS features of CNC. MATERIALS AND METHODS Eight patients with CNC were reviewed. Three patients underwent presurgical in vivo single-voxel MRS at short echo time (TE, 35 ms) and multi-voxel MR spectroscopic imaging at long TE (144 ms). The surgically resected tumor specimen of one of these patients was also studied ex vivo using high-resolution magic angle spinning (HRMAS) nuclear magnetic resonance. RESULTS All eight tumors were located in the lateral ventricles. In six patients, CNC extended into the third ventricle, and in two patients the tumor showed further contiguous intraventricular dissemination into the fourth ventricle. In all three patients who underwent MRS, a characteristic metabolite peak was detected at 3.55 parts per million (ppm) at both long and short TE. HRMAS confirmed the presence of elevated glycine (Gly) at 3.55 ppm, without increase in the concentration of myo-inositol found at the same chemical shift. Elevated choline (at 3.2 ppm) was also seen in all three patients. CONCLUSION On MRS, CNCs have a typical appearance with a metabolite peak at 3.55 ppm due to increased Gly, and this feature may be helpful in presurgical diagnosis. Although they are rare benign intraventricular tumors, in atypical cases, CNCs can show extensive intraventricular dissemination into the fourth ventricle.
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Affiliation(s)
- Ing Berne Yeh
- Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore
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A rare case of extraventricular neurocytoma. Brain Tumor Pathol 2007; 24:19-23. [DOI: 10.1007/s10014-006-0210-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 09/14/2006] [Indexed: 10/23/2022]
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Leenstra JL, Rodriguez FJ, Frechette CM, Giannini C, Stafford SL, Pollock BE, Schild SE, Scheithauer BW, Jenkins RB, Buckner JC, Brown PD. Central neurocytoma: Management recommendations based on a 35-year experience. Int J Radiat Oncol Biol Phys 2007; 67:1145-54. [PMID: 17187939 DOI: 10.1016/j.ijrobp.2006.10.018] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the outcomes of patients with histologically confirmed central neurocytomas. METHODS AND MATERIALS The data from 45 patients with central neurocytomas diagnosed between 1971 and 2003 were retrospectively evaluated. Various combinations of surgery, radiotherapy (RT), and chemotherapy had been used for treatment. RESULTS The median follow-up was 10.0 years. The 10-year overall survival and local control rate was 83% and 60%, respectively. Patients whose tumor had a mitotic index of <3 (per 10 high-power fields) experienced a 10-year survival and local control rate of 89% and 74%, respectively, compared with 57% (p = 0.040) and 46% (p = 0.14) for patients with a tumor mitotic index of > or =3. The 10-year survival and local control rate was 90% and 74% for patients with typical tumors compared with 63% (p = 0.055) and 46% (p = 0.41) for those with atypical tumors. A comparison of gross total resection with subtotal resection showed no significant difference in survival or local control. Postoperative RT improved local control at 10 years (75% with RT vs. 51% without RT, p = 0.045); however, this did not translate into a survival benefit. No 1p19q deletions were found in the 19 tumors tested. CONCLUSION Although the overall prognosis is quite favorable, one-third of patients experienced tumor recurrence or progression at 10 years, regardless of the extent of the initial resection. Postoperative RT significantly improved local control but not survival, most likely because of the effectiveness of salvage RT. For incompletely resected atypical tumors and/or those with a high mitotic index, consideration should be given to adjuvant RT because of the more aggressive nature.
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Affiliation(s)
- James L Leenstra
- Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Lightfoot NJ, Lucas PG, Finnis NDM. Disseminated haemangioblastoma without evidence of the von Hippel-Lindau syndrome or haemangioblastomatosis--A case report and clinico-pathological correlation. Clin Neurol Neurosurg 2007; 109:305-10. [PMID: 17250956 DOI: 10.1016/j.clineuro.2006.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 12/16/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
A 71-year-old Caucasian female presented to our service with disseminated cranial and spinal haemangioblastomata but no other features to suggest the von Hippel-Lindau syndrome. We feel that this represents cellular dissemination through the cerebro-spinal fluid and may be an intermediate step to the development of frank haemangioblastomatosis. By comparing this presentation to that of other tumours we have suggested a potential pathological mechanism and have discussed its management.
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Affiliation(s)
- Nicholas J Lightfoot
- Department of Neurosurgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
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Ide M, Hagiwara S, Kawamura H, Aiba M. Central neurocytoma with unusually high MIB-1 index. Acta Neurochir (Wien) 2006; 148:1217-8. [PMID: 16955227 DOI: 10.1007/s00701-006-0878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Accepted: 07/20/2006] [Indexed: 10/24/2022]
Affiliation(s)
- M Ide
- Department of Neurosurgery, Tokyo Women's Medical University Medical Centre East, Tokyo, Japan.
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Affiliation(s)
- T S Jacques
- Division of Neuropathology and Department of Molecular Neuroscience, Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
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De Tommasi A, D'Urso PI, De Tommasi C, Sanguedolce F, Cimmino A, Ciappetta P. Central neurocytoma: two case reports and review of the literature. Neurosurg Rev 2006; 29:339-47. [PMID: 16953449 DOI: 10.1007/s10143-006-0041-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 02/20/2006] [Accepted: 07/13/2006] [Indexed: 11/29/2022]
Abstract
Central neurocytomas are low grade tumours usually located in the lateral ventricles next to Monro foramina. This paper reviews the literature on central neurocytomas observed in the last few years and discusses their clinical, histopathological, immunohistochemical and genetic characteristics. Important correlations between therapeutic strategies and biological findings as well as new genetic discoveries are also discussed. Two illustrative cases in which the authors report preliminary results about molecular analysis of some genetic markers are described.
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Affiliation(s)
- Antonio De Tommasi
- University of Bari, Azienda Policlinico-Piazza Giulio Cesare n.11, 70124 Bari, Italy.
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Sharma MC, Deb P, Sharma S, Sarkar C. Neurocytoma: a comprehensive review. Neurosurg Rev 2006; 29:270-85; discussion 285. [PMID: 16941163 DOI: 10.1007/s10143-006-0030-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 01/12/2006] [Accepted: 02/27/2006] [Indexed: 11/24/2022]
Abstract
Central neurocytomas (CN) are uncommon tumors of the central nervous system, most descriptions of which available in the literature are in the form of isolated case reports and small series. Owing to this rare incidence, diagnosis and management of this neoplasm remain controversial. Usually, these tumors affect lateral ventricles of young adults and display characteristic neuroimaging and histomorphologic findings. Neurocytomas often mimic oligodendrogliomas when confirmation of diagnosis rests on immunohistochemistry, ultrastructure, and genetic studies. Extraventricular neurocytomas, situated entirely within the brain parenchyma and spinal cord, have also been reported. Typically, CN are associated with a favorable outcome although cases with more aggressive clinical course with recurrences are not unknown. MIB-1 labeling index (LI) of >2% often heralds poor prognosis and tumour recurrence. Safe maximal resection is presently considered the ideal therapeutic option, with best long-term prognosis in terms of local control and survival. The role of adjuvant radiotherapy apparently seems to benefit patients with incomplete resection and in atypical neurocytoma. Utility of other therapeutic regimen, however, remains shrouded in controversy. Epidemiology, histogenesis, clinical profile, histology, neuroimaging and therapeutic modalities of neurocytomas have been comprehensively reviewed, with special emphasis on CN and extraventricular neurocytomas and their atypical counterparts.
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Affiliation(s)
- Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Lenzi J, Salvati M, Raco A, Frati A, Piccirilli M, Delfini R. Central neurocytoma: a novel appraisal of a polymorphic pathology. Our experience and a review of the literature. Neurosurg Rev 2006; 29:286-92; discussion 292. [PMID: 16604374 DOI: 10.1007/s10143-006-0024-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 12/01/2005] [Accepted: 12/28/2005] [Indexed: 11/30/2022]
Abstract
Central neurocytoma should be considered in the differential diagnosis of intraventricular tumours. The records of 20 patients operated on between 1975 and 2000 for central neurocytoma were retrospectively reviewed, and the histological gradings and clinical outcomes were compared. On the basis of our previous cases, in the latter five of this series, the following therapeutic protocol was adopted. In those cases in which total removal was achieved, no further treatment was given if the MIB-1 index was <4%; vice versa, if it was >4%, a course of conformational radiotherapy was delivered. In subtotally removed cases, radiosurgery with linac was also performed (median dose 20 Gy) as well as conformational radiotherapy whenever there was a recurrence of the lesion (median dose 45 Gy). In cases in which there was only partial cytoreduction, conformational radiotherapy was administered with the adjunct of polychemotherapy if the MIB-1 was >4%. Twenty patients were surgically treated: 11 men and nine women, with an average age of 26 years (range 17 years to 42 years).Total, subtotal and partial removals were achieved in, respectively, ten, three and seven cases. At average follow-up of 7 years, 16 patients had been cured, had significantly improved or were at least stable [Karnofsky performance status score (KPS)] >70 or more)]. On the other hand, four patients had worsened; of these, two had died and two had a KPS=50 and an unfavourable prognosis. The presence of histological atypia has proved to be a significantly negative risk factor for survival (P=0.02) while an MIB score >4% was significantly correlated with an unfavourable outcome (death or worsening of neurological status). The "atypical" neurocytoma seems to be a distinct entity, with a less favourable prognosis and a higher tendency to recur.
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Affiliation(s)
- Jacopo Lenzi
- Department of Neurosurgery, University of Rome La Sapienza, Rome, Italy
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