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Gaines JJ, Gilbert BC, Gossage JR, Parker W, Reddy A, Forseen SE. Schizencephaly in Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2022; 43:1603-1607. [PMID: 36265891 PMCID: PMC9731247 DOI: 10.3174/ajnr.a7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The presence of malformations of cortical development in patients with hereditary hemorrhagic telangiectasia has been reported on previous occasions. We evaluated a sample of adults with hereditary hemorrhagic telangiectasia for the presence of malformations of cortical development, spatial coincidence of malformations of cortical development and AVMs, and the coincidence of brain and pulmonary AVMs. MATERIALS AND METHODS A total of 141 patients 18 years of age or older who were referred to the Augusta University hereditary hemorrhagic telangiectasia clinic and underwent brain MR imaging between January 19, 2018, and December 3, 2020, were identified. MR imaging examinations were reviewed retrospectively by 2 experienced neuroradiologists, and the presence of malformations of cortical development and AVMs was confirmed by consensus. Demographic and clinical information was collected for each case, including age, sex, hereditary hemorrhagic telangiectasia status by the Curacao Criteria, mutation type, presence of malformations of cortical development, presence of brain AVMs, presence of pulmonary AVMs, and a history of seizures or learning disabilities. RESULTS Five of 141 (3.5%) patients with hereditary hemorrhagic telangiectasia had malformations of cortical development. Two of the 5 patients with polymicrogyria also had closed-lip schizencephaly. One of the patients had a porencephalic cavity partially lined with heterotopic GM. The incidence of spatially coincident polymicrogyria and brain AVMs was 40% (2/5 cases). Of the patients with hereditary hemorrhagic telangiectasia and malformations of cortical development, 4/5 (80%) had pulmonary AVMs and 2/5 (40%) had brain AVMs. CONCLUSIONS To our knowledge, we are the first group to report the presence of schizencephaly in patients with hereditary hemorrhagic telangiectasia. The presence of schizencephaly and porencephaly lends support to the hypothesis of regional in utero cerebral hypoxic events as the etiology of malformations of cortical development in hereditary hemorrhagic telangiectasia.
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Affiliation(s)
- J J Gaines
- Department of Medicine, Medical College of Georgia (J.J.G.) at Augusta University, Augusta, Georgia
| | - B C Gilbert
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - J R Gossage
- Department of Hereditary Hemorrhagic Telangiectasia (J.R.G.), Section of Pulmonary Diseases
| | - W Parker
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - A Reddy
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - S E Forseen
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
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Morris JA, Gilbert BC, Parker WT, Forseen SE. Anatomy of the Ventricles, Subarachnoid Spaces, and Meninges. Neuroimaging Clin N Am 2022; 32:577-601. [PMID: 35843664 DOI: 10.1016/j.nic.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The ventricular system, subarachnoid spaces, and meninges are structures that lend structure, support, and protection to the brain and spinal cord. This article provides a detailed look at the anatomy of the intracranial portions of these structures with a particular focus on neuroimaging methods.
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Affiliation(s)
- John A Morris
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Bruce C Gilbert
- Neuroradiology, Neuroradiology Section, Department of Radiology and Imaging, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - William T Parker
- Neuroradiology, Neuroradiology Section, Department of Radiology and Imaging, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Scott E Forseen
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
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Scelsi CL, Rahim TA, Morris JA, Kramer GJ, Gilbert BC, Forseen SE. The Lateral Ventricles: A Detailed Review of Anatomy, Development, and Anatomic Variations. AJNR Am J Neuroradiol 2020; 41:566-572. [PMID: 32079598 PMCID: PMC7144651 DOI: 10.3174/ajnr.a6456] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
The cerebral ventricles have been studied since the fourth century BC and were originally thought to harbor the soul and higher executive functions. During the infancy of neuroradiology, alterations to the ventricular shape and position on pneumoencephalography and ventriculography were signs of mass effect or volume loss. However, in the current era of high-resolution cross-sectional imaging, variation in ventricular anatomy is more easily detectable and its clinical significance is still being investigated. Interpreting radiologists must be aware of anatomic variations of the ventricular system to prevent mistaking normal variants for pathology. We will review of the anatomy and development of the lateral ventricles and discuss several ventricular variations.
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Affiliation(s)
- C L Scelsi
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - T A Rahim
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - J A Morris
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - G J Kramer
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - B C Gilbert
- Neuroradiology (B.C.G., S.E.F.), Medical College of Georgia, Augusta, Georgia
| | - S E Forseen
- Neuroradiology (B.C.G., S.E.F.), Medical College of Georgia, Augusta, Georgia
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Gupta VR, Giller C, Kolhe R, Forseen SE, Sharma S. Polymorphous Low-Grade Neuroepithelial Tumor of the Young: A Case Report with Genomic Findings. World Neurosurg 2019; 132:347-355. [PMID: 31520766 DOI: 10.1016/j.wneu.2019.08.221] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently recognized epileptogenic neuroepithelial tumor. Despite its distinctiveness, its polymorphous histology and the nature of its oligodendrocyte-like cells remain unclear. CASE DESCRIPTION A 30-year-old, right-handed man was diagnosed with intractable epilepsy since 22 years of age. Magnetic resonance imaging revealed T2 signal hyperintensity and corresponding T1 signal hypointensity within the subcortical white matter of the right middle temporal gyrus. Positron emission tomography scan demonstrated hypometabolism in the right anterior temporal region. Electroencephalography and stereo-electroencephalography monitoring localized seizures to the right temporal lobe, allowing the patient to undergo right temporal lobectomy. Histologic sections demonstrated cortical dysplasia, white matter heterotopia, and hippocampal reactive gliosis without neuronal loss. Interestingly, an approximately 6-mm subcortical neoplasm was identified in the temporal lobectomy. It was composed of well-differentiated oligodendroglial-like cells but exhibited mild-to-moderate nuclear variability and pleomorphism, and mild infiltration into the overlying cortex without perineuronal satellitosis. No mitotic activity, microvascular proliferation, or necrosis was identified, and Ki-67 labeling index was less than 1%. The tumor was diffusely CD34 positive with moderate glial fibrillary acidic protein and retained ATRX staining, and demonstrated the presence of the BRAF V600E mutation. The tumor was negative for reticulin condensation, synaptophysin, SMI31, neuronal nuclei immunostains, and both the IDH1 mutation and 1p19q codeletion. Overall histologic findings were most consistent with PLNTY. CONCLUSIONS The correct diagnosis of PLNTY and its distinction from closely resembling low-grade neuroepithelial tumors is important. We hope our proposed diagnostic features will aid in its proper diagnosis and management.
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Affiliation(s)
- V Rohan Gupta
- Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Cole Giller
- Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Ravindra Kolhe
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Scott E Forseen
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Suash Sharma
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
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Viers AG, Nguyen KD, Moon PX, Forseen SE, Heger IM. Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement. J Neurosurg Pediatr 2019; 23:634-638. [PMID: 30835709 DOI: 10.3171/2019.1.peds18583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Occipitocervical fusions in the pediatric population are rare but can be challenging because of the smaller anatomy. The procedure is even more exacting in patients with prior suboccipital craniectomy. A proposed method for occipitocervical fusion in such patients is the use of occipital condyle screws. There is very limited literature evaluating the pediatric occipital condyle for screw placement. The authors examined the occipital condyle in pediatric patients to determine if there was an age cutoff at which condylar screw placement is contraindicated. METHODS The authors performed a retrospective morphometric analysis of the occipital condyle in 518 pediatric patients aged 1 week-9 years old. Patients in their first decade of life whose occipital condyle was demonstrated on CT imaging in the period from 2009 to 2013 at the Augusta University Medical Center and Children's Hospital of Georgia were eligible for inclusion in this study. Exclusion criteria were an age older than 10 years; traumatic, inflammatory, congenital, or neoplastic lesions of the occipital condyles; and any previous surgery of the occipitocervical junction. Descriptive statistical analysis was performed including calculation of the mean, standard deviation, and confidence intervals for all measurements. Probability values were calculated using the Student t-test with statistical significance determined by p < 0.05. RESULTS Overall, male patients had statistically significantly larger occipital condyles than the female patients, but this difference was not clinically significant. There was no significant difference in left versus right occipital condyles. There were statistically significant differences between age groups with a general trend toward older children having larger occipital condyles. Overall, 20.65% of all patients evaluated had at least one measurement that would prevent occipital condyle screw placement including at least one patient in every age group. CONCLUSIONS Occipital condyle screw fixation is feasible in pediatric patients younger than 10 years. More importantly, all pediatric patients should undergo critical evaluation of the occipital condyle in the axial, sagittal, and coronal planes preoperatively to determine individual suitability for occipital condyle screw placement.
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Affiliation(s)
- Angela G Viers
- 1Department of Neurosurgery, Augusta University Medical Center, Augusta
| | - Khoi D Nguyen
- 1Department of Neurosurgery, Augusta University Medical Center, Augusta
| | - Perounsack X Moon
- 2Philadelphia College of Osteopathic Medicine Georgia Campus, Suwanee; and
| | - Scott E Forseen
- 3Department of Radiology and Imaging, Neuroradiology Section, Augusta, Georgia
| | - Ian M Heger
- 1Department of Neurosurgery, Augusta University Medical Center, Augusta
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Yowtak J, Sharma S, Forseen SE, Alleyne CH. Anterior Gray Matter Pituicytic Heterotopia with Monomorphic Anterior Pituitary Cells: A Variant of Nonsecretory Pituitary Adenoma Neuronal Choristoma? Report of a Rare Case and Review of the Literature. World Neurosurg 2016; 97:759.e1-759.e8. [PMID: 27744079 DOI: 10.1016/j.wneu.2016.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mixed tumors of adenomatous and neuronal cells in the sellar region are an uncommon finding. The origins of these heterogeneous tumors are unknown, and management remains unsettled. We report a very rare case of anterior gray matter pituicytic heterotopia with monomorphic anterior pituitary cells that likely represents a variant of nonsecreting pituitary adenoma neuronal choristoma (PANCH) with no ganglion cells. We also review the current literature for the various clinical presentations of PANCH. CASE DESCRIPTION A 49-year-old female complaining of headache, blurred vision, and hair loss was found to have a nonsecretory sellar mass with compression of the optic chiasm on magnetic resonance imaging (MRI). The mass was excised via a transsphenoidal procedure. Histological analysis of tissue sections revealed heterotopic gray matter with reactive gliosis without ganglion cells or Herring bodies. Only 1 smear exhibited characteristics of a pituitary adenoma. CONCLUSIONS The overall findings were most consistent with a variant of PANCH. At a postoperative follow-up of 4.5 years, there was resolution of visual symptoms, and the residual sellar mass was stable on MRI. Neuronal choristoma is hypothesized to originate from embryonal pituitary or hypothalamus, or by differentiation from pituitary adenoma cells. Surgery is the cornerstone of management, and the clinical course appears to be similar to that of nonfunctioning pituitary adenoma in reported cases.
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Affiliation(s)
- June Yowtak
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
| | - Suash Sharma
- Department of Pathology, Augusta University, Augusta, Georgia, USA
| | - Scott E Forseen
- Department of Radiology, Augusta University, Augusta, Georgia, USA
| | - Cargill H Alleyne
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA
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Switzer JA, Forseen SE, Bruno A, Hess DC. Serendipitous recanalization of basilar artery occlusion. J Stroke Cerebrovasc Dis 2013; 22:e671-3. [PMID: 23834852 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/17/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe a case of recanalization of a basilar artery occlusion with intravenous (IV) tenecteplase. CASE A 74-year-old man with a history of cardiomyopathy presented to an outside hospital with acute vertigo, dysarthria, gaze deviation, and ataxia. Computerized tomography arteriography demonstrated occlusion of the proximal basilar artery. IV tissue plasminogen activator was ordered; however, the patient received a cardiac dose of IV tenecteplase. The patient was transferred to our facility, whereby symptoms resolved, and repeat computerized tomography arteriography displayed recanalization of the basilar artery. CONCLUSIONS Tenecteplase has enhanced biochemical and pharmacokinetic properties that may be ideal for treatment of basilar artery occlusion and should be further investigated in a randomized clinical trial.
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Pillai JJ, Williams HT, Forseen SE, Park YD. Presurgical lateralization of seizure focus in temporal lobe epilepsy with noninvasive imaging. Clin Nucl Med 2013; 37:1179-81. [PMID: 23154478 DOI: 10.1097/rlu.0b013e31825ae8d0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We retrospectively compared the seizure focus-localizing capability of interictal PET/CT to that of interictal magnetic resonance diffusion-weighted imaging and ictal SPECT in 21 patient candidate for neurosurgery with temporal lobe epilepsy (TLE) by assessing overall lateralizing ability of these modalities and concordance of findings on these studies with results of electroencephalography (EEG). PET/CT demonstrated the greatest lateralizing ability of any of the imaging modalities and had the highest concordance rate for lateralization with EEG, highlighting its increasing diagnostic utility in the preoperative imaging workup of patients with medically intractable TLE.
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Affiliation(s)
- Jay J Pillai
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
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Potti A, Forseen SE, Koka VK, Pervez H, Koch M, Fraiman G, Mehdi SA, Levitt R. Determination of HER-2/neu overexpression and clinical predictors of survival in a cohort of 347 patients with primary malignant brain tumors. Cancer Invest 2004; 22:537-44. [PMID: 15565811 DOI: 10.1081/cnv-200026523] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION HER-2/neu overexpression has been associated with poor prognosis in a variety of malignancies. The extent and relevance of HER-2/neu overexpression in human central nervous system (CNS) malignancies is unclear. We retrospectively analyzed a large cohort of patients with primary malignant brain tumors to evaluate the role of HER-2/neu overexpression, clinical characteristics at presentation, and other predisposing factors as predictors of survival. MATERIALS AND METHODS Records of 347 adult patients (193 males, 154 females) diagnosed and followed between 1986 and 2001 with a biopsy-proven diagnosis of a primary malignant brain tumor at a tertiary care oncology center were reviewed. Archival pathologic samples were analyzed for HER-2/neu overexpression using the Hercep immunohistochemical (IHC) assay (DAKO). A score of 2+ or greater on the assay was considered positive for HER-2/neu overexpression. Mortality and its predictors were evaluated using multiple logistic regression. (This study was approved and reviewed by the Institutional Review Board Committee [IRB] of University of North Dakota School of Medicine and Health Sciences.) RESULTS Among the 347 adult patients with a mean age of 53 years (range; 41-73 years), overall mean survival was 23 months (range; 0-151 months). It was found that 10.4% of the archival pathologic samples showed presence of HER-2/neu overexpression by IHC. The HER-2/neu overexpression predicted significantly increased mortality [p = 0.01, analysis of variance (ANOVA)]. Other clinical predictors associated with increased mortality included site of tumor (occipital and parietal lobes) (p = 0.02, ANOVA), tumor histology (glioblastoma) (p < 0.01, ANOVA), and presenting symptom (nausea/vomiting) (p < 0.01, ANOVA). Also, there was a higher incidence of associated primary malignancies (outside the CNS) in the HER-2/neu overexpression group (30% vs. 7%). CONCLUSIONS HER-2/neu overexpression seen in 10.4% appears to predict a slight increased mortality in patients with primary malignant brain tumors, especially glioblastoma multiforme, and is associated with a high incidence of a second primary malignancy outside the CNS. Additionally, our data suggests that other clinical variables were predictive of increased mortality, including tumor location (occipital), histology (glioblastoma), and presenting symptoms (nausea/vomiting). The large, heterogeneous sample employed in our study allows more definitive conclusions to be made with regard to the usefulness of HER-2/neu and other clinical predictors of survival in patients with primary brain tumors.
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Affiliation(s)
- Anil Potti
- Department of Internal Medicine, Division of Oncology, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
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Koka V, Potti A, Forseen SE, Pervez H, Fraiman GN, Koch M, Levitt R. Role of Her-2/neu overexpression and clinical determinants of early mortality in glioblastoma multiforme. Am J Clin Oncol 2003; 26:332-5. [PMID: 12902879 DOI: 10.1097/01.coc.0000020922.66984.e7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Her-2/neu or c-erbB-2, a 185-kD protein is an important prognostic indicator/target for therapy in metastatic breast carcinoma. Recent reports have also identified a role for Her-2/neu overexpression in other solid tumors. We performed a retrospective analysis to evaluate the prevalence and prognostic role of Her-2/neu overexpression in patients with glioblastoma multiforme (GBM). Data collection (chart review) included demographic information, symptoms at presentation, histologic grade, survival time, and treatment offered. Testing for Her-2/neu overexpression was performed on paraffin-embedded archival tumor tissue using immunohistochemistry (IHC) (Hercep test). An IHC score of 2+ or greater was considered overexpression. An experienced pathologist who was blinded from the clinical history performed all the IHC testing. Between 1990 and 2001, 149 subjects (68 females, 81 males) with a biopsy-proven diagnosis of GBM were identified. Age range was 26 to 79 years (mean: 64 years) and overall mean survival was 12 months. Her-2/neu overexpression was detected in 23 patients (15.4%). Interestingly, the median survival for patients whose pathologic specimens revealed Her-2/neu overexpression was 4 months compared to those who lacked overexpression, in whom survival was 8 months. After adjusting for age, performance status, smoking history, and treatment, logistic regression analysis (with a survival of <3 months as the dependent variable) revealed that Her-2/neu overexpression significantly (p < 0.01) increased the odds of early mortality (<3 months). The results of our large study indicate that Her-2/neu overexpression may be a poor prognostic marker in patients with GBM. In addition, in a proportion of subjects (15.4%), Her-2/neu may be a potential target for tumor-specific monoclonal antibody therapy. The role of trastuzumab (alone or in combination with conventional therapy) needs to be evaluated.
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Affiliation(s)
- Vijay Koka
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102, USA
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Forseen SE, Potti A, Koka V, Koch M, Fraiman G, Levitt R. Identification and relationship of HER-2/neu overexpression to short-term mortality in primary malignant brain tumors. Anticancer Res 2002; 22:1599-602. [PMID: 12168843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION HER-2/neu overexpression has been associated with poor prognosis in solid tumors. The extent to which HER-2/neu is overexpressed in human central nervous system malignancies is unclear. We retrospectively analyzed a large cohort of patients with primary brain tumors to evaluate the prognostic role of HER-2/neu overexpression and clinical characteristics at presentation in patients with shortened survival (< 6 months). MATERIALS AND METHODS Between 1986 and 2001, 136 patients (81 males, 55 females) with a mean age of 69 years (age range: 49-78 years), with a biopsy-proven diagnosis of a primary malignant brain tumor and survival of < six months from the time of diagnosis, were identified. Archival tissue samples were analyzed for HER-2/neu overexpression using the Hercep immunohistochemical assay. A score of 2+ or greater on the assay was considered positive for HER-2/neu overexpression. Short-term mortality (less than 6 months) and its predictors were evaluated using multiple logistic regression. RESULTS Mean overall survival was 2.8 months. HER-2/neu overexpression was detected in 23 out of 136 specimens (17%). However, HER-2/neu overexpression did not predict increased 6-month mortality (p = 0.43). Interestingly, the presence of HER-2/neu overexpression was associated with a significantly increased risk of an associated second primary malignancy in addition to the primary brain tumor. Other factors examined did not predict increased 6-month mortality either, including site of tumor (p = 0.54), tumor histology (p = 0.77) and presenting symptoms (p = 0.32). CONCLUSION Her-2/neu overexpression was detected in 17% of patients with primary brain tumors, but, did not predict increased short-term mortality in patients with brain tumors surviving less than six months. We were not able to identify any clinical variables that could predict survival in our patient population. At present, there are few reliable prognostic indicators for brain tumors. Further studies are needed to specify whether certain tumor subtypes are more likely to overexpress HER-2/neu and to evaluate the role of HER-2/neu as a target for therapy in malignant brain tumors.
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Affiliation(s)
- Scott E Forseen
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo 58102, USA
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