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Yang L, Chen Q, Bian C. Gestational choriocarcinoma with pulmonary and cerebral metastases mimicking pulmonary tuberculosis: A case report. Asian J Surg 2024; 47:1270-1271. [PMID: 38042655 DOI: 10.1016/j.asjsur.2023.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Lingyun Yang
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Qianrun Chen
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ce Bian
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China.
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2
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Frosch M, Demerath T, Fung C, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Headache, Mental Confusion and Mild Hemiparesis in a 68-year-old Patient. Clin Neuroradiol 2023; 33:1159-1164. [PMID: 37872367 PMCID: PMC10654210 DOI: 10.1007/s00062-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
- M Frosch
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C Fung
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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3
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Kamp MA, von Sass C, Januzi D, Dibué M, Libourius K, Lawson McLean AC, Baumgarten P, Lawson McLean A, Dinc N, Senft CA. Frequency of social burden and underage children in neuro-oncological patients. J Cancer Res Clin Oncol 2023; 149:15911-15922. [PMID: 37679652 PMCID: PMC10620259 DOI: 10.1007/s00432-023-05338-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Brain tumours can cause significant burden for patients and their families, including physical, psychological, and social challenges. This burden can be particularly difficult for patients with malignant brain tumours and those with underage children. However, the frequency of social burden among neuro-oncological patients and the proportion of patients with underaged children is currently unknown. The aim of this retrospective study is to determine the frequency of social and family dysfunction among neuro-oncological patients, the percentage of such patients who have underage children, and to assess their associated burden. METHODS During a 22-month period, all brain tumour patients were asked to complete a short questionnaire that included epidemiological data, the EORTC-qlq-C30 and -BN20 questionnaire, and the distress thermometer. Data were collected and analysed using Prism 9 for macOS (version 9, GraphPad Prism). RESULTS Our analysis included 881 brain tumour patients, of which 540 were female. Median age was 61 years (ranging from 16 to 88 years). Of all patients, 228 suffered from malignant intracranial tumours. More than half of all patients and more than 65% of patients with malignant tumours reported that their illness or medical treatment interfered with their social activities and family life. Almost 30% of patients reported moderate or severe complaints. About 27% of all patients (and 31% of patients with malignancies) expressed moderate or major concerns that their family life could be disrupted. Among the patients with malignancies, 83.5% of patients had a total of 318 children at the time of tumour diagnosis, with a mean age of 33 ± 0.9. Of these patients with malignancies, 38 (17.9%) had a total of 56 underage children at the time of tumour diagnosis, and currently have 53 underage children. Patients with minor children had more financial worries but less interference of their disease with social activities, less psycho-oncological distress, and a more positive outlook into the future (each, p < 0.0001). They evaluated their general health status and quality of life in the week prior to their current appointment significantly better (each p < 0.0001). CONCLUSION Our study found that 17.9% of patients with malignant brain tumours have underage children. However, having underage children may actually be a positive resource for these patients, as they show lower distress values and better quality of life.
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Affiliation(s)
- Marcel A Kamp
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
| | - Christiane von Sass
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Donjetë Januzi
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Maxine Dibué
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Katharina Libourius
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Anna C Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Peter Baumgarten
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Aaron Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nazife Dinc
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian A Senft
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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4
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Karamani L, McLean AL, Kamp MA, Mayer TE, Müller W, Dinc N, Senft C. Tumor size, treatment patterns, and survival in neuro-oncology patients before and during the COVID-19 pandemic. Neurosurg Rev 2023; 46:226. [PMID: 37670022 PMCID: PMC10480251 DOI: 10.1007/s10143-023-02132-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic has disrupted healthcare delivery worldwide, leading to significant delays in cancer diagnosis and treatment. This study aimed to investigate the impact of the pandemic on the diagnosis and treatment of malignant brain tumors, specifically glioblastoma (GBM) and cerebral metastasis (CM), in a specialized neuro-oncology center. We analyzed data from 236 patients diagnosed with previously unknown malignant brain tumors between January 2018 and December 2021. Patients were classified into two groups: pre-COVID (January 2018 to December 2019) and COVID (January 2020 to December 2021). Tumor volumes were compared between the two groups and factors affecting tumor volumes were studied. Of 236 patients diagnosed with previously unknown malignant brain tumors, 114 were in the pre-COVID group and 122 were in the COVID group. Median tumor volumes at first diagnosis were significantly larger in the COVID group compared to the pre-COVID group (21.7 vs 15.7 cm3; p < 0.05). The survival times for the overall cohort and the GBM and CM subgroups did not differ significantly between the pre-COVID and COVID periods. Delays in diagnosis and treatment during the COVID-19 pandemic led to larger tumor volumes at diagnosis for patients with malignant brain tumors. However, these larger tumors did not result in worse survival outcomes. This counterintuitive finding highlights the crucial role of specialized neuro-oncological centers in mitigating the potential negative impact of delayed treatment and emphasizes the need for continued access to specialized care during times of crisis.
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Affiliation(s)
- Lydia Karamani
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany.
- Comprehensive Cancer Center Central Germany, Leipzig, Germany.
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Thomas E Mayer
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
- Institute of Diagnostic and Interventional Radiology, Neuroradiology Section, Jena University Hospital, FriedrichSchillerUniversity, Jena, Germany
| | - Wolf Müller
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
- Paul Flechsig Institute of Neuropathology, University Medicine Leipzig, Leipzig, Germany
| | - Nazife Dinc
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
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5
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Wolfert C, Rohde V, Hussein A, Fiss I, Hernández-Durán S, Malzahn D, Bleckmann A, Mielke D, Schatlo B. Surgery for brain metastases: radiooncology scores predict survival-score index for radiosurgery, graded prognostic assessment, recursive partitioning analysis. Acta Neurochir (Wien) 2023; 165:231-238. [PMID: 36152217 PMCID: PMC9840567 DOI: 10.1007/s00701-022-05356-x] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/25/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Radiooncological scores are used to stratify patients for radiation therapy. We assessed their ability to predict overall survival (OS) in patients undergoing surgery for metastatic brain disease. METHODS We performed a post-hoc single-center analysis of 175 patients, prospectively enrolled in the MetastaSys study data. Score index of radiosurgery (SIR), graded prognostic assessment (GPA), and recursive partitioning analysis (RPA) were assessed. All scores consider age, systemic disease, and performance status prior to surgery. Furthermore, GPA and SIR include the number of intracranial lesions while SIR additionally requires metastatic lesion volume. Predictive values for case fatality at 1 year after surgery were compared among scoring systems. RESULTS All scores produced accurate reflections on OS after surgery (p ≤ 0.003). Median survival was 21-24 weeks in patients scored in the unfavorable cohorts, respectively. In cohorts with favorable scores, median survival ranged from 42 to 60 weeks. Favorable SIR was associated with a hazard ratio (HR) of 0.44 [0.29, 0.66] for death within 1 year. For GPA, the HR amounted to 0.44 [0.25, 0.75], while RPA had a HR of 0.30 [0.14, 0.63]. Overall test performance was highest for the SIR. CONCLUSIONS All scores proved useful in predicting OS. Considering our data, we recommend using the SIR for preoperative prognostic evaluation and counseling.
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Affiliation(s)
- Christina Wolfert
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Abdelhalim Hussein
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ingo Fiss
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Silvia Hernández-Durán
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Dörthe Malzahn
- mzBiostatistics, Statistical Consultancy, 37075, Göttingen, Germany
| | - Annalen Bleckmann
- Clinic for Hematology/ Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- Medical Clinic A, Haematology, Haemostasiology, Oncology and Pulmonology, University Hospital Münster, 48149, Münster, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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6
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Belachew NF, Diebold M, Reinacher PC, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Transient Speech Disorder and a Mass Lesion in the Right Parietal White Matter. Clin Neuroradiol 2022; 32:875-881. [PMID: 35881163 PMCID: PMC9424149 DOI: 10.1007/s00062-022-01195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- N F Belachew
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Diebold
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P C Reinacher
- Stereotactic & Functional Neurosurgery, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology, Aachen, Germany
| | - M Prinz
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Erny
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany. .,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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7
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Papadimitriou K, Kiss-Bodolay D, Hedjoudje A, Millan DS, Simonin A, Fournier JY, Huscher K. Late metachronous cerebral metastasis of pancreatic adenocarcinoma of the tail of the pancreas: a case report. J Med Case Rep 2022; 16:144. [PMID: 35379334 PMCID: PMC8981778 DOI: 10.1186/s13256-022-03314-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pancreatic cancer is one of the leading causes of cancer mortality and one of the most lethal malignant neoplasms worldwide. It is known for its local tumor extension to the liver; other common sites include the lung, distant lymph nodes, and bone. Brain metastases are extremely rare and represent less than 0.6% of all brain metastases. Case report We report the case of a 66-year-old Caucasian female known to have adenocarcinoma of the tail of the pancreas treated with chemotherapy. During follow-up, thoracoabdominal computed tomography scans did not reveal any residual tumor or any metastasis. Moreover, tumor markers were within normal limits. She presented to the emergency department of our institution following an episode of a generalized tonic–clonic seizure 5 years following the initial diagnosis. Brain magnetic resonance imaging revealed an expansive left frontal intraaxial lesion compatible with high-grade glioma. The patient underwent surgical treatment. Histological examination revealed pancreatic metastasis. Conclusions Thought to be rare, metachronous cerebral pancreatic metastasis should be kept in mind in patients with pancreatic cancer. Early diagnosis and complete surgical resection play a key role in the survival of these patients.
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Affiliation(s)
- Kyriakos Papadimitriou
- Department of Neurosurgery, Hospital of Sion, Av. Grand-Champsec 80, 1951, Sion, Switzerland. .,Department of Clinical Neurosciences, Service of Neurosurgery Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Daniel Kiss-Bodolay
- Department of Neurosurgery, Hospital of Sion, Av. Grand-Champsec 80, 1951, Sion, Switzerland
| | - Abderrahmane Hedjoudje
- Department of Radiology, Hospital of Sion, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland
| | - Diego San Millan
- Department of Radiology, Hospital of Sion, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland
| | - Alexandre Simonin
- Department of Neurosurgery, Hospital of Sion, Av. Grand-Champsec 80, 1951, Sion, Switzerland
| | - Jean-Yves Fournier
- Department of Neurosurgery, Hospital of Sion, Av. Grand-Champsec 80, 1951, Sion, Switzerland
| | - Karen Huscher
- Department of Neurosurgery, Hospital of Sion, Av. Grand-Champsec 80, 1951, Sion, Switzerland
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8
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Schupper AJ, Price G, Hadjipanayis CG. Robotic-Assisted Digital Exoscope for Resection of Cerebral Metastases: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:436-444. [PMID: 34561708 DOI: 10.1093/ons/opab356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/17/2021] [Accepted: 08/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surgical resection is the primary treatment for cerebral metastases with safe complete resection as the goal. The robotically assisted digital surgical exoscope is a novel system with advanced visualization methods with recent applications in neurosurgery. OBJECTIVE To evaluate the outcomes for patients with cerebral metastases undergoing resection with the surgical exoscope. METHODS Data were retrospectively collected from patients with cerebral metastases where resection was achieved with using the surgical exoscope from 2016 to 2020. Demographics, clinical, imaging, and operative and outcome findings were collected. The relationship between perioperative data and discharge disposition as well as progression-free survival (PFS) and 12 mo overall survival (OS) was assessed. RESULTS A total of 31 patients (19 males) with a median patient age 63 yr (range 38-80) were included. Average pre- and postoperative volumes were 18.1 cc and 0.75 cc, respectively. Mean depth of the resected lesions was 0.6 cm (range 0-3.6 cm). Complete resection was achieved in 64.5% of patients. The mean extent of resection was 96.7%, with 71.0% achieving PFS at 6 mo. Overall PFS rate was 58.1% and the OS rate at 12 mo was 83.9%. Neurological complications included motor (35.5%) and sensory (12.9%) deficits, with 12 patients reporting no postoperative symptoms. CONCLUSION The surgical exoscope can delineate tumor tissues with high resolution, as shown by a gross total resection achieved for the majority of cases in our series. Postoperative complications and patient outcomes were similar to those reported with use of the operative microscope. Use of the exoscope can provide optimal visualization and delineation of cerebral metastases.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Gabrielle Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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9
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Chen JC, Zhuang DZ, Luo C, Chen WQ. Malignant pheochromocytoma with cerebral and skull metastasis: A case report and literature review. World J Clin Cases 2021; 9:2791-2800. [PMID: 33969061 PMCID: PMC8058670 DOI: 10.12998/wjcc.v9.i12.2791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/31/2020] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malignant pheochromocytoma with cerebral and skull metastasis is a very rare disease. Combining our case with 16 previously reported cases identified from a PubMed search, an analysis of 17 cases of malignant cerebral pheochromocytoma was conducted. This literature review aimed to provide information on clinical manifestations, radiographic and histopathological features, and treatment strategies of this condition.
CASE SUMMARY A 60-year-old man was admitted with a progressive headache and enlarging scalp mass lasting for 3 mo. Radiographic images revealed a left temporal biconvex-shaped epidural mass and multiple lytic lesions. The patient underwent a left temporal craniotomy for resection of the temporal tumor. Histopathological analysis led to identification of the mass as malignant pheochromocytoma. The patient’s symptoms were alleviated at the postoperative 3-mo clinical follow-up. However, metastatic pheochromocytoma lesions were found on the right 6th rib and the 6th to 9th thoracic vertebrae on a 1-year clinical follow-up computed tomography scan.
CONCLUSION Magnetic resonance spectroscopy and histopathological examination are necessary to make an accurate differential diagnosis between malignant cerebral pheochromocytoma and meningioma. Surgery is regarded as the first choice of treatment.
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Affiliation(s)
- Jun-Chen Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Dong-Zhou Zhuang
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Cheng Luo
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Wei-Qiang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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10
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Grubb AF, Hankollari E. Cerebral metastasis of Merkel cell carcinoma following resection with negative margins and adjuvant external beam radiation: a case report. J Med Case Rep 2021; 15:118. [PMID: 33714267 PMCID: PMC7956125 DOI: 10.1186/s13256-021-02690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. It is associated with advanced age, ultraviolet (UV) radiation, and Merkel cell polyomavirus. It has a predilection for the lymphatic system, but rarely spreads to the central nervous system. CASE PRESENTATION A 71-year-old Caucasian man with a history of rheumatoid arthritis and MCC of the right lower eyelid and cheek presented with left-sided hemineglect and word-finding difficulty. Twenty months earlier he had undergone local excision of a 3 cm lesion with negative margins, negative sentinel lymph node biopsy, and external beam radiation. On presentation he was found to have a 6.3 cm mass in the right frontotemporal region. He underwent prompt resection, with pathological analysis consistent with metastatic MCC. He subsequently underwent stereotactic radiosurgery (SRS) and adjunctive immunotherapy with pembrolizumab. He has since tolerated the therapy well and is currently without neurological symptoms or evidence of recurrence. CONCLUSIONS Cerebral metastasis of MCC is a rare event and should be considered when a patient with a history of MCC presents with neurological symptoms. Optimal treatment regimens of these rare cases are unclear; however, prompt resection, stereotactic radiosurgery, and adjunctive immunotherapy have shown an initial positive response in this patient.
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Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Elizabeth Hankollari
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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11
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Dietel E, Nestler U, Nenning H, Eisenlöffel C, Stassart R, Meixensberger J. A late systemic and brain metastasis from subcutaneous leiomyosarcoma of the right forearm: a case report and review of the literature. J Med Case Rep 2021; 15:14. [PMID: 33461603 PMCID: PMC7814649 DOI: 10.1186/s13256-020-02625-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Leiomyosarcomas are rare malignant tumors which originate from smooth muscle cells and very seldom give rise to intracerebral metastases. Nearly all cases of intracranial metastases stem from leiomyosarcomas of the uterus. We present a 61-year-old Caucasian man who developed multiple intracranial and extracranial metastases from leiomyosarcoma of the right forearm, diagnosed and treated 9 years before the current presentation. Case presentation The Caucasian patient presented to the emergency department due to a progressive hemiparesis on the left side. Magnetic resonance imaging scans of the neurocranium showed multiple intracerebral masses with perifocal edema. One of these was located in the right parietal lobe, corresponding to the hemiparesis. The patient underwent microsurgical complete resection of the parietal mass and was subsequently subjected to further radiotherapy. Histopathological studies revealed metastasis of the former leiomyosarcoma. Conclusions Leiomyosarcomas represent a rare entity of mesenchymal tumors. Intracerebral metastasis of these tumors is even less frequent. This case shows the importance of long-term follow-up in patients with leiomyosarcoma.
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Affiliation(s)
- Eric Dietel
- Department of Neurosurgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Ulf Nestler
- Department of Neurosurgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Hans Nenning
- Elsapark Pathology associates, Elsastraße 1, 04315, Leipzig, Germany
| | - Christian Eisenlöffel
- Department of Neuropathology, University of Leipzig, Liebigstraße 26, 04103, Leipzig, Germany
| | - Ruth Stassart
- Department of Neuropathology, University of Leipzig, Liebigstraße 26, 04103, Leipzig, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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12
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Vijayakumar V, Rajasundaram S, Prasad PVU, Vimalathithan NS, Saravanan S, Venkatesan R. Brain Oligometastasis from Synchronous Uterine Malignancies. Indian J Surg Oncol 2020; 11:87-9. [PMID: 33088137 DOI: 10.1007/s13193-020-01069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
Synchronous tumors of female genital tract have been uncommonly reported in literature. The most likely scenario would represent a metastatic disease from a primary tumor within the genital tract as the presence of primary synchronous tumors of the genital tract is an extremely rare event. Most primary synchronous tumors tend to involve the endometrium and ovary, while the incidence of synchronous primary tumors involving the uterine cervix and endometrium as documented in a few case series has been around 0.4%. We present a 41-year-old lady with an extremely rare occurrence of synchronous tumors of the uterus with an endometrioid adenocarcinoma of the uterine fundus and a squamous cell carcinoma of the uterine cervix. The patient presented to us with cerebral metastasis, which was successfully managed surgically.
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13
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Abstract
Chemotherapy has played a minor role as adjuvant therapy in treatment of cerebral metastases from solid cancers. The blood-brain barrier and cerebral metastases' considerable machinery of self-preservation have been significant obstacles to delivery and efficacy of chemotherapy. However, several methods intended to surmount these challenges have arisen alongside advent of technology and with the development of targeted molecular therapies. Focused ultrasound and molecular Trojan horses represent two such novel means of increasing permeability of the blood-brain barrier to effector agents. Published data on efficacy of these targeted therapies remain mostly restricted to retrospective studies and phase II prospective clinical trials.
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Affiliation(s)
- Chase H Foster
- Department of Neurological Surgery, George Washington University Hospital, 2150 Pennsylvania Avenue, Northwest, Suite 7-420, Washington, DC 20037, USA
| | - Pooja Dave
- The GW School of Medicine & Health Sciences, 2150 Pennsylvania Avenue, Northwest, Suite 7-420, Washington, DC 20037, USA
| | - Jonathan H Sherman
- West Virginia University, Eastern Division, 800 North Tennessee Avenue, Suite 104, Martinsburg, WV 25401, USA.
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14
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Kumaria A, Haider Z, Ali A, Pillai D, Bommireddy R, Bateman A, Gakhar H. Intracranial Mimics of Cauda Equina Syndrome: Heads or Tails? World Neurosurg 2020; 144:e643-e647. [PMID: 32916368 DOI: 10.1016/j.wneu.2020.09.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future. CES results from compression of spinal nerve roots. Current practice mandates lumbosacral magnetic resonance imaging (MRI) scanning to diagnose CES. However, it may not reveal compression or provide an explanation for the presentation. We present 3 cases of suspected CES who went on to have intracranial pathology. METHODS Retrospective review of all patients presenting with CES-type features who were subsequently found to have causative intracranial pathology over a 6-month period. RESULTS Three cases were found, and these are hereby presented. CASE PRESENTATION Case 1: A 57-year-old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52-year-old lady presented with lower back and right buttock pain, with right-sided leg numbness, saddle hypoesthesia, and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69-year-old lady presented with a 6-day history of urinary incontinence, right foot drop, and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe. CONCLUSIONS Negative lumbosacral MRI will not exclude extraspinal mimics of CES and, although rare, these cases should be considered.
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Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom.
| | - Zulfiqar Haider
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Arousa Ali
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Dilip Pillai
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Raj Bommireddy
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Antony Bateman
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Harinder Gakhar
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
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15
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Jamshidi AM, Eichberg DG, Gultekin S, Komotar RJ. Brain Metastasis From Bartholin Gland Carcinoma. World Neurosurg 2020; 143:280-284. [PMID: 32736128 DOI: 10.1016/j.wneu.2020.07.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/11/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Small cell neuroendocrine carcinoma of the Bartholin gland is an extremely uncommon gynecologic tumor. Brain metastasis from a malignant gynecologic lesion is rarely encountered and the prognosis for this type of metastasis is quite poor. CASE DESCRIPTION We report a case of a brain metastasis from a small cell neuroendocrine carcinoma of the Bartholin gland that was treated by surgical resection followed by whole-brain radiation therapy and review the literature. CONCLUSIONS Different treatment options, including resection, stereotactic radiosurgery, and whole-brain radiation therapy, as well as chemotherapy, are available and should each be considered on an individual basis.
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Affiliation(s)
- Aria M Jamshidi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sakir Gultekin
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Zakaria R, Chen YJ, Hughes DM, Wang S, Chawla S, Poptani H, Berghoff AS, Preusser M, Jenkinson MD, Mohan S. Does the application of diffusion weighted imaging improve the prediction of survival in patients with resected brain metastases? A retrospective multicenter study. Cancer Imaging 2020; 20:16. [PMID: 32028999 PMCID: PMC7006156 DOI: 10.1186/s40644-020-0295-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastases are common in clinical practice. Many clinical scales exist for predicting survival and hence deciding on best treatment but none are individualised and none use quantitative imaging parameters. A multicenter study was carried out to evaluate the prognostic utility of a simple diffusion weighted MRI parameter, tumor apparent diffusion coefficient (ADC). METHODS A retrospective analysis of imaging and clinical data was performed on a cohort of 223 adult patients over a ten-year period 2002-2012 pooled from three institutions. All patients underwent surgical resection with histologically confirmed brain metastases and received adjuvant whole brain radiotherapy and/or chemotherapy. Survival was modelled using standard clinical variables and statistically compared with and without the addition of tumor ADC. RESULTS The median overall survival was 9.6 months (95% CI 7.5-11.7) for this cohort. Greater age (p = 0.002), worse performance status (p < 0.0001) and uncontrolled extracranial disease (p < 0.0001) were all significantly associated with shorter survival in univariate analysis. Adjuvant whole brain radiotherapy (p = 0.007) and higher tumor ADC (p < 0.001) were associated with prolonged survival. Combining values of tumor ADC with conventional clinical scoring systems such as the Graded Prognostic Assessment (GPA) score significantly improved the modelling of survival (e.g. concordance increased from 0.5956 to 0.6277 with Akaike's Information Criterion reduced from 1335 to 1324). CONCLUSIONS Combining advanced MRI readings such as tumor ADC with clinical scoring systems is a potentially simple method for improving and individualising the estimation of survival in patients having surgery for brain metastases.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. .,Institute of Integrative Biology, University of Liverpool, Liverpool, UK.
| | - Yin Jie Chen
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | | | - Sumei Wang
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Sanjeev Chawla
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Harish Poptani
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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17
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Wan Y, Du H, Zhang L, Guo S, Xu L, Li Y, He H, Zhou L, Chen Y, Mao L, Jin H, Hu B. Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report. BMC Neurol 2019; 19:249. [PMID: 31646971 PMCID: PMC6813067 DOI: 10.1186/s12883-019-1474-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Background Cardiac myxoma is the most common benign cardiac tumor. Brain metastases or multiple cerebral aneurysms are extremely rare, especially for the case of both complications. Brain metastases are usually found at the same time or few months after the diagnosis or surgical removal of cardiac myxoma Case presentation We describe a case of patient, operated for a cardiac myxoma, who presented multiple central nervous system metastases associated, cerebral aneurysms and subsequent intracerebral hemorrhage Conclusions The long-term follow-up of the patients with atrial myxoma even after complete surgical excision is recommended, especially for the patient with central nervous system manifestations before atrial myxoma excision
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hai Du
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Neurology, Caidian People Hospital, Wuhan, 430100, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuang Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Xu
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China
| | - Yuanyuan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lian Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunping Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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18
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Knipps J, Fischer I, Neumann LM, Rapp M, Dibué-Adjei M, Freiin von Saß C, Placke JM, Mijderwijk HJ, Steiger HJ, Sabel M, Cornelius JF, Kamp MA. Quantification of PpIX-fluorescence of cerebral metastases: a pilot study. Clin Exp Metastasis 2019; 36:467-475. [PMID: 31376098 DOI: 10.1007/s10585-019-09986-x] [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] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
5-ALA fluorescence-guided surgery (FGS) is a major advance in neuro-oncological surgery. So far, Protoporphyrin IX (PpIX)-fluorescence has been observed in about half of cerebral metastases resected with routinely equipped microscopes during 5-ALA FGS. The aim of the present pilot study was to quantify PpIX-induced fluorescence of cerebral metastases with a spectrometer. We hypothesize that non-fluorescing metastases under the operating microscope may have spectrometrically measurable levels of fluorescence. A second aim was to analyze correlations between quantified 5-ALA fluorescence and histology or primary tumor type, respectively. Standard FGS was performed in all patients. The fluorescence intensity of the metastasis was semi-quantitatively determined in vivo by a senior surgeon using a special surgical microscope equipped for FGS. A systematic spectrometric ex vivo evaluation of tumor specimens and PpIX-induced fluorescence was performed using a spectrometer connected by optic fibers to a handheld probe. Quantification of 5-ALA-derived fluorescence was measured in a standardized manner with direct contact between mini-spectrometer and metastasis. The difference between the maximum PpIX-fluorescence at 635 nm and the baseline fluorescence was defined as the PpIX fluorescence intensity of the metastasis and given in arbitrary units (AU). Diagnosis of a cerebral metastasis was confirmed by histopathological analysis. A total of 29 patients with cerebral metastases were included. According to neuropathological analysis, 11 patients suffered from non-small cell lung cancer, 10 patients from breast cancer, 6 patients from cancer originating in the gastro-intestinal tract, 1 patient suffered from a malignant melanoma and one patient from renal cancer. The mean age was 63 years (37-81 years). 15 patients were female, 14 patients male. 13 cerebral metastases were considered as ALA-positive by the surgeon. In nine metastases, 5-ALA fluorescence was not visible to the naked eye and could only be detected using the spectrometer. The threshold for an ALA signal rated as "positive" by the surgeon was PpIX fluorescence above 1.1 × 106 AU. The mean PpIX fluorescence of all analyzed cerebral metastases was 1.29 × 106 ± 0.23 × 106 AU. After quantification, we observed a significant difference between the mean 5-ALA-derived fluorescence in NSCLC and breast cancer metastases (Mean Diff: - 1.2 × 106; 95% CI of difference: - 2.2 × 106 to - 0.15 × 106; Šidák-adjusted p = 0.026). In our present pilot series, about half of cerebral metastases showed a 5-ALA fluorescence invisible to the naked eye. Over 50% of these non-fluorescent metastases show a residual 5-ALA fluorescence which can be detected and quantified using a spectrometer. Moreover, the quantified 5-ALA signal significantly differed with respect to the primary tumor of the corresponding cerebral metastasis. Further studies should evaluate the predictive value of the 5-ALA signal and if a quantified 5-ALA signal enables a reliable intraoperative differentiation between residual tumor tissue and edematous brain-in particular in metastases with a residual fluorescence signal invisible to the naked eye.
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Affiliation(s)
- Johannes Knipps
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Igor Fischer
- Division of Informatics and Statistics, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lisa M Neumann
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Maxine Dibué-Adjei
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christiane Freiin von Saß
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan-Malte Placke
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Hendrik-Jan Mijderwijk
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.,Division of Informatics and Statistics, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan-Frederick Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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19
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Gwacham NI, Van Brunt L, Ernst Y, Gibbon D. Leptomeningeal spread of gestational trophoblastic neoplasia in a 19-year old woman. Gynecol Oncol Rep 2019; 29:29-33. [PMID: 31245524 PMCID: PMC6582189 DOI: 10.1016/j.gore.2019.06.002] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/03/2019] [Indexed: 11/25/2022] Open
Abstract
Gestational trophoblastic neoplasia (GTN) with brain metastasis is usually seen in patients with advanced disease. Ten percent of metastatic gestational trophoblastic disease involves the brain and spinal cord, most often manifesting as an intracerebral mass or subdural hematoma, and are generally known to be a poor prognostic factor (Dadlani et al., 2010). Leptomeningeal metastases are tremendously rare and not well documented in the literature. A standardized treatment regimen for patients with brain metastases has not been established and is controversial due to a number of multimodal treatments that have been published in the literature without a prospective trial having been completed. We report a case of a patient with gestational trophoblastic disease that metastasized to the lung and leptomeninges, who after treatment with induction chemotherapy using etoposide (E) and cisplatin (P) followed by etoposide, methotrexate and dactinomycin (EMA) chemotherapy achieved a complete response without brain radiation (Han et al., 2012). EMA-EP, after induction with EP, can be utilized as first line chemotherapy in cases of high risk GTN. Stage IV high risk GTN may present with relatively low β-HCG levels. Intravenous chemotherapy alone is capable of curing most patients with high risk GTN. Management of high risk GTN requires multidisciplinary individualized treatment. Despite leptomeningeal spread of disease, a cure of GTN was able to be achieved with chemotherapy alone.
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Affiliation(s)
- Nnamdi I Gwacham
- Department of Obstetrics & Gynecology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Lindsey Van Brunt
- Department of Obstetrics & Gynecology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Yizhou Ernst
- Department of Obstetrics & Gynecology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Darlene Gibbon
- Department of Obstetrics & Gynecology, Saint Barnabas Medical Center, Livingston, NJ, USA
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20
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Meskelevicius D, Schäfer A, Weber JK, Hegmann L, Haddad L, Kamp MA, Mainzer B, Rapp M, Steiger HJ, Sabel M. Determination of optimal time window for cortical mapping in awake craniotomy: assessment of intraoperative reaction speed. Neurosurg Rev 2020; 43:633-42. [PMID: 30877481 DOI: 10.1007/s10143-019-01094-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/18/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
Currently, there is no known time frame when the patients are the most responsive during awake craniotomy. The aim of this work is therefore to determine when the patient has the shortest reaction time and so to extrapolate the optimal time window for cortical mapping. In this analytic observational study, our group has recorded the reaction times of 35 patients undergoing an awake craniotomy and compared them with the preoperative baseline. The operations were performed according to a "sleep-awake-awake" protocol. Data collection was performed in parallel with standard methods for evaluation of language and cognitive functions. The preoperative reaction times of our patient cohort (average ± SD = 510 ± 124 ms) were significantly shorter than those measured during the operation 786 ± 280 ms, p < .001. A one-factor ANOVA within subjects showed a significant increase in reaction times; p < .001. Post hoc comparisons on a Bonferroni-corrected α-error level of .05 showed significant differences between the reaction speed during the 0-10 min time frame and the preoperative baseline, as well as the intraoperative reaction times during the 20-30 min, 30-40 min, and the t > 40 min time frames. In conclusion, measurement of intraoperative reaction speed seems to be a technically feasible method that is well tolerated by the patients. The intraoperative reaction speed performance was shown to be significantly slower than on the day before the operation. The patients seem to be the slowest directly after extubation and gradually wake up during the awake phase. The poorest wakefulness is demonstrated during the first 20 min after extubation.
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21
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Jandial R, Hoshide R, Waters JD, Somlo G. Operative and Therapeutic Advancements in Breast Cancer Metastases to the Brain. Clin Breast Cancer 2017; 18:e455-e467. [PMID: 29100727 DOI: 10.1016/j.clbc.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/06/2017] [Revised: 08/14/2017] [Accepted: 10/01/2017] [Indexed: 12/31/2022]
Abstract
Patients with breast cancer are surviving longer as the state of the art for care advances. Because patients are surviving longer with primary breast cancer, the incidence of secondary metastatic disease has risen. Metastatic breast cancer to the brain was once thought to be universally fatal. While it is still quite lethal, its treatment after diagnosis is increasingly safe and effective. Critical progress has been made in understanding the interaction between breast metastases and the neural niche, neuroimaging of functional anatomy, minimally invasive image-guided brain surgery, characterizing subtypes of breast cancer based on molecular and genetic profiles, and individualized pharmaceuticals and immunotherapies. In this review, we discuss recent advances that have brought us to state-of-the-art management of metastatic breast cancer to the brain.
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Affiliation(s)
- Rahul Jandial
- Department of Neurosurgery, City of Hope, Duarte, CA.
| | - Reid Hoshide
- Department of Neurosurgery, University of California, San Diego, San Diego, CA
| | - J Dawn Waters
- Department of Neurosurgery, Stanford University, Palo Alto, CA
| | - George Somlo
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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22
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Ali MA, Hirshman BR, Wilson B, Schupper AJ, Joshi R, Proudfoot JA, Goetsch SJ, Alksne JF, Ott K, Aiyama H, Nagano O, Carter BS, Chiang V, Serizawa T, Yamamoto M, Chen CC. Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume. World Neurosurg 2017; 108:151-6. [PMID: 28754641 DOI: 10.1016/j.wneu.2017.07.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of a disease-specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). METHODS Patient and tumor characteristics were collected from RCC cohorts with new BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. RESULTS In univariable logistic regression models, CITV, KPS, and the number of BM were independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P = 0.042). The incorporation of the CITV into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI >0 of 0.3156 (95% confidence interval [CI], 0.0883-0.5428; P = 0.0065) and IDI of 0.0151 (95% CI, 0.0036-0.0277; P = 0.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. CONCLUSION CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV.
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Abstract
Magnetic resonance spectroscopy (MRS) is a magnetic resonance-based imaging modality that allows noninvasive sampling of metabolic changes in normal and abnormal brain parenchyma. MRS is particularly useful in the differentiation of developmental or non-neoplastic disorders from neoplastic processes. MRS is also useful during routine imaging follow-up after radiation treatment or during antiangiogenic treatment and for predicting outcomes and treatment response. The objective of this article is to provide a concise but thorough review of the basic physical principles, important applications of MRS in brain tumor imaging, and future directions.
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Affiliation(s)
- O Rapalino
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - E M Ratai
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Building 149, 13th Street, Room 2301, Charlestown, MA 02129, USA.
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24
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Souchon R, Feyer P, Thomssen C, Fehm T, Diel I, Nitz U, Janni W, Bischoff J, Sauer R. Clinical Recommendations of DEGRO and AGO on Preferred Standard Palliative Radiotherapy of Bone and Cerebral Metastases, Metastatic Spinal Cord Compression, and Leptomeningeal Carcinomatosis in Breast Cancer. ACTA ACUST UNITED AC 2014; 5:401-7. [PMID: 21494406 DOI: 10.1159/000322661] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/19/2022]
Abstract
BACKGROUND To provide guidance for clinical practice on preferred standard palliative radiotherapy (RT) of different sites of metastasis for breast cancer patients based on current published evidence complemented by expert opinion. METHODS The breast cancer expert panel of the German Society for Radiation Oncology (DEGRO) and members of the Working Party of Gynecologic Oncology (AGO) Breast Committee formulated recommendations based on the panel's interpretation of the level of evidence referring to the criteria of evidence-based medicine added to the AGO grades of recommendation. RESULTS For different types and sites of metastasis, distinct therapeutic goals (alleviation of symptoms, pain relief, local tumor control, prevention or improvement of neurological deficits, stabilization of the spine or other bones) require complex approaches considering individual factors (i.e. life expectancy, tumor progression at other sites). With regard to different therapeutic goals, different dose concepts and fractionation schedules, and single-versus multi-fraction palliative RT should be adapted individually. CONCLUSIONS RT is an effective tool in palliation treatment of bone metastasis (BM), cerebral metastasis (CM) and metastatic spinal cord compression (MSCC), or leptomeningeal carcinomatosis (LC) and plays a central role in an interdisciplinary approach. Preferred technique, targeting, and different dose schedules are described in detail in the DEGRO guidelines, which are also integrated in the updated 2010 AGO recommendations.
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Affiliation(s)
- Rainer Souchon
- Department of Radiation Oncology, University of Tübingen, Germany
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Gonda DD, Kim TE, Warnke PC, Kasper EM, Carter BS, Chen CC. Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int 2012; 3:97. [PMID: 23061013 PMCID: PMC3463839 DOI: 10.4103/2152-7806.100185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/12/2012] [Indexed: 12/21/2022] Open
Abstract
Background: Between 2005 and 2010, we treated patients with hydrocephalus related to cerebral metastases, who were not good candidates for surgical resection by either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS). Patients were excluded from ETV if they had a clinical history suggestive of non-obstructive hydrocephalus, including: (1) history of infection or ventricular hemorrhage and (2) leptomeningeal carcinomatosis. The rest of the patients were treated with VPS. Methods: We analyzed the clinical outcome of these patient cohorts, to determine whether the efficacy of VPS was compromised due to a history of infection, ventricular hemorrhage, or leptomeningeal carcinomatosis, and compared these results to those patients who underwent ETV. Results: Sixteen patients were treated with ETV and 36 patients were treated with VPS. The overall efficacy of symptomatic palliation was comparable in the ETV and VPS patients (ETV = 69%, VPS = 75%). In both groups, patients with more severe hydrocephalic symptoms such as nausea, vomiting, and lethargy were more likely to benefit from the procedure. The overall complication rate for the two groups was comparable (ETV = 12.6%, VPS = 19.4%), although the spectrum of complications differed. The overall survival, initial Karnofsky performance status (KPS), and three-month KPS, were similarly comparable (median survival: ETV 3 months, VPS 5.5 months; initial KPS: ETV = 66 ± 7, VPS = 69 ± 12; 3 months KPS: ETV = 86 ± 7, KPS = 84 ± 12). Conclusion: VPS remains a reasonable option for poor RPA grade metastasis patients with hydrocephalus, even in the setting of a previous infection, hemorrhage, or in those with leptomeningeal disease. Optimal treatment of this population will involve the judicious consideration of the relative merits of VPS and ETV.
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Affiliation(s)
- David D Gonda
- Department of Neurosurgery, University of California, San Diego, USA ; Center for Theoretic and Applied Neuro-Oncology, University of California, San Diego, USA
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Chen CC, Kasper E, Warnke P. Palliative stereotactic-endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from cerebral metastasis. Surg Neurol Int 2011; 2:76. [PMID: 21748029 PMCID: PMC3130359 DOI: 10.4103/2152-7806.82083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/16/2011] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is increasingly used in the treatment of obstructive hydrocephalus. The literature supporting its use in the setting of metastatic disease, however, remains limited. METHODS Between 2005 and 2010, 16 patients underwent ETV for treatment of obstructive hydrocephalus secondary to cerebral metastasis. Efficacy of symptomatic palliation and associated complications were reviewed. The results were compared to reported data for ventriculoperitoneal shunt placement in adult brain tumor patients. Patient selection criteria for ETV are reviewed. RESULTS Eleven of the 16 patients experienced symptomatic improvement after ETV (69%). Patients who presented with headache associated with nausea, vomiting, or lethargy were more likely to respond to treatment relative to patients presenting with headache alone. Of the 16 ETV patients, one suffered a wound infection and another underwent external ventricular drainage for assessment of intracranial pressure, yielding an overall complication rate of 12.5%. CONCLUSIONS In select patients with obstructive hydrocephalus related to cerebral metastasis, ETV constitutes a minimally invasive palliative option. The efficacy of ETV in this population is comparable to those reported for obstructive hydrocephalus secondary to primary cerebral neoplasm or other non-neoplastic causes. Patients receiving chemotherapy close to the time of ETV may be at increased risk for infection.
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Affiliation(s)
- Clark C Chen
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, USA
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Goutham C, Kumar JP, Anil P, Peter SN, Ravi R, Chakravorthy VM. Malignant Course of a Metastatic Melanoma During Pregnancy: A Case Report. World J Oncol 2011; 2:79-82. [PMID: 29147229 PMCID: PMC5649707 DOI: 10.4021/wjon285w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 11/03/2022] Open
Abstract
Cutaneous melanoma can metastasize to any organ, including brain and spinal cord. A 27-year-old lady, four months after conception presented with generalized seizures and was diagnosed to have subarachnoid hemorrhage. Further investigation did not reveal aneurysm. She underwent right ventriculo-peritoneal shunt for hydrocephalus and MTP for unprotected radiation from CT scan. Six weeks later she came to our institution with symptoms of dorsal compression. Imaging showed multiple intradural extramedullary spinal lesions at D3-D4, D8 and D10-D11. Surgical excision of the lesions was done and histopathology was consistent with metastatic deposits from malignant melanoma which was confirmed by immunohistochemistry studies also. Her conscious level deteriorated on the second postoperative day and CT scan showed multiple small tumor emboli with evidence of right temporal bleed and diffuse cerebral edema. In spite of aggressive treatment she could not be saved. This reported case concludes that pregnancy aggravates the clinical course of metastatic melanoma.
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Affiliation(s)
- Cugati Goutham
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
| | - Jain Pradeep Kumar
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
| | - Pande Anil
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
| | - Symss Nigel Peter
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
| | - Ramamurthi Ravi
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
| | - Vasudevan Mathabushi Chakravorthy
- Dr. Achanta Lakshmipathi Neurosurgical Center, Post Graduate Institute of Neurological Surgery, Voluntary Health Services Hospital, Chennai - 600113, India
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Abstract
We first report a rare case of metastasis from gastric hepatoid adenocarcinoma (HAC) to cerebral parenchyma, in a 50-year-old Chinese patient. He complained of a one-month history of a paroxysm of headache in the left temple and pars parietalis accompanied with binocular caligation caligo, insensible feeling of limbs and transient anepia. Magnetic resonance (MR) imaging revealed a spherical occupying lesion in the left posterior-temple lobe which was clinically diagnosed as a metastatic tumor. Three years ago, the patient accepted total gastrectomy as he was pathologically diagnosed at gastroscopy having an adenocarcinoma. Eight months after gastrectomy, the occupying lesion in liver was detected by ultrasound and CT, and he accepted transcatheter arterial embolization. Before operation of the brain metastasis, no obvious abnormality was found in liver by ultrasound. Histopathological characteristics of the brain tumor were identical to those of stomach tumor. The growth pattern of both tumors showed solid cell nests. The tumor cells were polygonal, and had abundant eosinophilic cytoplasm and round nuclei with obvious nucleoli. Sinusoid-like blood spaces were located between nodular tumor cells. Immunohistochemistry-stained tumor cells were positive for AFP and negative for Hep-Par-1. According to these histopathological findings, both tumors were diagnosed as HAC and metastatic HAC. The patient remained alive 16 mo after tumorectomy of the cerebral metastasis. The differential diagnosis of brain metastasis from metastatic tumors should use a panel of antibodies to avoid confusing with the brain metastasis of hepatocellular carcinoma (HCC). This paper describes this rare case of metastasis from gastric hepatoid adenocarcinoma to cerebral parenchyma, and provides a review of the literature concerning its histopathological and immunohistochemical characteristics.
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