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Cai Y, Liu D, Yang Z, Chen X, Liu J, Zhang J, Li S, Li J, Yang Z. Factors associated with prognosis of dysembryoplastic neuroepithelial tumors patients after surgical resection: a retrospective observational study. Br J Neurosurg 2024; 38:372-377. [PMID: 33527856 DOI: 10.1080/02688697.2021.1878107] [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: 02/16/2019] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore factors that might be associated with prognosis of dysembryoplastic neuroepithelial tumors (DNTs). METHODS DNTs patients who were admitted to the Department of Neurosurgery of Xiangya Hospital between 1 January 2010 and 31 December 2018 and underwent surgical resection were retrospectively analyzed. Clinical, neuroimaging, and pathological features of DNTs were compared among patients with different outcomes and analyzed using the Kaplan-Meier curves and univariable Cox regression analysis. RESULTS Thirty-three DNTs patients were included finally, of which the average age at seizure onset was 11.59 ± 7.46 years old and the average duration of seizures prior to surgical resection was 3.00 ± 4.68 years. After surgical resection, the patients were followed up for 2.39 ± 1.97 years, and 28 patients (84.85%) were seizure-free (class I of the Engel Outcome Scale) while five patients (15.15%) were seizure-continuous (class II or III of the Engel Outcome Scale). When compared with seizure-free patients, seizure-continuous patients had greater age at seizure onset and longer duration of seizures before surgical resection (p < .05). No variables were found to be statistically significantly associated with prognosis in univariable Cox regression analysis, but patients with extra-temporal DNTs were found to have better prognosis than those with temporal DNTs (log-rank test p = .048). CONCLUSIONS Elder seizure onset age, longer duration of seizures prior to surgical resection, and a temporal location may be risk factors of poor prognosis for DNTs patients after surgical resection.
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Affiliation(s)
- Yuxiang Cai
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Xiaoyu Chen
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Jian Liu
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Junmei Zhang
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Sushan Li
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Jingbo Li
- Department of Gastroenterology, Xiangya Third Hospital Affiliated to Central South University, Changsha, People's Republic of China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital Affiliated to Central South University, Changsha, People's Republic of China
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Nakata S, Arai Y, Fukuoka K, Shirakura T, Yamazaki A, Osawa S, Hama N, Shibata T, Miyagishima T, Horiguchi K, Tosaka M, Yokoo H, Yoshimoto Y, Nobusawa S. Pediatric diffuse glioma with EP300::BCOR fusion manifesting as low-grade epilepsy-associated neuroepithelial tumor: a case presentation. Brain Tumor Pathol 2024; 41:35-39. [PMID: 38133797 DOI: 10.1007/s10014-023-00475-4] [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: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Satoshi Nakata
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ayako Yamazaki
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sho Osawa
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Natsuko Hama
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Keishi Horiguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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Mehrotra A, Singh S, Kanjilal S, Pal L, Paliwal VK, Sardhara J, Behari S. Seizure-outcome after surgery of low-grade epilepsy associated neuro-epithelial tumors. J Neurosurg Sci 2023; 67:591-597. [PMID: 33320468 DOI: 10.23736/s0390-5616.20.05144-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most patients with glioneuronal tumors present with seizures. Although several studies have shown that greater extent of resection improves overall patient survival, few studies have focused on postoperative seizure outcome after resection of these tumors. The aim of this study was to characterize seizure control rates in patients undergoing glioneuronal tumor resection and evaluate the association between poor seizure outcome and tumor recurrence or progression. METHODS The study population included patients who had undergone resection of glioneuronal tumors between 2014 and 2019 at our institution. Seizure outcome was assessed using Engel grading. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS Twenty-six patients (N.=16, temporal lobe; N.=6, frontal lobe; N.=4, parietal lobe) with mean seizures duration of 56.9-months, were assessed. Histopathologically, N.=15 dysembryoplastic neurepithelial tumor, N.=7 ganglioglioma and N.=4 Diffuse lepto-meningeal neuroepithelial tumor. There were 2 cases of complex DNET and one case of DLMNT had associated cortical dysplasia. At mean follow-up of 49.7 months, N.=20 Engel 1, N.=4 Engel 2 and N.=2 had Engel 3 outcome. N.=20 underwent gross total excision (N.=18 Engel 1 and N.=2 Engel 2) and N.=6 sub-total excision. Among the 4 patients who needed re-surgery, two were in Engel 2 and another two were in Engel 3. CONCLUSIONS Good seizure-outcome is likely associated with extent of resection. Younger age of patient, less than one-year of seizure duration and absence of generalization of seizure are good prognostic indicators. The best seizure-control can be achieved by early surgical intervention.
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Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India -
| | - Suyash Singh
- Department of Neurosurgery All India Institute of Medical Sciences, Raebarely, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Lily Pal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vimal K Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Martinoni M, Fabbri VP, La Corte E, Zucchelli M, Toni F, Asioli S, Giannini C. Glioneuronal and Neuronal Tumors of the Central Nervous System. Adv Exp Med Biol 2023; 1405:253-280. [PMID: 37452941 DOI: 10.1007/978-3-031-23705-8_9] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Glioneuronal and neuronal tumors (GNTs) are rare neoplasms composed of neural and glial elements frequently located in the temporal lobe. Epilepsy is the main symptom and diagnosis mostly occurs before adulthood. The great majority of GNTs are WHO grade I tumors, but anaplastic transformations and forms exist. Their common association with focal cortical dysplasia is well recognized and should be taken into consideration during neurophysiological presurgical and surgical planning since the aim of surgery should be the removal of the tumor and of the entire epileptogenic zone according to anatomo-electrophysiological findings. Surgery still remains the cornerstone of symptomatic GNT, while radiotherapy, chemotherapy, and new target therapies are generally reserved for anaplastic, unresectable, or evolving tumors. Furthermore, since many GNTs show overlapping clinical and neuroradiological features, the definition of specific histopathological, genetic, and molecular characteristics is crucial. Epileptological, oncological, neurosurgical, and pathological issues of these tumors make a multidisciplinary management mandatory.
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Affiliation(s)
- Matteo Martinoni
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Viscardo Paolo Fabbri
- Surgical Pathology Section, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Emanuele La Corte
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Toni
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Programma di neuroradiologia con tecniche ad elevata complessità, IRCCS Istituto delle Scienze Neurologiche di Bologna ETC, Bologna, Italy
| | - Sofia Asioli
- Surgical Pathology Section, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Caterina Giannini
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Anatomic Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
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5
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Zhao S, Wang J, Li MN, Ding Y, Pan MH, Song K. [Clinicopathological features of polymorphous low-grade neuroepithelial tumor of the young]. Zhonghua Bing Li Xue Za Zhi 2022; 51:640-646. [PMID: 35785835 DOI: 10.3760/cma.j.cn112151-20220315-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the clinicopathological features and differential diagnosis of polymorphous low-grade neuroepithelial tumor of the young (PLNTY). Methods: Five cases of PLNTY diagnosed at the First Affiliated Hospital and Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China from 2019 to 2021 were collected. All cases were evaluated using clinical and imaging data, histology, immunohistochemical staining and molecular genetics. The relevant literature was reviewed. Results: There were two male and three female patients, aged 10 to 39 years, with an average age of 25 years. Clinically, the tumors were in the temporal lobe (3 cases), the lateral ventricle (1 case) and the left head of caudate nucleus (1 case). The clinical manifestations included epilepsy in 3 cases, right visual disturbance in 1 case, and post-trauma incidental finding in 1 case. Microscopically, the lesions were characterized with infiltrative growth, cellular pleomorphism (oligodendroglioma-like cells were always present, with low-grade, pleomorphic nuclei) and variable calcifications. Immunohistochemically, the tumor cells were positive for GFAP and Olig2. They also showed intense and diffuse expression of CD34 while CD34 expressing ramified neural elements were present in regional cortex. Ki-67 proliferation index was less than 3%. Molecular genetics showed the BRAF V600E mutation in 2 cases, the PAK5-Q337R missense mutation in 1 case, the FGFR2-CTNNA3 fusion in 1 case, and the FGFR2-INA and FGFR2-PPRC1 concomitant fusion in 1 case. No postoperative chemoradiotherapy was given. Follow-up intervals ranged from 3 to 29 months while no recurrence or metastasis was identified. Conclusions: PLNTY is uncommon. A definite diagnosis of PLNTY relies on histopathological examination and molecular genetics. It is important to distinguish PLNTY from high grade gliomas and avoid overtreatment. The recently reported the PAK5-Q337R missense mutation and the FGFR2-PPRC1 gene fusion in PLNTY may help diagnose and understand the pathogenesis of PLNTY.
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Affiliation(s)
- S Zhao
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - J Wang
- Department of Pathology, Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
| | - M N Li
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Y Ding
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - M H Pan
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kun Song
- Department of Pathology, Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
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Oku S, Yamasaki F, Kojima M, Takayasu T, Takano M, Yonezawa U, Taguchi A, Hiyama E, Sugiyama K. [Astroblastoma with Rapid Cyst Expansion and Hemorrhage in an Adult: A Case Report]. Brain Nerve 2022; 74:385-392. [PMID: 35437291 DOI: 10.11477/mf.1416202049] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Astroblastoma is an extremely rare primary brain tumor accounting for 0.45 to 2.8% of all neuroglial tumors and usually occurs in pediatrics and young adults. The natural history of astroblastoma still remains unknown. In the World Health Organization (WHO) classification of tumors of the central nervous system, astroblastoma is classified as other neuroepithelial tumors and standard treatment other than surgery has not been established. As molecular and genetic diagnosis becomes more important in the latest WHO classification of brain tumors, the development of therapeutic options based on the information of molecular genetics are expected. Here we report a case of astroblastoma in a 49-year-old male. Small tumor was discovered by coincidence during his check-up following traffic accident, but three months later, tumor bleeding with cystic enlargement resulted in disturbance of consciousness. Initial diagnosis of low grade astroblastoma with BRAFV600E mutation was made. After 1 year, local tumor recurrence was observed. The histological diagnosis at recurrence was high grade astroblastoma. We here, discuss about diagnosis, treatment and the possibility of usefulness of molecular genetic analysis for astroblastoma with some literature review. (Received 10 August, 2021; Accepted 15 December, 2021; Published 1 April, 2022).
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Affiliation(s)
- Shinichiro Oku
- Department of Neurosurgery, Hiroshima University Hospital
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Kurtulan O, Bilginer B, Soylemezoglu F. Challenges in the Intraoperative Consultation of Low-Grade Epilepsy-Associated Neuroepithelial Tumors by Cytomorphology in Squash Preparations. Acta Cytol 2022; 66:142-148. [PMID: 35016169 DOI: 10.1159/000521249] [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: 10/13/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Low-grade epilepsy-associated neuroepithelial tumors (LEATs) create a diagnostic challenge in daily practice and intraoperative pathological consultation (IC) in particular. Squash smears are extremely useful in IC for accurate diagnosis; however, the knowledge on cytopathologic features of LEATs is based on individual case reports. Here, we discuss the 3 most common and well-established entities of LEATs: ganglioglioma (GG), dysembryoplastic neuroepithelial tumor (DNT), and papillary glioneuronal tumor (PGNT). METHODS Thirty patients who underwent surgery for GG, DNT, and PGNT between 2001 and 2021 were collected. Squash smears prepared during intraoperative consultation were reviewed by 1 cytopathologist and an experienced neuropathologist. RESULTS Among the 30 tumors, 16 (53.3%) were GG, 11 (36.6%) DNT, and 3 (10%) PGNT. Cytomorphologically, all of the 3 tumor types share 2 common features such as dual cell population and vasculocentric pattern. GG smears were characteristically composed of dysplastic ganglion cells and piloid-like astrocytes on a complex architectural background of thin- to thick-walled vessels. DNT, on the other hand, showed oligodendroglial-like cells in a myxoid thin fibrillary background associated with a delicate capillary network. Common cytological features of PGNT were hyperchromatic cells with narrow cytoplasm surrounding hyalinized vessels forming a pseudopapillary pattern and bland cells with neuroendocrine nuclei dispersed in a neuropil background. CONCLUSION A higher diagnostic accuracy can be obtained when squash smears are applied with frozen sections. However, it is important to integrate clinical and radiologic features of the patient as well as to know the cytopathologic features of the LEAT spectrum in the context of differential diagnosis to prevent misinterpretation in the IC.
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Affiliation(s)
- Olcay Kurtulan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçak Bilginer
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Soylemezoglu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zheng Z, Jiang H, Wu H, Ding Y, Wang S, Ming W, Zhu J. Epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumor of temporal lobe: a single-institution experience of 61 patients. Neurol Sci 2021; 43:3333-3341. [PMID: 34816317 PMCID: PMC9018634 DOI: 10.1007/s10072-021-05703-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
Background Low-grade epilepsy-associated neuroepithelial tumor (LEAT) is highly responsive to surgery in general. The appropriate surgical strategy remains controversial in temporal LEAT. The aim of this study is to analyze the surgical seizure outcome of temporal LEAT, focusing on the aspects of surgical strategy. Methods Sixty-one patients from a single epilepsy center with temporal LEAT underwent surgery. The surgical strategy was according to the multidisciplinary presurgical evaluation. Electrocorticogram (ECoG)-assisted resection was utilized. Surgical extent including lesionectomy and extended resection was described in detail. Seizure outcome was classified as satisfactory (Engel class I) and unsatisfactory (Engel classes II–IV). Results After a median follow-up of 36.0 (30.0) months, 83.6% of patients achieved satisfactory outcome, including 72.1% with Engel class Ia. There was 39.3% (24/61) of patients with antiepileptic drug (AED) withdrawal. Use of ECoG (χ2 = 0.000, P > 0.1), preresection spike (χ2 = 0.000, P = 0.763), or spike residue (P = 0.545) was not correlated with the seizure outcome. For lateral temporal LEAT, outcome from lesionectomy was comparable to extended resection (χ2 = 0.499, P > 0.1). For mesial temporal LEAT, 94.7% (18/19) of patients who underwent additional hippocampectomy were satisfactory, whereas only 25% (1/4) of patients who underwent lesionectomy were satisfactory (P = 0.009). Conclusion Surgical treatment was highly effective for temporal LEAT. ECoG may not influence the seizure outcome. For lateral temporal LEAT, lesionectomy with or without cortectomy was sufficient in most patients. For mesial temporal LEAT, extended resection was recommended.
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Affiliation(s)
- Zhe Zheng
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Hongjie Jiang
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Hemmings Wu
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Yao Ding
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Shuang Wang
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Wenjie Ming
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Junming Zhu
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China.
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China.
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Sajko T, Rotim K, Jurilj M, Rotim A, Splavski B, Jurčić Čulina I. Surgical and Seizure Treatment Outcomes in Adult Dysembryoplastic Neuroepithelial Tumors: a Case Series. Acta Clin Croat 2021; 60:627-631. [PMID: 35734497 PMCID: PMC9196212 DOI: 10.20471/acc.2021.60.04.09] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) are benign neoplasms classified in the category of glioneuronal tumors. The estimated incidence of DNETs is 0.03 per 100,000 person per year with the age peak in a range between 10 and 14 years, and decreasing dramatically with increasing age. They are seldom diagnosed in persons above 20 years of age, being a cause of tumor-related intractable epilepsy that begins in childhood or adolescence. They have been proven to be the second most common type of epileptogenic tumors in pediatric population. These rare tumors cause chronic drug-resistant partial complex seizures with or without secondary generalization. Herein, we provide institutional case series of six adult patients with temporal lobe DNET presenting with complex partial seizures. Lesionectomy was performed with tumor resection in toto in three patients. In another three, partial resection was performed, whereas tumor remnant was left intact to avoid possible basal ganglia damage. All patients were seizure free postoperatively. Lesionectomy alone in temporal lobe epilepsy was associated with less favorable outcome than anterior temporal lobectomy. Total tumor removal is considered a major prognostic factor in most studies.
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Affiliation(s)
- Tomislav Sajko
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Krešimir Rotim
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Mia Jurilj
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Ante Rotim
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Bruno Splavski
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
| | - Ivana Jurčić Čulina
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia
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10
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El Ahmadieh TY, Cai C, Mickey BE. Dysembryoplastic Neuroepithelial Tumor with Enlarging Heterogeneously Enhancing Organizing Hematoma. World Neurosurg 2019; 131:177-179. [PMID: 31421300 DOI: 10.1016/j.wneu.2019.08.036] [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: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022]
Abstract
This report portrays an unusual presentation of a dysembryoplastic neuroepithelial tumor characterized by a chronic, enlarging, heterogeneously enhancing organizing hematoma. Differential diagnoses included the malignant transformation of a low-grade glioma, radiation necrosis, and radiation-induced cavernoma. A dysembryoplastic neuroepithelial tumor may have atypical characteristics and behavior, so continued follow-up with serial imaging is recommended.
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Affiliation(s)
- Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Chunyu Cai
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Ko A, Kim SH, Kim SH, Park EK, Shim KW, Kang HC, Kim DS, Kim HD, Lee JS. Epilepsy Surgery for Children With Low-Grade Epilepsy-Associated Tumors: Factors Associated With Seizure Recurrence and Cognitive Function. Pediatr Neurol 2019; 91:50-56. [PMID: 30477743 DOI: 10.1016/j.pediatrneurol.2018.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/16/2018] [Accepted: 10/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Low-grade epilepsy-associated tumors (LEATs) are associated with childhood seizures that are typically drug-resistant, necessitating surgical interventions. In this study, we aimed to investigate the efficacy of surgical intervention in children with LEATs and to identify factors associated with seizure and cognitive outcomes. METHODS We reviewed 58 children less than 18 years of age who underwent epilepsy surgery due to histopathologically confirmed LEATs and had a minimum postoperative follow-up duration of 24 months. RESULTS Of the 58 patients who were followed for a median duration of 5.6 (IQR 3.2 to 10.0) years, 51 (87.9%) were seizure-free after surgery. In univariate analysis, shorter epilepsy duration, fewer antiepileptic drugs at time of surgery, gross total resection, and unilobar tumor involvement were associated with seizure freedom. In multivariate analysis, gross total resection was independently associated with seizure freedom. The preoperative and postoperative full-scale intelligence quotient (FSIQ) scores were 78.9 ± 27.1 and 80.9 ± 28.7, respectively. In univariate analysis, younger age at seizure onset, longer epilepsy duration, more antiepileptic drugs at time of surgery, multilobar tumor involvement, and presence of generalized epileptic discharges were associated with lower preoperative FSIQ. In multivariate analysis, longer epilepsy duration was independently associated with lower preoperative FSIQ scores. Postoperative FSIQ scores were significantly influenced by preoperative FSIQ scores. CONCLUSIONS Epilepsy surgery for LEATs in children resulted in excellent seizure outcome. Gross total resection was the only independent factor associated with favorable seizure outcome. Preoperative and postoperative cognitive abilities were significantly influenced by epilepsy duration, so early surgical intervention should be considered.
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Affiliation(s)
- Ara Ko
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyung Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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12
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Vornetti G, Marucci G, Zenesini C, de Biase D, Michelucci R, Tinuper P, Tallini G, Giulioni M. Relationship among clinical, pathological and bio-molecular features in low-grade epilepsy-associated neuroepithelial tumors. J Clin Neurosci 2017; 44:158-163. [PMID: 28673671 DOI: 10.1016/j.jocn.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 03/03/2017] [Accepted: 06/12/2017] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the relationship between molecular markers and clinicopathological features in patients operated on for low-grade epilepsy-associated neuroepithelial tumors. Molecular-genetic signatures are becoming increasingly important in characterizing these lesions, which represent the second most common cause of focal epilepsy in patients undergoing epilepsy surgery. Data from 22 patients operated on for histopathologically confirmed low-grade epilepsy-associated neuroepithelial tumors were retrospectively collected. All specimens were examined for BRAF and IDH mutational status, 1p/19q codeletion and CD34 expression. The relationship between bio-molecular markers and several demographic, clinical and pathological features were analyzed. BRAF mutation was found in 11 (50.0%) patients and CD34 expression in 13 (59.1%). No patients presented IDH mutation or 1p/19q codeletion. Multiple seizure types were present in 5 (45.5%) patients with BRAF mutation and in none of those with BRAF wild type (p=0.035). Moreover, BRAF mutation was predominant in right-sided lesions (p=0.004) and CD34 expression was significantly associated with a longer duration of epilepsy (p=0.027). Several other clinicopathological features, such as association with focal cortical dysplasia and postoperative seizure outcome, showed no significant correlation with molecular markers. Further studies are necessary both to confirm these data in larger cohort of patients and to investigate possible relationships between molecular markers and other clinicopathological features.
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Affiliation(s)
- Gianfranco Vornetti
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Gianluca Marucci
- Department of Neuropathology, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Corrado Zenesini
- Unit of Epidemiology and Biostatistics, IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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13
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Huse JT, Snuderl M, Jones DTW, Brathwaite CD, Altman N, Lavi E, Saffery R, Sexton-Oates A, Blumcke I, Capper D, Karajannis MA, Benayed R, Chavez L, Thomas C, Serrano J, Borsu L, Ladanyi M, Rosenblum MK. Polymorphous low-grade neuroepithelial tumor of the young (PLNTY): an epileptogenic neoplasm with oligodendroglioma-like components, aberrant CD34 expression, and genetic alterations involving the MAP kinase pathway. Acta Neuropathol 2017; 133:417-429. [PMID: 27812792 PMCID: PMC5325850 DOI: 10.1007/s00401-016-1639-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 02/07/2023]
Abstract
Epileptogenic tumors affecting children and young adults are a morphologically diverse collection of neuroepithelial neoplasms that, as a group, exhibit varying levels of glial and/or neuronal differentiation. Recent advances in molecular profiling technology, including comprehensive DNA sequencing and methylation analysis, have enabled the application of more precise and biologically relevant classification schemes to these tumors. In this report, we describe a morphologically and molecularly distinct epileptogenic neoplasm, the polymorphous low-grade neuroepithelial tumor of the young (PLNTY), which likely accounts for a sizable portion of oligodendroglioma-like tumors affecting the pediatric population. Characteristic microscopic findings most notably include infiltrative growth, the invariable presence of oligodendroglioma-like cellular components, and intense immunolabeling for cluster of differentiation 34 (CD34). Moreover, integrative molecular profiling reveals a distinct DNA methylation signature for PLNTYs, along with frequent genetic abnormalities involving either B-Raf proto-oncogene (BRAF) or fibroblast growth factor receptors 2 and 3 (FGFR2, FGFR3). These findings suggest that PLNTY represents a distinct biological entity within the larger spectrum of pediatric, low-grade neuroepithelial tumors.
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Affiliation(s)
- Jason T Huse
- Departments of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, 2130 W Holcombe Blvd, LSP9.4009, Houston, TX, 77030, USA.
| | - Matija Snuderl
- Department of Pathology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DFKZ), 69120, Heidelberg, Germany
| | - Carole D Brathwaite
- Department of Pathology, Nicklaus Children's Hospital, Miami, FL, 33155, USA
| | - Nolan Altman
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL, 33155, USA
| | - Ehud Lavi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Alexandra Sexton-Oates
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Ingmar Blumcke
- Institute of Neuropathology, University of Erlangen, 91054, Erlangen, Germany
| | - David Capper
- Department of Pathology, University of Heidelberg, 69120, Heidelberg, Germany
| | - Matthias A Karajannis
- Department of Pediatrics, New York University Langone Medical Center, New York, NY, 10016, USA
- Department of Ototlaryngology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 408 E 69th St. (Z564), New York, NY, 10065, USA
| | - Lukas Chavez
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DFKZ), 69120, Heidelberg, Germany
| | - Cheddhi Thomas
- Department of Pathology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Jonathan Serrano
- Department of Pathology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Laetitia Borsu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 408 E 69th St. (Z564), New York, NY, 10065, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 408 E 69th St. (Z564), New York, NY, 10065, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 408 E 69th St. (Z564), New York, NY, 10065, USA
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15
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Fernandez-Vega I, Saiz A, Santos-Juanes J, Piña-Batista K, Corte-Torres MD, Astudillo A. 64 Year-Old Woman with Longstanding Migraine. Primary Diffuse Leptomeningeal Gliomatosis (PDLG) (WHO Grade III). Brain Pathol 2015; 25:365-6. [PMID: 26086054 DOI: 10.1111/bpa.12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yao K, Wu B, Xi M, Duan Z, Wang J, Qi X. Distant dissemination of mixed low-grade astroblastoma-arteriovenous malformation after initial operation: a case report. Int J Clin Exp Pathol 2015; 8:7450-7456. [PMID: 26261652 PMCID: PMC4525986] [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] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/20/2015] [Indexed: 06/04/2023]
Abstract
We present a rare case of low-grade astroblastoma coexisting with an arteriovenous malformation (AVM) underwent surgery two times in a 38-year-old man. After the first surgery, this case was reported as a mixed low-grade astroblastoma and AVM. The lesion was completely resected surgically along with AVM. The patient underwent postoperative radiotherapy. Twenty months later, MRI showed enhanced lesions in suprasellar, pineal region and multiple small lesions in the spinal cord, whereas completely no recurrent lesion at the primary tumor site. So, the patient rationally underwent surgical removal in suprasellar and pineal region. After the second surgery, this case was diagnosed as a high-grade astroblastoma. Cells from the second surgical specimens showed high MIB-1 index and an increased olig-2 index. In addition, it is not common for low-grade astroblastoma metastasis to suprasellar, pineal region and spine with completely no recurrence at the original primary tumor site. Therefore it is difficult to predict tumor behavior and patient's clinical outcome merely based on histologic features. The important issue is whether the AVM was thought to be the cause of poor progress of this tumor. More cases are needed to confirm this. Classification and histogenesis of this tumor is still debated. Lack of clinicopathological correlation makes the prognosis of this tumor unpredictable. Anyway, we should be very discreet to treat the astroblastoma, even for low-grade astroblastoma.
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Affiliation(s)
- Kun Yao
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
| | - Bin Wu
- Department of Neurosurgery, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Mei Xi
- Department of Neurology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Zejun Duan
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
| | - Jiqiang Wang
- Department of Neurosurgery, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Xueling Qi
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
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17
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Hasegawa M, Nouri M, Nagahisa S, Hayashi T, Adachi K, Hirose Y, Abe M. Neuroepithelial cyst of the fourth ventricle. Childs Nerv Syst 2015; 31:155-9. [PMID: 24993126 DOI: 10.1007/s00381-014-2478-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/26/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Neuroepithelial cyst is considered an unusual differential diagnosis for cysts in the posterior fossa. Here, we present a paediatric case with such a pathology and review the pertinent literature. METHODS A 12-year old girl with headache, vertigo and disturbed gait was diagnosed with a cystic lesion in the fourth ventricle after brain MRI study. She was operated with the pre-operative diagnosis of arachnoid cyst. RESULTS A transparent, colourless cyst was observed intra-operatively. As frozen sections were consistent with endodermal cyst, total removal of the cyst was attempted. Definite histopathological studies and immunohistochemistry stains were in favour of neuroepithelial cyst. No regrowth of the cyst or recurrence of the symptoms was observed in her 2-year follow-up. CONCLUSIONS As neuroepithelial cyst is rarely encountered in the posterior fossa, the clinical, radiological and pathological characteristics of our case along with similar cases in the literature were reviewed and discussed.
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Affiliation(s)
- Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukak, Toyoake, Aichi, 470-1192, Japan,
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18
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Tikkakoski T, Ostrovska V, Ingo S, Bode MK, Timo K, Tuominen H. [Gliomatosis cerebri as cause of neuropsychiatric symptoms]. Duodecim 2014; 130:1183-1187. [PMID: 25016665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gliomatosis cerebri (GC) is a rare cancer of the central nervous system, having already penetrated into various areas of the central nervous system upon becoming manifest. In tissue specimens the histopathologic picture of the tumor appears similar to that seen in diffuse gliomas at different stages of disease. Typical MRI findings in GC include diffuse increases in signal intensity in the brain, and indistinct gray-white matter demarcation in T2-weighted images. Surgical treatment is usually not possible. We describe a patient, in whom CG turned eventually out to be the cause of severe neuropsychiatric symptoms.
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Hermanova M, Horakova I, Velecky L. [What is your diagnosis? Dysembryoplastic neuroepithelial tumor (DNET) WHO grade 1]. Cesk Patol 2012; 48:91-92. [PMID: 23091825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- M Hermanova
- 1. patologicko-anatomicky ustav LJ MU a FN u sv. Anny v Brne
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20
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Prayson RA, Napekoski KM. Composite ganglioglioma/dysembryoplastic neuroepithelial tumor: a clinicopathologic study of 8 cases. Hum Pathol 2012; 43:1113-8. [PMID: 22221701 DOI: 10.1016/j.humpath.2011.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/17/2011] [Accepted: 08/24/2011] [Indexed: 11/15/2022]
Abstract
Ganglioglioma and dysembryoplastic neuroepithelial tumor are both low-grade glioneuronal neoplasms that most commonly occur in association with chronic epilepsy. Rare cases of tumors with composite features of ganglioglioma and dysembryoplastic neuroepithelial tumor have been reported. We retrospectively reviewed the clinicopathologic features of 8 composite tumors (7 were female; median age, 20 years). All patients had chronic epilepsy and had tumors in either the temporal or the frontal lobe. Six patients are currently seizure-free (follow-up: median, 90 months). All tumors were multinodular. Some nodules had distinct features of each tumor type (range, 5%-85% of the tumor). Seven tumors contained nodules with mixed features of both tumor types. Five of 7 evaluable tumors demonstrated adjacent focal cortical dysplasia (Palmini type I). Mitotic activity, vascular proliferation, or necrosis was not observed in any of the tumors. Three tumors demonstrated focal meningeal extension. Composite tumors commonly arise in the temporal lobe in young patients with chronic epilepsy; they appear to behave as a World Health Organization grade I neoplasm. Histologically, these multinodular tumors appear to maintain distinct areas with features of each tumor and foci where the 2 patterns are merged. A subset of composite tumors are associated with adjacent focal cortical dysplasia.
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Affiliation(s)
- Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Abstract
Gliomatosis cerebri (GC) is an uncommon brain tumour defined as a diffuse neoplastic glial cell infiltration of the brain, involving more than two cerebral lobes and, occasionally, the infratentorial structures or the spinal cord. GC of the oligodendroglial phenotype is extremely rare, especially in the paediatric setting. We describe an unusual case of oligodendroglial GC diagnosed in a 16-year-old boy with Ollier disease. To our knowledge this is the first case of GC reported in a child with Ollier disease.
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Affiliation(s)
- Ruth A Mitchell
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Zaghloul KA, Schramm J. Surgical management of glioneuronal tumors with drug-resistant epilepsy. Acta Neurochir (Wien) 2011; 153:1551-9. [PMID: 21603887 DOI: 10.1007/s00701-011-1050-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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: 05/06/2011] [Accepted: 05/09/2011] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the options for the surgical management of glioneuronal tumors (GNTs) associated with drug-resistant epilepsy, with an emphasis on the surgical issues involved in addressing the epileptogenic nature of these lesions. We briefly summarize the pathological hallmarks of these lesions in order to outline how these tumors contribute to seizure activity. Understanding the pathophysiology of these lesions is important in discussing the advantages and disadvantages of different surgical strategies. There have been a number of studies that have investigated the utility of different surgical approaches in improving seizure outcome, and we highlight some of these studies in order to shed light on surgical issues related to these tumors.
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Affiliation(s)
- Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
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Liu J, Lu DH, Piao YS, Wang W, Chen L, Wei LF, Yang H. [Expression and diagnostic significance of CD34 in brain tumors of patients with refractory epilepsy]. Zhonghua Bing Li Xue Za Zhi 2010; 39:151-155. [PMID: 20450759] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study the immunohistochemical expression and diagnostic significance of CD34 in brain tumors of patients with refractory epilepsy. METHODS Immunohistochemical study for CD34 was performed on formalin-fixed paraffin-embedded tissue blocks of 54 cases of brain tumors occurring in patients with refractory epilepsy. The tumor types included ganglioglioma (GG, number = 21), dysembryoplastic neuroepithelial tumor (DNT, number = 8), tumors/lesions which had the transitional features that between glioneuronal hamartia and mixed neuronal-glial tumor (number = 21) and pleomorphic xanthoastrocytoma (PXA, number = 4). Cases of glioblastoma (number = 4) and oligoastrocytoma (number = 5) were used as controls. RESULTS Twenty of the 21 cases of GG, 1 of the 8 cases of DNT, 16 of the 21 cases of tumors/lesions which had the transitional features and 3 of the 4 cases of PXA showed cytoplasmic and membranous positivity for CD34. The adjoining brain tissues in 9 of the 18 cases of GG, 6 of the 16 cases of tumors/lesions which had the transitional features and 1 of the 3 cases of PXA also expressed CD34. In contrast, only 1 case of glioblastoma showed membranous positivity for CD34. CONCLUSIONS CD34 preferred to staining for GG and PXA. Which represent a valuable tool for distinguishing GG, PXA and DNT, oligoastrocytoma, glioblastoma.
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Affiliation(s)
- Jing Liu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Lee J, Lee BL, Joo EY, Seo DW, Hong SB, Hong SC, Suh YL, Lee M. Dysembryoplastic neuroepithelial tumors in pediatric patients. Brain Dev 2009; 31:671-81. [PMID: 19058938 DOI: 10.1016/j.braindev.2008.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 10/05/2008] [Accepted: 10/06/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Dysembryoplastic neuroepithelial tumors (DNTs) are benign cortical tumors that are frequently associated with the medically intractable focal epilepsy. In this study, the authors delineate the clinical characteristics of DNTs in children and evaluate the role of cortical dysplasia (CD) in the epileptogenicity to find out the optimum surgical strategy. METHODS A retrospective analysis was performed for clinical data of children with DNT, who underwent surgery between 1996 and 2006. The adopted surgical methods were uniform according to the tumor location and included intraoperative electrocorticography (ECoG)-guided resection. The prognostic factors were evaluated for the two prognostic group categorized by the seizure outcome at one year after surgery. RESULTS Of 22 patients, the overall seizure free rate was 90.9% and the other two patients belonged to Engel class II during the mean follow-up period of 44.1 months. There was no worsening of the seizure after one year of surgery. Associated CD was found in 18 cases (81.8%) and in the 80% (8 of 10 cases) of the additionally resected areas according to the electrophysiologic studies. CONCLUSIONS The CD associated with DNT appears to have its own epileptogenicity. Therefore, complete removal of the CD with tumor itself is important for patient outcome. A thorough surgical approach can be accomplished by comprehensive presurgical evaluations and extensive surgery with the aid of the intraoperative ECoG or intracranial recording.
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Affiliation(s)
- Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Belsare G, Lee AG, Maley J, Kirby P, St Louis EK, Follett K. Pseudo-subarachnoid hemorrhage and cortical visual impairment as the presenting sign of gliomatosis cerebri. Semin Ophthalmol 2009; 19:78-80. [PMID: 15590541 DOI: 10.1080/08820530490882742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 49-year-old white male presented with a pseudo-subarachnoid hemorrhage and diffuse brain edema. Neuroimaging showed brain edema causing the unusual findings of a pseudo-subarachnoid hemorrhage and bilateral occipital lobe infarcts following herniation and compression of the posterior cerebral arteries. An enlarged corpus callosum was noted which led to a brain biopsy and a diagnosis of gliomatosis cerebri.
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Affiliation(s)
- Geeta Belsare
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Trabelsi A, Stita W, Mestiri S, Gharbi O, Bellara I, Yacoubi MT, Korbi S. A history of partial complex seizures in a 30-year-old woman. Pathologica 2008; 100:411-413. [PMID: 19253602] [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: 05/27/2023] Open
Abstract
Dysembryoplastic neuroepithelial tumour is an uncommon lesion of the brain characterised by a heterogeneous population of neurons, astrocytes and oligodendroglia-like cells. Most patients are young adults with a long history of drug-resistant seizures. We report a case of a 31 year-old woman with a history of severe epileptic attacks. Cerebral imaging showed a left temporal tumour measuring 4 cm in its greater dimension. After surgical intervention, histopathological examination showed a tumoural proliferation with both glial and neuronal components that was confirmed by immunohistochemistry. We also describe the spectrum of dysembryoplastic neuroepithelial tumours and their histological features.
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Affiliation(s)
- A Trabelsi
- Department of Pathology, Farhat Hached Hospital, Sousse, Tunisia.
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Hong SB, Joo EY, Tae WS, Cho JW, Lee JH, Seo DW, Suh YL, Hong SC. Preictal versus ictal injection of radiotracer for SPECT study in partial epilepsy: SISCOM. Seizure 2008; 17:383-6. [PMID: 17768074 DOI: 10.1016/j.seizure.2007.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 03/06/2007] [Revised: 07/20/2007] [Accepted: 07/24/2007] [Indexed: 11/17/2022] Open
Abstract
A 27-year-old man had complex partial seizures and a dysembryoplastic neuroepithelial tumor (DNT) in the left inferior-basal temporal region. The patient's seizures consisted of incomprehensible speech, staring, unresponsiveness, fumbling and then looking around. For the brain SPECT study, radiotracer was injected during the preictal (11s prior to seizure onset), ictal (at 25 s out of 47 s seizure duration) and interictal periods. Interictal SPECT was subtracted from preictal or ictal-injection SPECTs and then the subtracted SPECTs were overlaid on the patient's MRI (SISCOM). SISCOM with preictal-injection SPECT showed hyperperfusion at the brain lesion, whereas SISCOM with ictal-injection SPECT showed hyperperfusion at the ipsilateral amygdala-hippocampus and hypoperfusion around the tumor lesion. After the DNT and nearby temporal lobe tissues were resected with preservation of amygdala-hippocampus, the patient became seizure free without complaint of subjective postsurgical memory decline. In this patient, SISCOM with preictal injection of radiotracer localized an epileptogenic zone, whereas SISCOM with the ictal injection showed hyperperfusion at the symptomatogenic zone.
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Affiliation(s)
- Seung Bong Hong
- Department of Neurology, Samsung Medical Center, SBRI, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
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Piovesan EJ, Teive HG, de Paola L, Silvado CE, Crippa A, Amaral VCG, Della Colleta MV, Di Stani F, Werneck LC. Uncontrolled headache induced by oxcarbazepine. J Headache Pain 2007; 8:301-5. [PMID: 17955169 PMCID: PMC3476151 DOI: 10.1007/s10194-007-0415-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 09/20/2007] [Indexed: 11/05/2022] Open
Abstract
Headache induced by acute exposure to a specific drug constitutes an idiosyncratic side effect. Metabolic imbalance appears as the leading aetiology, among several other hypotheses. Either primary headaches show a higher susceptibility to this idiosyncratic reaction or a drug-induced primary headache evolves in intensity and duration, becoming uncontrolled until the complete discontinuation of the drug in consideration. The goal of this study is to describe three patients diagnosed with migraine and epilepsy (both under control) who evolved into status migrainosus after the introduction of oxcarbazepine (OXC), as part of a switch off from carbamazepine (CBZ). Twenty-four to seventy-two hours following the switch, all patients developed intractable headache, despite the use of different symptomatic drugs. Complete recovery of the headache symptoms occurred only after OXC was discontinued. We discuss the potential mechanisms associated to OXC and status migrainosus, drug-induced headaches and uncontrolled headaches.
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Affiliation(s)
- Elcio Juliato Piovesan
- Headache Clinic, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 120 andar, sala 1236, CEP-80060-900, Curitiba-Paraná, Brazil.
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Abstract
AIMS Dysembryoplastic neuroepithelial tumours (DNTs) have been considered benign lesions characterised by a chronic, indolent clinical course. Previous studies have suggested that increased proliferation rates may be balanced by corresponding rates of apoptosis. The objective of this study was to determine whether a correlation exists between histological features and indices of proliferation/apoptosis. METHODS Fourteen consecutive surgical specimens meeting the histological criteria for DNT were retrospectively reviewed for evidence of aggressive histological features, including anaplasia, mitotic activity, and Ki67 labelling. Immunohistochemistry was performed semiquantitatively to evaluate and compare proliferation (Ki76) and apoptosis (TUNEL). The clinical course of the patients was also reviewed. RESULTS Atypical histological features were demonstrated in the glial component of select complex DNTs. TUNEL indices, however, had negligible correlation with proliferative indices. A balance between cell proliferation and apoptosis was not evident particularly in those cases displaying aggressive histological features. CONCLUSIONS While there is no clearly defined clinical or pathological pattern to indicate aggressive growth of DNTs, elevated proliferative indices coupled with atypical histological features in complex DNTs should be taken into consideration in determining the aggressiveness of surgical extirpation and follow-up until experience with these uncommon tumours is greater.
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Affiliation(s)
- N Duggal
- LHSC, University Campus, Department of Clinical Neurological Sciences (Division of Neurosurgery), London, Ontario, Canada N6A 5A5.
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Notarianni C, Akin M, Fowler M, Nanda A. Brainstem astroblastoma: a case report and review of the literature. ACTA ACUST UNITED AC 2007; 69:201-5. [PMID: 17765957 DOI: 10.1016/j.surneu.2006.12.045] [Citation(s) in RCA: 23] [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] [Received: 12/07/2005] [Accepted: 12/09/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Astroblastoma is a rare glial tumor that occurs mainly in the cerebral hemispheres of young adults. Our purpose in writing this article is to report one case of astroblastoma located within the medulla and review the literature on this infrequent tumor. METHODS One case of astroblastoma was retrospectively reviewed. Presenting complaints, radiographic images, operative procedure, and histopathologic findings were recorded. RESULTS Contrast-enhanced MRI scan revealed a well-defined, well-circumscribed, contrast-enhanced cystic lesion approximately 16 mm in diameter within the medulla oblongata. Light microscopy demonstrated a papillary neoplasm composed of mildly pleomorphic cells with indistinct cytoplasmic borders. The nuclei were generally round to oval in shape. Occasional rosettes of tumor cells were seen around blood vessels. Mitoses were not seen within the submitted specimen. One small area of necrosis was present. The tumor exhibited thickened but not hyalinized blood vessel walls. The tumor cells exhibited strong staining for EMA and vimentin throughout the tissue section. Neurofilament, CAM 5.2, and CK immunostains were negative, except for rare positive staining of CK between cells and within rare tumor cells. Ki-67 was positive in small numbers of tumor nuclei, with an overall reactivity of 7%. By electron microscopy, the tumor nuclei had irregularly round to oval nuclei with moderate clumping of the chromatin, especially at the nuclear margins. CONCLUSIONS The combination of the radiologic and histopathologic characteristics of this tumor is necessary for making the diagnosis of astroblastoma. This article serves to summarize these characteristics as well as to report of an unusual location for this mainly hemispheric tumor.
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Affiliation(s)
- Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71130-3932, USA
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Affiliation(s)
- John O Fleming
- Department of Neurology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 44901, USA
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Chen L, Xu QZ, Piao YS, Zhang GJ, Yu T, Yang XP, Yang H, Lu DH. [Dysembryoplastic neuroepithelial tumor: a clinicopathologic and immunohistochemical study]. Zhonghua Bing Li Xue Za Zhi 2007; 36:524-528. [PMID: 17980099] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To study the clinicopathologic features, immunophenotype and histogenesis of dysembryoplastic neuroepithelial tumor (DNT). METHODS Fourteen cases of DNT were retrieved from the archival files of the Department. The histopathologic features and immunohistochemical findings were retrospectively studied. The long-term follow-up data were analyzed. RESULTS Eleven of the 14 cases studied were located in the temporal lobe. Histologically, the tumor consisted of a heterogeneous admixture of neuronal and glial cells (including 1 simple form case, 8 complex form cases and 5 non-specific form cases). The specific glioneuronal element was seen in 9 cases. Variable degrees of cortical dysplasia (CD) were found in 10 out of the 11 cases which had sufficient tissue samples for thorough histologic examination. The morphologic appearance of CD included the presence of heterotopic neurons in molecular layer and/or white matter (7 cases), persistent subpial granular cell layer (4 cases), dyslamination (10 cases) and cellular abnormalities. Immunohistochemically, the oligodendroglial-like cells expressed Olig2. Some of which were positive for nestin, MAP-2, neurofilament and glial fibrillary acidic protein, but negative for NeuN. Long-term follow up revealed that 12 patients had class I postoperative seizure and 2 patients had class II seizure. No tumor recurrence was detected. CONCLUSIONS DNT is frequently associated with CD. The morphologic diagnosis can be confirmed by immunohistochemical study using a panel of antibodies.
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Affiliation(s)
- Li Chen
- Department of Pathology and Functional Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
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33
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Affiliation(s)
- Iqroop Chopra
- Department of Neurosurgery, Charring Cross Hospital, London, UK
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34
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Abstract
Abstract
OBJECTIVE
Astroblastomas are rare glial neoplasms that usually occur in young adults and have a predilection for the cerebral hemispheres. Patients typically present with signs of increased intracranial pressure and seizures. Imaging studies reveal circumscribed, contrast-enhancing tumors that contain both cystic and solid components with variable peritumoral edema. Hemorrhage, which suggested the presence of a vascular lesion in this patient, has not been previously described as a feature of this neoplasm.
CLINICAL PRESENTATION
The authors report the case of a 33-year-old woman who presented with spontaneous intraparenchymal hemorrhage. The collective radiographic data suggested the presence of a cavernous malformation.
INTERVENTION
A right frontotemporal craniotomy was performed under frameless stereotactic image guidance. An astroblastoma was diagnosed after resection and neuropathological examination.
CONCLUSION
A rare radiological to pathological correlation of astroblastoma is presented in which the evolving hematoma, as observed on magnetic resonance imaging scans, complicated the radiographic diagnosis of this lesion. The clinical, radiographic, and pathological features of astroblastomas, as well as the natural history of these rare glial neoplasms, are reviewed. This case illustrates the capacity of astroblastomas to hemorrhage, disguising the classic radiographic findings typical of this glial neoplasm.
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MESH Headings
- Adult
- Brain Neoplasms/complications
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/surgery
- Diagnosis, Differential
- Female
- Hemangioma, Cavernous, Central Nervous System/complications
- Hemangioma, Cavernous, Central Nervous System/diagnostic imaging
- Hemangioma, Cavernous, Central Nervous System/surgery
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Humans
- Neoplasms, Neuroepithelial/complications
- Neoplasms, Neuroepithelial/diagnostic imaging
- Neoplasms, Neuroepithelial/surgery
- Radiography
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Affiliation(s)
- Luis M Tumialán
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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35
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Alaraj A, Chan M, Oh S, Michals E, Valyi-Nagy T, Hersonsky T. Astroblastoma presenting with intracerebral hemorrhage misdiagnosed as dural arteriovenous fistula: review of a rare entity. ACTA ACUST UNITED AC 2007; 67:308-13. [PMID: 17320647 DOI: 10.1016/j.surneu.2006.05.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 10/06/2005] [Accepted: 05/11/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Astroblastoma is one of the most unusual types of tumors whose histogenesis has been recently clarified. It occurs mainly among children and young adults. It is grossly well demarcated and shows histologically characteristic perivascular pseudorosettes with frequent vascular hyalinization. Immunohistochemically, the tumor cells show diffuse strong positivity for GFAP, S-100 protein, vimentin, as well as neuron-specific enolase and focal positivity for EMA. CASE DESCRIPTION Our patient is a 33-year-old gentleman who presented with intraparenchymal hemorrhage in the left temporal lobe. A 4-vessel cerebral angiogram revealed a dural AVF in the left posterior temporal area. The lesion was resected, and pathology showed a GFAP-positive lesion with prominent astroblastoma rosettes. There was abundant hemosiderin consistent with a prior hemorrhage. Because of its high degree of proliferation, the presence of astroblastic pseudorosettes, prominent perivascular hyalinization, regional hyaline changes, and pushing borders with regard to the adjacent brain, the tumor was considered anaplastic. CONCLUSIONS Astroblastoma is a rare pure pathologic entity--a distinct form of astrocytic gliomas. The diagnosis of astroblastoma is often difficult because of the astroblastic aspects that can be found in astrocytic tumors, in ependymomas, and in nonneuroepithelial tumors. The natural history seems to be between astrocytomas and glioblastomas. Total resection and radiation therapy seem to be the advisable treatments.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Abstract
AbstractOBJECTIVEDuring the past 15 years, the concept of dysembryoplastic neuroepithelial tumors has continued to evolve. We present an interesting case of dysembryoplastic neuroepithelial tumor that showed rapid growth during a short period of time.CLINICAL PRESENTATIONA 9-year-old boy had been experiencing intractable complex partial seizures since the age of 7 years. Magnetic resonance imaging scans demonstrated a well-demarcated 3.5-cm lesion with a 1.5-cm ring-enhanced core in the left temporal lobe. One month later, the lesion had rapidly grown to occupy three times more space than on the first evaluation, with the ring-enhanced core reaching approximately five times its initial volume.INTERVENTIONA combined tumor removal and epileptogenic focus resection surgery was performed immediately. In the pathological examination, the presence of the specific glioneuronal element with a Ki-67 labeling index of lower than 1%, as well as the glial component with a Ki-67 labeling index of 8%, led to a postoperative diagnosis of dysembryoplastic neuroepithelial tumor, complex form. No adjuvant therapy was performed. Five years after surgery, there is no evidence of any recurrence and the boy continues to be seizure free without antiepileptic drugs.CONCLUSIONThe lesion did not behave as a stable benign entity as it is generally accepted, and is, therefore, presented as an argument in favor of an early and complete resection.
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Affiliation(s)
- Oltea Sampetrean
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
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37
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Lee MC, Kang JY, Seol MB, Kim HS, Woo JY, Lee JS, Jung S, Kim JH, Woo YJ, Kim MK, Kim HI, Kim SU. Clinical features and epileptogenesis of dysembryoplastic neuroepithelial tumor. Childs Nerv Syst 2006; 22:1611-8. [PMID: 16944177 DOI: 10.1007/s00381-006-0162-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Dysembryoplastic neuroepithelial tumor (DNT) frequently causes medically intractable epilepsy. OBJECTIVE The aim of this study was to investigate the basic mechanism of epileptogenecity of the tumor. MATERIALS AND METHODS Clinicopathological data in 13 cases of DNT and immunohistochemical changes of ionotropic glutamate receptor subunits in the tumor and peritumoral epileptogenic cortex were studied. CONCLUSIONS Magnetic resonance imaging combined with electroencephalography (EEG), electrocorticography, and depth-electrode EEG was valuable to localize complicated epileptogenic zones of the patients with DNT. Neuropathological examinations of the peritumoral cerebral cortex presenting abnormal spikes showed different histopathological grades of neuronal migration disorder (NMD). The tumor cells in DNT disclosed increased immunopositivities of N-methyl-D: -aspartate receptor 1 (NR1) and NR2A/B, and peritumoral epileptogenic NMD revealed increased immunopositivities of GluR2 and GluR3. The amplification of ionotropic glutamate receptor subunits in the tumor and peritumoral NMD may be the underlying cause of epileptic seizures in DNT patients.
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Affiliation(s)
- Min-Cheol Lee
- Department of Pathology, Chonnam National University Medical School and Hospital, 5 Hakdong, Dongku, Gwangju, 501-746, South Korea.
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Deb P, Sharma MC, Tripathi M, Sarat Chandra P, Gupta A, Sarkar C. Expression of CD34 as a novel marker for glioneuronal lesions associated with chronic intractable epilepsy. Neuropathol Appl Neurobiol 2006; 32:461-8. [PMID: 16972880 DOI: 10.1111/j.1365-2990.2006.00734.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [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: 11/30/2022]
Abstract
The spectrum of glioneuronal lesions underlying intractable epilepsies includes malformative pathologies like focal cortical dysplasia (FCD); and neoplastic lesions like gangliogliomas (GG) and dysembryoplastic neuroepithelial tumours (DNT). These may occur either singly or as dual lesions, having simultaneous presence of both elements. Currently, the relationship between the malformative and neoplastic glioneuronal lesions is poorly understood. Recently, CD34, a stem cell marker transiently expressed during early neurulation, has been identified in these tumours. This study was undertaken to (i) evaluate the role of CD34 as a diagnostic marker for glioneuronal lesions of epilepsy, namely, GG, DNT and FCD, and (ii) attempt to define the relationship among these lesions, using CD34 as a marker. Tissues resected from 47 patients with intractable epilepsy due to glioneuronal lesions (GG, FCD, DNT) were studied. These were evaluated for CD34 expression, using immunohistochemistry. Dysplastic or atypically differentiated neural precursors which could not be identified on routine haematoxylin and eosin (H&E) staining were highlighted by CD34 immunostaining. The pattern of immunostaining was diffuse in GGs, unlike FCDs, wherein cells were present singly or in small clusters. However, cases of DNT and control tissue were largely CD34-immunonegative. Based on these findings, we propose a possible common origin of GG and FCD, from a bipotent precursor that undergoes abnormal glioneuronal development, while DNTs possibly have a different origin. The CD34-immunoreactive cells represent dysplastic or undifferentiated neural precursors, which may signify a valuable marker for the diagnostic evaluation of neoplastic and/or malformative pathologies in patients with intractable epilepsy.
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Affiliation(s)
- P Deb
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract
We report a case of a 14-year-old boy with a dysembryoplastic neuroepithelial tumor and mental retardation with intractable seizures, which were demonstrated to be predominantly tonic seizures by video-electroencephalography (EEG). He did not have any electrographic evidence of Lennox-Gastaut syndrome. Head magnetic resonance imaging (MRI) revealed a right parietal dysembryoplastic neuroepithelial tumor. He has been seizure free since surgical removal of the tumor. Clinicians need to be aware that tonic seizures can be associated with an underlying focal pathology that might be treatable.
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Affiliation(s)
- Hema Patel
- Section of Pediatric Neurology, Department of Neurology, Riley Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
The development of intraoperative hyperthermia has been reported in association with blood malignancies. This is case report of hyperthermia in a child with neuroblastoma, which was not an episode of malignant hyperthermia as determined by arterial blood cases and physiologic vital signs.
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Affiliation(s)
- James F Mayhew
- Department of Anesthesiology University of Mississippi Medical Center, Batson Children's Hospital, Jackson, 39216, USA.
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Stargatt R, Rosenfeld JV, Anderson V, Hassall T, Maixner W, Ashley D. Intelligence and adaptive function in children diagnosed with brain tumour during infancy. J Neurooncol 2006; 80:295-303. [PMID: 16807781 DOI: 10.1007/s11060-006-9187-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 03/16/2006] [Accepted: 04/21/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Late effects of treatment in children diagnosed and treated for brain tumours in infancy is a major concern. Assessment of infants presenting with brain tumours is difficult and there is little information available regarding the development of infants prior to treatment and hence the impact of the tumour itself on developmental outcomes. AIM To describe the development of children diagnosed with brain tumours in infancy and to document their cognitive and adaptive function at school entry. METHOD Infants were psychologically evaluated at the time of diagnosis of a brain tumour and during their fifth or sixth year in preparation for school entry. RESULTS Children diagnosed with brain tumours in infancy display developmental delays in a number of areas of adaptive function. By the time these children are school age they display further compromise in cognitive and academic skills and adaptive behaviour. Higher levels of deficit at follow-up were associated with tumour location in the supratentorium, younger age at diagnosis and longer time since diagnosis. The effect of radiotherapy could not be determined because of differing degrees of developmental compromise in the treatment groups at baseline. CONCLUSION Brain tumours in infancy confer a risk of poor developmental progress at the time of diagnosis. These children display additional compromise of development by the time they reach school age. Research protocols evaluating the impact of treatment in infants diagnosed with brain tumours need to take account of the developmental status of the child at diagnosis.
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Affiliation(s)
- Robyn Stargatt
- Department of Psychology, Murdoch Childrens' Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.
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42
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Gao X, Wu G, Wang Y, Jiang CC. [Diagnosis and treatment of dysembryoplastic neuroepithelial tumor]. Zhonghua Wai Ke Za Zhi 2006; 44:688-90. [PMID: 16784683] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To discuss the diagnosis and treatment of dysembryoplastic neuroepithelial tumor (DNT). METHODS From November 2001 to February 2005, 18 patients were admitted. The data of the 18 patients were reviewed. RESULT Epilepsy was the main complaint. There was no mass effect on MRI. Multinodular and specific glioneuronal element was typical in pathological examination, seizure could be controlled by operation. CONCLUSIONS DNT is benign tumor which could be treated by surgery, total removal of tumor and using intraoperative electrocorticography could improve the result of operation.
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Affiliation(s)
- Xiang Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Corapçíoğlu F, Memet Ozek M, Sav A, Uren D. Congenital pineoblastoma and parameningeal rhabdomyosarcoma: concurrent two embryonal tumors in a young infant. Childs Nerv Syst 2006; 22:533-8. [PMID: 16283194 DOI: 10.1007/s00381-005-0006-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pineoblastomas are very rare brain tumors in fetus and neonates, comprising only 0.9% of congenital brain tumors. The occurrence of multiple tumors of different histopathologic types in the same individual is a rare event, most often encountered in hereditary cancer syndromes. CASE REPORT We report a female fetus presented with a congenital pineoblastoma at the 32nd week of gestation, with hydrocephalus and concurrent parameningeal embryonal rhabdomyosarcoma in early infancy. RESULTS Cytogenetic analysis showed normal karyotype in the peripheral blood of the patient, and p53 mutational analysis revealed no germ line mutations. DISCUSSION This is the first case with concurrent congenital pineoblastoma and parameningeal embryonal rhabdomyosarcoma in early infancy. We suggest that concurrence of these tumors could be due to mutations in other tumor suppressor genes or secondary to exposure to unknown in utero factors.
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Affiliation(s)
- Funda Corapçíoğlu
- Department of Pediatrics, Division of Pediatric Oncology, Kocaeli University, Kocaeli, Turkey
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Hata N, Shono T, Yoshimoto K, Mizoguchi M, Kawamura T, Nagata S, Matsumoto K, Hayashi K, Iwaki T, Sasaki T. An astroblastoma case associated with loss of heterozygosity on chromosome 9p. J Neurooncol 2006; 80:69-73. [PMID: 16636749 DOI: 10.1007/s11060-006-9157-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 02/02/2006] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
The tumorigenesis of astroblastomas has not yet been elucidated on the basis of histopathological studies, and genetic studies may be useful for obtaining additional information regarding the tumorigenesis of these tumors. Here, we report an astroblastoma case in which a genetic analysis was performed. A 16-year-old female with a progressive headache was found to have a demarcated cystic tumor with a mural nodule in the right parietal lobe. Total removal of the tumor was achieved and a histological examination verified that the tumor was an astroblastoma. A genetic analysis using microsatellite markers revealed loss of heterozygosity (LOH) on chromosome 9p. The postoperative course was uneventful and, to date, she has been followed up for 2 years with no signs of recurrence. This is the first reported case of an astroblastoma in which LOH was detected on 9p. Based on this result, the tumorigenesis of astroblastomas is discussed.
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Affiliation(s)
- Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Krutsay M, Sipos G. [Gliomatosis cerebri]. Magy Onkol 2006; 50:55-58. [PMID: 16617385] [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] [Received: 01/10/2006] [Accepted: 03/06/2006] [Indexed: 05/25/2023]
Abstract
A 64 years old woman presented with weakness, vertigo, paresthesia, dementia, which progressed to coma in a three-month-long period. The autopsy revealed pulmonary thrombosis and infarction, gastric erosions, peptic ulcer in the duodenum, leiomyoma in the esophagus, fibrosis of the pancreas and mild atherosclerosis. On macroscopic examination, the 1440 g brain did not show any bleeding, infarction or tumor. The histologic examination revealed gliomatosis cerebri of the white matter of the cerebral hemispheres.
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Abstract
OBJECT Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. METHODS The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. CONCLUSIONS Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.
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Affiliation(s)
- Chow Huat Chan
- Neurosurgical Department, Austin Hospital, Heidelberg, Victoria, Australia
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Slee M, Pretorius P, Ansorge O, Stacey R, Butterworth R. Parkinsonism and dementia due to gliomatosis cerebri mimicking sporadic Creutzfeldt-Jakob disease (CJD). J Neurol Neurosurg Psychiatry 2006; 77:283-4. [PMID: 16421148 PMCID: PMC2077600 DOI: 10.1136/jnnp.2005.072223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lellouch-Tubiana A, Boddaert N, Bourgeois M, Fohlen M, Jouvet A, Delalande O, Seidenwurm D, Brunelle F, Sainte-Rose C. Angiocentric neuroepithelial tumor (ANET): a new epilepsy-related clinicopathological entity with distinctive MRI. Brain Pathol 2006; 15:281-6. [PMID: 16389940 PMCID: PMC8095937 DOI: 10.1111/j.1750-3639.2005.tb00112.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [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: 10/19/2022] Open
Abstract
Several types of glioneuronal tumors are known to induce intractable partial seizures in children and adults. The most frequent are dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas. We report here a new clinicopathological entity within the spectrum of glioneuronal tumors observed in 10 children who underwent surgery for refractory epilepsy. These tumors demonstrate a unique, pathognomonic histological pattern and a specific appearance at magnetic resonance imaging (MRI). The most striking neuropathological feature is an angiocentric polarity of the tumor with gliofibrillary acidic protein (GFAP) positive fusiform and bipolar astrocytic cells arranged around blood vessels (perivascular cuffing with tumoral astrocytes). Characteristic MRI findings include involvement of cortical gray and white matter, intrinsically high signal on T1-weighted images, as well as a stalk like extension to the ventricle. Immunohistochemical neuronal markers (neurofilament protein, synaptophysin and chromogranin) confirm the presence of a neuronal cell component. Therefore, the term angiocentric neuroepithelial tumor (ANET) is proposed.
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Takahashi A, Hong SC, Seo DW, Hong SB, Lee M, Suh YL. Frequent association of cortical dysplasia in dysembryoplastic neuroepithelial tumor treated by epilepsy surgery. ACTA ACUST UNITED AC 2005; 64:419-27. [PMID: 16253690 DOI: 10.1016/j.surneu.2005.02.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 01/26/2004] [Accepted: 02/03/2005] [Indexed: 01/12/2023]
Abstract
BACKGROUND We report on our experience with epilepsy surgery in the treatment of localization-related epilepsy caused by dysembryoplastic neuroepithelial tumor (DNT) aimed at achieving the best seizure control. METHODS A retrospective analysis was performed on the pathological reports as well as on clinical data of 24 case patients with medically intractable epilepsy with DNT treated surgically between 1995 and 2000 at the Samsung Medical Center. Resective surgery was performed using subdural electrodes or intraoperative electrocorticography in all patients. RESULTS The mean follow-up period was 57.2 months. Two patients had rare seizures transiently after surgery but remained free from seizures after 6 months. Others remained completely free from seizures. There was a strong tendency of temporal lobe involvement (19 cases; 79.2%). Size of tumors located at medial temporal regions was significantly smaller than those at lateral temporal or frontal lobes (P < .05). A rather radical resection (tumor plus surrounding tissue showing active epileptogenicity) was performed in all but one case where only focal lesionectomy was done. In 20 of the 24 cases (83.3%), association of cortical dysplasia (CD) was found on pathological examination. CONCLUSIONS We conclude that DNT is frequently associated with CD, with a wide area of epileptogenic activity that might be related to the presence of CD around the DNT. Comprehensive preoperative investigations for accurate localization of epileptogenic activity, meticulous brain mapping, and a rather radical resection of pathological areas might be essential for the achievement of excellent seizure control in DNT-associated epilepsy.
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Affiliation(s)
- Akio Takahashi
- Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Japan
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Rosenberg DS, Demarquay G, Jouvet A, Le Bars D, Streichenberger N, Sindou M, Kopp N, Mauguière F, Ryvlin P. [11C]-Methionine PET: dysembryoplastic neuroepithelial tumours compared with other epileptogenic brain neoplasms. J Neurol Neurosurg Psychiatry 2005; 76:1686-92. [PMID: 16291894 PMCID: PMC1739454 DOI: 10.1136/jnnp.2004.051607] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Brain tumours responsible for longstanding partial epilepsy are characterised by a high prevalence of dysembryoplastic neuroepithelial tumour (DNT), whose natural evolution is much more benign than that of gliomas. The preoperative diagnosis of DNT, which is not yet feasible on the basis of available clinical and imaging data, would help optimise the therapeutic strategy for this type of tumour. This study tested whether [(11)C]-methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumours. METHODS Prospective study of 27 patients with partial epilepsy of at least six months duration related to a non-rapidly progressing brain tumour on magnetic resonance imaging (MRI). A structured visual analysis, which distinguished between normal, moderately abnormal, or markedly abnormal tumour methionine uptake, as well as various regions of interest and semiquantitative measurements were conducted. RESULTS Pathological results showed 11 DNTs (41%), 5 gangliogliomas (18%), and 11 gliomas (41%). MET-PET visual findings significantly differed between the various tumour types (p<0.0002), regardless of gadolinium enhancement on MRI, and were confirmed by semiquantitative analysis (p<0.001 for all calculated ratios). All gliomas and gangliogliomas were associated with moderately or markedly increased tumour methionine uptake, whereas 7/11 DNTs had a normal methionine uptake, including all six located in the mesiotemporal structures. No DNT presented with a marked MET-PET abnormality. CONCLUSION Normal MET-PET findings in patient with an epileptogenic and non-rapidly progressing brain tumour are suggestive of DNT, whereas a markedly increased tumour methionine uptake makes this diagnosis unlikely.
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Affiliation(s)
- D S Rosenberg
- Cermep, Hopital Neurologique, 59 Bd Pinel, Lyon 69003, France
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