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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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Nair JN, Naidu B, Balasubramanian A, Krishnamurthy G. Polymorphous low-grade neuroepithelial tumour of young (PLNTY): the new kid on the block. Childs Nerv Syst 2024; 40:555-561. [PMID: 37796295 DOI: 10.1007/s00381-023-06162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Polymorphous low grade neuroepithelial tumor of the young (PLNTY) is a newly described epileptogenic tumor first reported by Jason. T. Huse et al. in 2016. Only a very few cases have been reported so far and has been recently incorporated in the World Health Organization (WHO) Central Nervous System Classification of tumours, 5th edition, 2021. Here we report a rare case of PLNTY which closely resembles DNET (Dysembryoplastic neuroepithelial tumor) with plenty of interesting findings which would otherwise go unnoticed resulting in a nonspecific or misclassified diagnosis. CASE REPORT A 12 year old boy presented to the Neurosurgery OPD with seizures for the past five years and was given multiple antiepileptics for the same. Magnetic resonance imaging (MRI) showed a well-defined lobulated cortical mass with T1 hypo intensity and T2 hyperintensity in the left temporal lobe measuring 2.1 × 2 × 1.3 cm suggesting a DNET. Left temporal craniotomy and excision of the lesion was done. Frozen section showed features of a low grade glial neoplasm. Routine sections demonstrated polymorphous findings including oligodendroglia like features, neuronal nuclear pleomorphism, spindled astroglial elements, perivascular rosettes, calcification, and vascular mineralization. By immunohistochemistry (IHC), the tumor cells were diffusely positive for GFAP and CD34.Ki67 labelling index was low. A final diagnosis of PLNTY was made based on the above findings. The child has been epilepsy free since the past one-month post-surgery and is on follow up. DISCUSSION/CONCLUSION PLNTY is a newly discovered distinct pediatric low grade glial neoplasm which was earlier grouped into nonspecific forms of DNET. It is characterized morphologically and molecularly by the presence of oligodendroglial component, CD34 expression, BRAFV600E mutation and alterations in the MAP kinase pathway. They are known to behave in a low-grade fashion amenable to control by excision with occasional cases of recurrence reported. It is important to recognize and report similar tumors to determine the long-term risk of recurrence and create a more complete understanding on their radiology and molecular genetics.
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Affiliation(s)
- Jishnu N Nair
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Bhaskar Naidu
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Archana Balasubramanian
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
| | - Ganesh Krishnamurthy
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
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Kopachev DN, Ryzhova MV, Kislyakov AN, Shaikhaev EG, Zheludkova OG, Kumirova EV, Meshcheryakov SV, Vlasov PA, Shkatova AM, Semenova ZB, Gushcha AO. [Supratentorial neuroepithelial tumor with PLAGL1 gene fusion - a new type of morphologically variable pediatric brain neoplasm defined by a distinct DNA methylation class. A case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:62-68. [PMID: 38549412 DOI: 10.17116/neiro20248802162] [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: 04/02/2024]
Abstract
BACKGROUND Methylation analysis has become a powerful diagnostic tool in modern neurooncology. This technique is valuable to diagnose new brain tumor types. OBJECTIVE To describe the MRI and histological pattern of neuroepithelial tumor with PLAGL1 gene fusion. MATERIAL AND METHODS We present a 6-year-old patient with small right frontal intraaxial tumor causing drug resistant epilepsy. Despite indolent preoperative clinical course and MRI features suggesting glioneuronal tumor, histological evaluation revealed characteristics of high-grade glioma, ependymoma and neuroblastoma. RESULTS Methylation analysis of tumor DNA confirmed a new type of a recently discovered neoplasm - neuroepithelial tumor with PLAGL1 fusion (NET PLAGL1). PCR confirmed fusion of PLAGL1 and EWSR1 genes. No seizures were observed throughout the follow-up period. There was no tumor relapse a year after surgery. CONCLUSION Methylation analysis in neurooncology is essential for unclear tumor morphology or divergence between histological and clinical data. In our case, this technique confirmed benign nature of tumor, and we preferred follow-up without unnecessary adjuvant treatment.
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Affiliation(s)
- D N Kopachev
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
- Neurology Research Center, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A N Kislyakov
- Morozov Children's Clinical Hospital, Moscow, Russia
| | | | - O G Zheludkova
- Voyno-Yasenetsky Practical Center for Specialized Medical Care for Children, Moscow, Russia
| | - E V Kumirova
- Morozov Children's Clinical Hospital, Moscow, Russia
| | - S V Meshcheryakov
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
| | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - Zh B Semenova
- Research Institute for Emergency Pediatric Surgery and Traumatology, Moscow, Russia
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Franzini A, Picozzi P, Lasio GB, Pessina F. Staged Gamma Knife radiosurgery for a rosette-forming glioneuronal tumor of the fourth ventricle: a case report. Childs Nerv Syst 2023; 39:3323-3326. [PMID: 37272935 DOI: 10.1007/s00381-023-06014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Rosette-forming glioneuronal tumor (RGNT) is a rare slow-growing neoplasm with mixed glial and neurocytic components. Surgical resection is the mainstay of treatment, whereas the role of adjuvant radiation therapies for residual or recurrent tumors has been poorly investigated. CASE PRESENTATION We describe the case of a patient with a recurrent fourth ventricular RGNT who was treated with two-staged Gamma Knife radiosurgery (GKRS). GKRS was effective in controlling tumor growth and safe up to seven years from treatment. CONCLUSIONS This case suggests that GKRS may be a safe and effective treatment for patients with recurrent or residual RGNT.
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Affiliation(s)
- Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano (Mi), Italy.
| | - Piero Picozzi
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano (Mi), Italy
| | | | - Federico Pessina
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano (Mi), Italy
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Rozzano (Mi), Italy
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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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Sprenger F, da Silva EB, Cavalcanti MS, de Almeida Teixeira BC. Radiology-Pathology and Surgical Correlation in Astroblastoma. AJNR Am J Neuroradiol 2023; 44:390-395. [PMID: 36958802 PMCID: PMC10084905 DOI: 10.3174/ajnr.a7824] [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] [Received: 09/07/2022] [Accepted: 02/17/2023] [Indexed: 03/25/2023]
Abstract
Astroblastoma is a rare astrocytic glial neoplasm that affects mainly young girls, peaking between 10 and 30 years of age, with low- and high-grade manifestations. Imaging characteristics are well-described, but histopathologic and, more recently, molecular analysis is fundamental to establish the diagnosis, now based on MN1 alterations. We describe a case with typical imaging and histologic features of an MN1-altered astroblastoma.
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Affiliation(s)
- F Sprenger
- From the Department of Radiology (F.S., B.C.d.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - E B da Silva
- Department of Neurosurgery (E.B.d.S.), Instituto de Neurologia de Curitiba, Curitiba, Brazil
| | - M S Cavalcanti
- Neopath Patologia Diagnóstica (M.S.C.), Curitiba, Brazil
| | - B C de Almeida Teixeira
- From the Department of Radiology (F.S., B.C.d.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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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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Ould Ismail AA, Parra O, Hughes EG, Green DC, Loo E, Zanazzi G, Lin CC. Novel FGFR2::ZCCHC24 Fusion in Dysembryoplastic Neuroepithelial Tumor. J Neuropathol Exp Neurol 2022; 81:1029-1032. [PMID: 36164838 PMCID: PMC9960002 DOI: 10.1093/jnen/nlac087] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Abdol Aziz Ould Ismail
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ourania Parra
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Edward G Hughes
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Donald C Green
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eric Loo
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - George Zanazzi
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Chun-Chieh Lin
- From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Rao S, Nufina TA, Sugur H, Arumalla K, Devi BI, Santosh V. Spinal astroblastoma: a rare tumour in an unusual location. Childs Nerv Syst 2022; 38:1797-1801. [PMID: 35152342 DOI: 10.1007/s00381-022-05468-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
Astroblastomas are central nervous system tumours with unknown cell of origin and clinical behaviour. These tumours occur most commonly in cerebral hemispheres with spinal astroblastomas being very rare. We report a case of spinal astroblastoma which harboured MN1 alteration.
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Affiliation(s)
- Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - T A Nufina
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Harsha Sugur
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kirit Arumalla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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10
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Liu Y, Zhu K, Liu L, Tang HF. [Cribriform neuroepithelial tumor: report of a case]. Zhonghua Bing Li Xue Za Zhi 2022; 51:551-553. [PMID: 35673730 DOI: 10.3760/cma.j.cn112151-20211104-00799] [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: 06/15/2023]
Affiliation(s)
- Y Liu
- Graduate School of Zhejiang Chinese Medical University, Hangzhou 310053, China Department of Pathology,the Children's Hospital, Zhejiang University School of Medicine; National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - K Zhu
- Department of Pathology,the Children's Hospital, Zhejiang University School of Medicine; National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - L Liu
- Department of Pathology,the Children's Hospital, Zhejiang University School of Medicine; National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - H F Tang
- Department of Pathology,the Children's Hospital, Zhejiang University School of Medicine; National Clinical Research Center for Child Health, Hangzhou 310052, China
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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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12
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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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Gu J, Wang Y, Yu J. Cerebral astroblastoma with oligodendroglial-like cells: A case report. Medicine (Baltimore) 2021; 100:e27570. [PMID: 34713831 PMCID: PMC8556017 DOI: 10.1097/md.0000000000027570] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Astroblastoma is a rare tumor of the central nervous system with uncertain biological behavior and origin. Its histopathological features have been well established, while, to our knowledge, astroblastoma with oligodendroglial-like cells have not been reported. PATIENT CONCERNS A 15-year-old girl presented with nausea, vomiting, headache, and visual disturbance. DIAGNOSIS Magnetic resonance imaging revealed a large neoplasm in the left temporal. Histologically, the tumor showed solid and pseudopapillary structure. Immunohistochemical staining showed that the tumor cells were positive for glial fibrillary acidic protein and vimentin. The oligodendroglial-like cells were positive for glial fibrillary acidic protein, vimentin, and oligodendrocyte transcription factor 2. The antigen KI67 labeling index was about 4%. Sequencing for isocitrate dehydrogenase (IDH) 1 codon 132 and IDH2 codon 172 gene mutations showed negative results. Furthermore, fluorescent analysis revealed neither 1p nor 19q deletion in the lesion. Based on these findings, the girl was finally diagnosed as astroblastoma. INTERVENTIONS A craniotomy with total excision of the tumor was performed. OUTCOMES The follow-up time was 1 year, no evidence of disease recurrence was found in magnetic resonance imaging. LESSONS Cerebral astroblastoma with oligodendroglial-like cells is a clinically rare tumor of central nervous system. Clear distinction and diagnosis are critical.
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Affiliation(s)
- Jian Gu
- Department of Pathology, the First Affiliated Hospital of China Medical University,Shenyang, China
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Yihua Wang
- Department of Pathology, the First Affiliated Hospital of China Medical University,Shenyang, China
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Juanhan Yu
- Department of Pathology, the First Affiliated Hospital of China Medical University,Shenyang, China
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, China
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14
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Tsutsui T, Arakawa Y, Makino Y, Kataoka H, Mineharu Y, Naito K, Minamiguchi S, Hirose T, Nobusawa S, Nakano Y, Ichimura K, Haga H, Miyamoto S. Spinal cord astroblastoma with EWSR1-BEND2 fusion classified as HGNET-MN1 by methylation classification: a case report. Brain Tumor Pathol 2021; 38:283-289. [PMID: 34313881 DOI: 10.1007/s10014-021-00412-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/15/2021] [Indexed: 12/01/2022]
Abstract
The most recurrent fusion of central nervous system high-grade neuroepithelial tumor with MN1 alteration (HGNET-MN1) is MN1 rearrangement. Here, we report the case of a 36-year-old man with spinal cord astroblastoma showing Ewing Sarcoma breakpoint region 1/EWS RNA-binding protein 1 (EWSR1)-BEN domain-containing 2 (BEND2) fusion. The patient presented with back pain, gait disturbance and dysesthesia in the lower extremities and trunk. Magnetic resonance imaging showed an intramedullary tumor at the T3-5 level, displaying homogeneous gadolinium enhancement. Partial tumor removal was performed with laminectomy. Histological examinations demonstrated solid growth of epithelioid tumor cells showing high cellularity, a pseudopapillary structure, intervening hyalinized fibrous stroma, and some mitoses. Astroblastoma was diagnosed, classified as HGNET-MN1 by the German Cancer Research Center methylation classifier. MN1 alteration was not detected by fluorescence in situ hybridization (FISH), but EWSR1-BEND2 fusion was detected by FISH and RNA sequencing. Previously, a child with EWSR1-BEND2 fusion-positive spinal astroblastoma classified as HGNET-MN1 was reported. In conjunction with that, the present case provides evidence that EWSR1-BEND2 fusion is identified in the entity of HGNET-MN1. Taken together, the BEND2 alteration rather than MN1 may determine the biology of a subset of the central nervous system HGNET-MN1 subclass.
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Affiliation(s)
- Takeyoshi Tsutsui
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yasuhide Makino
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kentaro Naito
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology, Hyogo Cancer Center, Akashi, Hyogo, 673-8558, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, 371-8514, Japan
| | - Yoshiko Nakano
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
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15
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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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16
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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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17
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Kwon SM, Kim JH, Byun J, Kim YH, Hong SH, Cho YH, Kim CJ. Malignant Transformation of a Rosette-Forming Glioneuronal Tumor to Glioblastoma. World Neurosurg 2019; 130:271-275. [PMID: 31203071 DOI: 10.1016/j.wneu.2019.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/13/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND A rosette-forming glioneuronal tumor (RGNT), a rare brain tumor, presents as a benign feature with a favorable outcome. To date, a few cases with aggressive behaviors, such as recurrence or dissemination, but none with malignant transformation, have been reported. We describe 1 case that recurred as glioblastoma after complete resection of the benign RGNT. CASE DESCRIPTION A man aged 58 years presented with headache and dizziness without neurologic symptoms. Magnetic resonance imaging showed a 4 × 2.5 cm, well-demarcated mass in the left cerebellar hemisphere. The patient underwent gross total resection of the tumor and a diagnosis of RGNT was made. There was no evidence of recurrence on serial follow-up. However, a recurrent heterogeneous enhancing mass in the previous surgical cavity was observed on a 7-year postoperative magnetic resonance imaging scan. Reoperation was performed and a histopathological study revealed a glioblastoma. CONCLUSIONS To the best of our knowledge, this is the first case of spontaneous malignant transformation of an RGNT. Our case may be helpful in better understanding the biological behavior and clinical outcome of RGNT. We emphasize the malignant potential of this rare tumor and the necessity of future large-scaled research for most appropriate therapeutic strategies.
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Affiliation(s)
- Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Joonho Byun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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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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19
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Gempt J, Bette S, Albertshauser J, Cammardella JH, Gradtke C, Wiestler B, Schirmer L, Ryang YM, Meyer B, Ringel F. Personality Traits in Patients with Neuroepithelial Tumors - A Prospective Study. Sci Rep 2018; 8:17055. [PMID: 30451871 PMCID: PMC6243000 DOI: 10.1038/s41598-018-34980-w] [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: 06/07/2017] [Accepted: 10/28/2018] [Indexed: 11/09/2022] Open
Abstract
Aim of this study was to analyze personality traits in patients with neuroepithelial brain tumors. Personality alteration is a common feature in brain tumor patients, but not much is known about associations between specific personality changes and brain tumors. We assessed potential factors influencing personality such as tumor location, tumor grade and tumor volume. Mini-mental state examination (MMSE), Beck's Depression Inventory II (BDI-II), and the NEO Five-Factor Inventory (NEO-FFI) for the five factors of personality were acquired. Patients had lower scores regarding the factor openness and higher scores regarding the BDI-II compared to the norm population. No significant influencing factors (tumor entity, location) were found regarding personality traits. Neuroticism was associated with depression, whereas extraversion showed an opposed association. Patients with intrinsic brain tumors have differences in personality traits compared to the control population, with an emphasis on the factor openness. No significant confounding factors like tumor grade, entity, or location were found for personality traits.
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Affiliation(s)
- Jens Gempt
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany.
| | - Stefanie Bette
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jennifer Albertshauser
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jasmin Hernandez Cammardella
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Corinna Gradtke
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Benedikt Wiestler
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Lucas Schirmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neurology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
| | - Yu-Mi Ryang
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Florian Ringel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
- Neurochirurgische Klinik und Poliklinik, Johannes Gutenberg-Universität Mainz, Langenbeckstraße, Mainz, 155131, Germany
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20
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Abstract
PURPOSE Astroblastoma is an uncommon pediatric neuroepithelial tumor. The prognosis and appropriate treatment of astroblastoma were not well understood. Previous reports suggested the best treatment for astroblastoma is surgical total resection. The authors report a case of pediatric astroblastoma that underwent gross total resection with the use of fluorescent guidance by 5-aminolevulinic acid (5-ALA). CASE REPORT A 13-year-old girl presented with the tumor that was well-circumscribed cystic and solid mass with marked gadolinium enhancement in the right occipital lobe. At surgery, fluorescence of the tumor was clearly distinctive from the normal cerebral tissue. All fluorescent tissue including residual cyst wall was removed. Postoperative MRI showed gross total resection of the tumor. No serious side effect or complications occurred. The histopathologic diagnosis was suggestive of astroblastoma. The patients had no evidence of recurrence of tumor without adjuvant radiotherapy during the last 1 year of follow-up time. CONCLUSION 5-ALA is useful to achieve gross total resection including cystic lesion of pediatric astroblastoma. A larger prospective study is warranted to establish the use of 5-ALA in pediatric brain tumor.
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Affiliation(s)
- Yuji Agawa
- Department of Neurosurgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
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21
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Park JT, Baca Vaca GF, Avery J, Miller JP. Utility of Stereoelectroencephalography in Children with Dysembryoplastic Neuroepithelial Tumor and Cortical Malformation. Neurodiagn J 2017; 57:191-210. [PMID: 28898173 DOI: 10.1080/21646821.2017.1326270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 06/07/2023]
Abstract
BACKGROUND Uncontrolled seizures in children can contribute to irreversible cognitive impairment and developmental delay, in addition to placing them at risk for sudden unexplained death in epileptic patients (SUDEP). Since its introduction at Saint Ann Hospital in Paris in the 1960s, stereoelectroencephalography (SEEG) is increasingly being utilized at epilepsy centers in the United States as an invasive tool to help localize the seizure focus in drug-resistant focal epilepsy. INDICATIONS Children with symptomatic epilepsy, commonly due to cortical dysplasia and dysembryoplastic neuroepithelial tumor (DNET), may benefit from SEEG investigation. The arrangement of SEEG electrodes is individually tailored based on the suspected location of the epileptogenic zone (EZ). The implanted depth electrodes are used to electrically stimulate the corresponding cortices to obtain information about the topography of eloquent cortex and EZ. Morbidity: Surgical morbidity in these children undergoing SEEG investigation is low, but not negligible. The number of electrodes directly correlates with the risk of intraoperative complication. Thus a risk and benefit analysis needs to be carefully considered for each patient. Neurodiagnostic technology: Both during and after the SEEG electrode implantation, the intraoperative monitoring and EEG technologists play a vital role in the successful monitoring of the patient. CONCLUSION SEEG is an important tool in the process of epilepsy surgery in children with symptomatic epilepsy, commonly due to cortical dysplasia and DNET.
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Affiliation(s)
- Jun T Park
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Guadalupe Fernandez Baca Vaca
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Jennifer Avery
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
| | - Jonathan P Miller
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
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Minkin K, Naydenov E, Gabrovski K, Dimova P, Penkov M, Tanova R, Nachev S, Romanski K. Intraoperative fluorescein staining for benign brain tumors. Clin Neurol Neurosurg 2016; 149:22-6. [PMID: 27450764 DOI: 10.1016/j.clineuro.2016.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 05/18/2016] [Revised: 07/06/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Successful use of high-dose fluorescein-sodium (20mg/kg) with a standard light microscope for resection of high-grade gliomas, meningiomas, hemangioblastoma and metastases was reported. The principle of brain tumor staining by fluorescein-sodium (Fl-Na) consists in the accumulation of fluorescein in brain tumors with impaired blood-brain barrier. The aim of our study was to investigate for the first time the usefulness of high-dose fluorescein in patients operated on for benign neuroepithelial brain tumors (grade I WHO tumors) with contrast enhancement on magnetic resonance imaging. METHODS Our study included 11 patients operated on for benign neuroepithelial primary brain tumors with contrast enhancement on magnetic resonance imaging (MRI): pilocytic astrocytomas (5 patients), dysembrioplastic neuroepithelial tumors (4) and gangliogliomas grade I (2). In all cases, Fl-Na was injected intravenously (20mg/kg) just after the craniotomy using a peripheral venous line. The dural opening was performed 10min later. Microsurgical tumor resection using conventional neurosurgical microscope guided by the fluorescein staining was performed. RESULTS Complete resection of the yellow-green stained tissue was achieved in 10 patients confirmed by postoperative control MRI study. Subtotal resection of the colored tissue was achieved in one case with fourth ventricle pilocytic astrocytoma because of the involvement of the medial eminence and functional constraints discovered during intraoperative neuromonitoring. Three patients have had a postoperative volume of resection greater than the tumor volume because of the planed perilesionectomy by our epilepsy surgery team. Surrounding tissue not stained by Fl-Na was obtained in these 3 cases. The histopathological examination did not find tumor tissue in the perilesional Fl-Na negative tissue. On the other hand, all 11 Fl-Na positive specimens presented signs of tumor involvement. We did not observe complications related to the use of high dose Fl-Na. CONCLUSIONS High doses intravenous Fl-Na seems to be a useful intraoperative technique for delineation of benign neuroepithelial brain tumors with contrast enhancement. Further larger studies may reveal the real value of high doses Fl-Na as intraoperative method for increasing the extent of resection in these particular indications.
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Affiliation(s)
- Krasimir Minkin
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria; Medical University, Sofia, Bulgaria.
| | - Emanuil Naydenov
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Petia Dimova
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Marin Penkov
- Department of Neuroradiology, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Rositsa Tanova
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Sevdelin Nachev
- Department of Neuropathology, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Kiril Romanski
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
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Vonhoff CR, Lochhead A, Koustais S, Watson N, Andrici J, Brewer J, Gill AJ. Differences in the Pathological Diagnosis and Repeat Craniotomy Rates in Cerebral Tumors Undergoing Biopsy or Resection in an Urban Versus Regional Center. Medicine (Baltimore) 2015; 94:e2131. [PMID: 26632735 PMCID: PMC5059004 DOI: 10.1097/md.0000000000002131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary intracranial tumors occur with an incidence of between 2.5 and 6 per 100,000 individuals. They require specialist expertise for investigation and management including input from radiology, pathology, neurosurgery, and oncology. Therefore, most patients with intracranial neoplasia are investigated and managed in larger hospitals. The geographically dispersed population of Australia has facilitated the development of neurosurgical units in regional areas. However, major metropolitan hospitals are over-represented compared with regional centers in most research cohorts. We therefore sought to investigate the spectrum of intracranial neoplasms undergoing biopsy and surgery at a major regional center in Australia and to compare the demographic and pathological features to similar cohorts treated in major metropolitan hospitals.We searched the pathological databases of both a major regional pathology provider and a major metropolitan pathology practice, which provides surgical pathology services for both a large private and a large public neurosurgical hospital, to identify all cerebral tumors undergoing biopsy or resection over a 14-year period (calendar years 2001 and 2014).In all, 3717 cerebral tumors were identified. Among them, 51% were from an urban private hospital, 33% from an urban public hospital, and 16% from a regional public hospital. Overall, one-third of them were neuroepithelial in origin, a quarter metastatic disease, a fifth meningeal, and one-tenth were pituitary adenomas. The regional center treated a higher proportion of metastatic tumors and less meningeal tumors compared with the urban center. Additionally, patients were less likely to undergo a second operation in the regional center (P < 0.001). The differences give an important insight into the burden of neurosurgical disease in regional Australia, and how it differs from that encountered in large metropolitan centers.
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Affiliation(s)
- Craig R Vonhoff
- From the Department of Neurosurgery, Wollongong Hospital (CRV, SK); Southern IML Pathology, Wollongong (AL); Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research (NW, JA, AJG); Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards (JB); Sydney Medical School, University of Sydney (JA, JB, AJG); and Sydney Vital Translational Research Centre, Royal North Shore Hospital, Pacific Highway, St Leonards, New South Wales, Australia (AJG)
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24
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Sabharwal P, Sadashiva N, Unchagi A, Mahadevan A, Pandey P. Intraventricular Astroblastoma in an Infant: A Case Report and Review of the Literature. Pediatr Neurosurg 2015; 50:325-9. [PMID: 26406441 DOI: 10.1159/000369032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Astroblastomas are rare intracranial tumours of uncertain origin and are commonly present in the supratentorial compartment. Astroblastomas often affect children and young adults. Their occurrence in an intraventricular location, in an infant, is extremely uncommon. We describe a 1-year-old boy who presented with features of raised intracranial pressure. An MRI scan revealed an intralateral ventricular tumour. Complete excision was performed. Its histopathological examination revealed features consistent with astroblastoma. A follow-up MRI scan after 9 months did not show any residual tumour, and the patient was followed up without any adjuvant therapy. The radiological and histopathological characteristics of this tumour are described in our report.
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25
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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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26
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Paudel K, Borofsky S, Jones RV, Levy LM. Dysembryoplastic neuroepithelial tumor with atypical presentation: MRI and diffusion tensor characteristics. J Radiol Case Rep 2013; 7:7-14. [PMID: 24421925 DOI: 10.3941/jrcr.v7i11.1559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Indexed: 11/15/2022] Open
Abstract
We report the neuroimaging findings of a 26-year-old female patient with a biopsy-proven dysembryoplastic neuroepithelial tumor (DNET). DNETs are an uncommon, usually benign, glial-neural cortical neoplasm of children and young adults who typically present with intractable seizures. DNETs may occur in any region of the supratentorial cortex, but have a predilection for the temporal lobes. Accurate neuroimaging diagnosis is essential since patients with DNET benefit from complete resection. However, accurate differentiation from other cortical lesions may be challenging. Typical conventional Magnetic Resonance Imaging (MRI) features can help in the differentiation from other similar cortical tumors. Diffusion tensor imaging can also provide important additional diagnostic information regarding the degree of involvement of adjacent parenchyma and white matter tracts. In this case, tractography and fractional anisotropy maps demonstrated that fiber tracts surrounding the lesion were displaced, but fiber integrity was maintained, which is more suggestive of a DNET rather than a more aggressive neoplasm. Accurate identification of DNETs is essential for the purpose of rendering a timely diagnosis and start appropriate treatment.
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Affiliation(s)
- Kalyan Paudel
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
| | - Samuel Borofsky
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
| | - Robert V Jones
- Department of Pathology, the George Washington University Hospital, Washington, DC, USA
| | - Lucien M Levy
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
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27
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Vasil'ev SA, Pesnia-Prasolov SB, Krylov VV, Zuev AA, Pavlov VN, Viatkin AA, Kungurtsev SV, Galian TN. [Cryodestruction in neurosurgery]. Khirurgiia (Mosk) 2013:105-108. [PMID: 23503393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study aimed to work out the method of cryodestruction of brain tumors. 10 patients with neuroepithelial brain tumors were prospectively operated on with the use of cryodestruction. MRI was performed before and after the operation. The operation strated from tumor biopsy under the ultrasound control with further injection of cryoprobe with further destruction. The study demonstrated that ultrasound navigation is an effective means of the cryodestruction control on all stages. The cryodestruction itself is a miniinvasive, easily controlled and effective method, applicable for tumors, located in functionally important regions of the brain, where major surgery could be mutilating.
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28
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Wang JF, Jiang T, Qiu XG, Jin Q, Chen BS. An initial exploration of surgery following radiotherapy for the treatment of gliomatosis cerebri. Chin Med J (Engl) 2012; 125:4526-4527. [PMID: 23253734] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Jiang-fei Wang
- Department of Neurosurgery, Capital Medical University, Beijing, China
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29
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Bai HM, Wang WM, Li TD, He H, Shi C, Guo XF, Liu Y, Wang LM, Wang SS. Three core techniques in surgery of neuroepithelial tumors in eloquent areas: awake anaesthesia, intraoperative direct electrical stimulation and ultrasonography. Chin Med J (Engl) 2011; 124:3035-3041. [PMID: 22040550] [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: 05/31/2023] Open
Abstract
BACKGROUND The goal of surgery in the treatment of intrinsic cerebral tumors is to resect the maximum tumor volume, and to spare the eloquent areas. However, it is difficult to discover the eloquent areas intraoperatively due to individual anatomo-functional variability both for sensori-motor and language functions. Consequently, the surgery of intrinsic cerebral tumors frequently results in poor extent of resection or permanent postoperative deficits, or both, and remains a difficult problem for neurosurgeons. METHODS From January 2003 to January 2010, 112 patients with neuroepithelial tumors in/close to the eloquent areas were operated on under awake anesthesia with the intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The extent of the tumors was verified by intraoperative ultrasonography. The maximal resection of the tumors and minimal damage of the eloquent areas were the surgical goal of all patients. RESULTS Totally 356 cortical sites in 99 patients were detected for motor response by intraoperative direct electrical stimulation, 50 sites in 16 patients for sensory, 72 sites in 48 patients for language. Sixty-six patients (58.9%) achieved total resection, 34 (30.4%) subtotal and 12 (10.7%) partial. Fifty-eight patients (51.8%) had no postoperative deficit, while 37 patients (33.0%) had transitory postoperative paralysis, 26 patients (23.2%) with transitory postoperative language disturbance and 3 patients (2.7%) with permanent neurological deficits. No patient complained of pain recollection following operation. CONCLUSIONS Awake anesthesia, intraoperative direct electrical stimulation and ultrasonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgery for neuroepithelial tumors in/adjacent to eloquent areas.
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Affiliation(s)
- Hong-Min Bai
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, China
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Abstract
Astroblastoma is a rarely diagnosed primary brain neoplasm whose histogenesis has been clarified recently. It occurs in children and young adults and presents as a well-circumscribed, contrast enhancing lesion in the cerebral hemisphere. Here the authors present a case of 25-year-old woman with an astroblastoma in the left frontal convexity that was excised. The characteristic radiological and histopathological features of this case are described. An astroblastoma should be included in the differential of a localised brain tumour, especially in a young patient.
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Affiliation(s)
- Fariba Binesh
- Department of Pathology, Yazd Shahid Sadoghi University, Yazd, Islamic Republic of Iran.
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31
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Zhang XJ, Piao YS, Chen L, Tang GC, Wei LF, Yang H, Lu DH. [Multiple intracranial lesions: a clinicalpathologic study of 62 cases]. Zhonghua Bing Li Xue Za Zhi 2011; 40:599-603. [PMID: 22177243] [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: 05/31/2023]
Abstract
OBJECTIVE To study the clinicalpathologic features of intracranial multiple lesions. METHODS The clinical, radiologic and pathologic features of intracranial multiple lesions in 62 cases during the period from 2005 to 2009 in Xuanwu Hospital were retrospectively reviewed. RESULTS There were 32 males and 30 females in 62 cases. The mean age of seize onset and duration of disease were 37.4-year-old and 11.6 months, respectively. The lesions could affect cerebral hemisphere, basal ganglia, brain stem, cerebellum and other parts, most lesions were located above the tentorium. Pathological diagnosis as follows: 13 patients with glioma; metastatic tumors in 13 cases; 12 cases of central nervous system infection; immune-mediated inflammatory demyelinating disease in 8 cases; 5 cases of primary lymphoma of central nervous system; primary angiitis of the central nervous system 3 cases; mitochondrial encephalopathy 2 cases; vein thrombosis in 2 cases; Rosai-Dorfman disease in 2 cases; 2 case of radiation encephalopathy. Among them, mitochondrial encephalopathy and vein thrombosis lesions located in the cortex; metastatic tumor and blood-borne infection mainly involving junction of grey and white matter; glioma, radiation encephalopathy and demyelinating disease include white matter lesions; vascular inflammation showed cortical and subcortical white matter lesions. CONCLUSIONS A variety of tumor and non-neoplastic diseases can be expressed in intracranial multiple lesions, which gliomas, metastatic tumor and central nervous system infections are more common. In order to improve the diagnosis of intracranial multiple lesions, active work in the brian biopsy, study the clinical, imaging and pathological findings must be closely.
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MESH Headings
- Adolescent
- Adult
- Aged
- Brain Neoplasms/diagnosis
- Brain Neoplasms/pathology
- Brain Neoplasms/surgery
- Child
- Demyelinating Diseases/diagnosis
- Demyelinating Diseases/pathology
- Demyelinating Diseases/surgery
- Female
- Glioma/diagnosis
- Glioma/pathology
- Glioma/surgery
- Histiocytosis, Sinus/diagnosis
- Histiocytosis, Sinus/pathology
- Histiocytosis, Sinus/surgery
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasms, Neuroepithelial/diagnosis
- Neoplasms, Neuroepithelial/pathology
- Neoplasms, Neuroepithelial/surgery
- Retrospective Studies
- Toxoplasmosis, Cerebral/diagnosis
- Toxoplasmosis, Cerebral/pathology
- Toxoplasmosis, Cerebral/surgery
- Tuberculosis, Central Nervous System/diagnosis
- Tuberculosis, Central Nervous System/pathology
- Tuberculosis, Central Nervous System/surgery
- Young Adult
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Affiliation(s)
- Xiao-juan Zhang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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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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Yuan J, Sharma N, Choudhri H, Figueroa R, Sharma S. Intraventricular dysembryoplastic neuroepithelial tumor in a pediatric patient: is it the most common extracortical location for DNT? Childs Nerv Syst 2011; 27:485-90. [PMID: 20959995 DOI: 10.1007/s00381-010-1307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 09/18/2010] [Accepted: 10/04/2010] [Indexed: 11/26/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is commonly located in the supratentorial cortex. Extracortical localization of DNT is extremely rare. A 15-year-old female presented with loss of consciousness after head trauma. MRI demonstrated hydrocephalus secondary to a small non-enhancing T1 hypointense and T2 hyperintense mass lesion in the foramen of Monro; with radiologic impression of low-grade astrocytoma or colloid cyst. Tumor was gross totally resected. Histologic examination showed partly microcystic architecture with oligodendroglia-like neurocytic cells, glioneuronal element, and floating neurons, with synaptophysin reactivity mainly in cell processes, consistent with DNT. Focal subependymoma-like pattern was noted. The low tumor cellularity and morphologic pattern did not support a central neurocytoma. Patient was asymptomatic and was radiologically stable 9 months post-surgery. Literature review of previously reported supratentorial extracortical DNT cases demonstrate that 24 of 25 cases involved the ventricular system (as in our case) of which eight additionally involved periventricular deep gray or white matter. None of the cases recurred following surgery. Clinico-pathologically, extracortical DNTs were similar to the cerebral cortical simple DNTs and differed only in their presentation related to their location. The novel aspects of this report are the radiologic resemblance of DNT to colloid cyst and focal subependymoma-like pattern on histology. Importantly, intra-/periventricular region appears to be the most common extracortical location of cerebral DNT with a 100% disease-free survival reported in the literature.
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Affiliation(s)
- Ji Yuan
- Department of Pathology, Medical College of Georgia, Augusta, GA 30912, USA
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Davidescu M, Motaş N, Bluoss C, Motaş C, Rus O, Horvat T. [Neurogenic tumors of the posterior mediastinum]. Chirurgia (Bucur) 2011; 106:199-203. [PMID: 21698862] [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: 05/31/2023]
Abstract
The posterior mediastinum is the potential space along each side of the vertebral column and adjacent proximal portions of the ribs--the paravertebral sulci. From the posterior mediastinal tumors, the most commonly encountered are the neurogenic tumors (75%), the remaining 25% are represented by a heterogenous group of rare tumors including teratoma, lymphoma, sarcoma and other lesions arising outside the mediastinum and projecting into the posterior compartment. Surgical excision, by thoracotomy or miniinvasive techniques, is the first line of treatment in the posterior mediastinal tumors. Tumors with extension into the spinal canal (dumbbell tumors), accounting for nearly 10% of the posterior mediastinal tumors, require a multidisciplinary approach: thoracic surgeon and neurosurgeon. We present the experience of the "Carol Davila" University of Medicine and Pharmacy Thoracic Surgery Clinic in the surgery of neurogenic posterior mediastinal tumors throughout a 9 year period (2001 - 2010). 42 cases admitted and operated in this period are being analysed.
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Affiliation(s)
- M Davidescu
- Clinica de Chirurgie Toracica, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu, U.M.E Carol Davila Bucureşti, România.
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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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Affiliation(s)
- H Moukarram
- Department of Obstetrics and Gynaecology, Royal Bolton Hospital, Bolton, UK.
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Kemerdere R, Dashti R, Ulu MO, Biçeroğlu H, Demiröz AS, Albayram S, Erdinçler P. Supratentorial high grade astroblastoma: report of two cases and review of the literature. Turk Neurosurg 2009; 19:149-152. [PMID: 19431125] [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]
Abstract
Astroblastoma is a rare glial tumor with uncertain histopathological origin and unpredictable clinical behavior. In this report, the authors present two cases of high grade intracerebral astroblastomas. Both tumors occurred in children as supratentorial, well-circumscribed, peripheral masses. The lesions differed radigraphically; one contained a huge cystic component and heterogeneously enhancing mural nodule while the other appeared as a prominently contrastenhancing solid mass lesion. Both patients were treated with surgery and postoperative radiotherapy. They were followed-up long-term and no recurrence of the tumor was detected in either case. We also discussed the radiological and histological characteristics with prognostic features.
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Affiliation(s)
- Rahşan Kemerdere
- Istanbul University Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
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Bilginer B, Söylemezoğlu F, Cila A, Akalan N. Intraventricular dysembryoplastic neuroepithelial tumor-like neoplasm with disseminated spinal tumor. Turk Neurosurg 2009; 19:69-72. [PMID: 19263357] [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]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT)- like lesions arise in extracortical locations and behave in a benign fashion similar to that of cortical DNTs. They usually come to attention by symptoms and signs of increased intracranial pressure rather than focal neurological impairment. Here we report a case of 9-year-old boy with a complaint of headache and back pain. A third ventricular mass lesion with disseminated spinal tumor was detected on his magnetic resonance imaging. The presence of floating neurons in a mucinous matrix, oligodendrocyte-like cells (OLCs) aligning axonal columns and vessels, immunohistochemical profile of the neoplasm in addition to the clinical and radiological manifestations of the patient led to the diagnosis of "DNT-like neoplasm of the third ventricle".
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Affiliation(s)
- Burçak Bilginer
- Hacettepe University School of Medicine, Department of Neurosurgery, Ankara, Turkey.
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Zakrzewski K, Biernat W, Liberski PP, Polis L, Nowoslawska E. Pilocytic astrocytoma as a predominant component of a recurrent complex type DNT. Folia Neuropathol 2009; 47:284-288. [PMID: 19813149] [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: 05/28/2023] Open
Abstract
Dysembryoplastic neuroepithelial tumour (DNT) is a benign lesion of the cerebral hemispheres usually presenting minimal biological activity after surgical excision. We report an unusual case of a 7-year-old girl with a temporal lobe DNT, which recurred four years after subtotal resection of the tumour. In the recurrent lesion we identified pilocytic astrocytoma (PA) as a predominant component of the tumour. Small pieces of the removed tissues also disclosed remnants of DNT. Clinical presentation of the primary tumour consisted of partial simple seizures, while the recurrent tumour manifested with headache and vomiting. Likewise, the radiological appearance of both tumours was different. We conclude that patients with incompletely removed DNT may suffer local recurrence of that tumour. In rare cases development of a secondary, histologically different neoplasm may also occur.
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Affiliation(s)
- Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland.
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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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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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Schittenhelm J, Mittelbronn M, Wolff M, Truebenbach J, Will BE, Meyermann R, Beschorner R. Multifocal dysembryoplastic neuroepithelial tumor with signs of atypia after regrowth. Neuropathology 2007; 27:383-9. [PMID: 17899694 DOI: 10.1111/j.1440-1789.2007.00780.x] [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] [Indexed: 11/29/2022]
Abstract
We report the case of a multifocal dysembryoplastic neuroepithelial tumor (DNT) in a 7-year-old girl with local tumor regrowth 6 years later. The tumor was localized in the right parietal lobe extending from the cortex into the periventricular white matter. After subtotal resection of a histopathologically confirmed DNT we observed unexpected tumor progression in long-term follow-up. Therefore, a second surgery was performed when the patient was 14 years of age. In neuropathological examination of the second specimen the tumor showed an increased cellularity and pleomorphism, microvascular proliferations, an elevated proliferative activity (MIB1-index focally up to 10%) and cellular atypia not typical for WHO grade I DNT. Furthermore, MRI studies showed additional supratentorial and infratentorial lesions which remained stable over years and are also well consistent with DNTs. Thus, an unusual form of a DNT with multifocal lesions, local regrowth and morphological transformation is supposed.
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Affiliation(s)
- Jens Schittenhelm
- Institute of Brain Research, University of Tuebingen, Calwerstr. 3, D-72076 Tuebingen, Germany.
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Gonzales M, Dale S, Susman M, Nolan P, Ng WH, Maixner W, Laidlaw J. Dysembryoplastic neuroepithelial tumor (DNT)-like oligodendrogliomas or DNTs evolving into oligodendrogliomas: Two illustrative cases. Neuropathology 2007; 27:324-30. [PMID: 17899685 DOI: 10.1111/j.1440-1789.2007.00783.x] [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] [Indexed: 11/30/2022]
Abstract
A review of dysembryoplastic neuroepithelial tumors (DNTs) in 14 patients over a 12-year period revealed four patients re-operated because of changes on magnetic resonance imaging (MRI) suggesting tumor recurrence or progression. In three of these, the histological features were identical to the initial DNT. In the fourth patient, persistent DNT was surrounded by WHO grade 2 oligoastrocytoma. In one of the other 10 patients, WHO grade 2 oligodendroglioma was present in white matter deep to and completely separate from a cortically based DNT. Fluorescence in situ hybridization showed codeletion of 1p and 19q in both the DNT and oligodendroglioma and oligoastrocytoma components. Deletions were not identified in any other tumor. Our findings corroborate other studies that 1p and 19q deletions are uncommon in DNT. These two unusual tumors also raise the possibility that rare DNTs may evolve into oligodendroglioma or oligoastrocytoma. DNTs with this altered biology can be identified by 1p and 19q deletion analysis.
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Affiliation(s)
- Michael Gonzales
- Departments of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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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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Abstract
Abstract
OBJECTIVE
Dysembryoplastic neuroepithelial tumors (DNTs) are clinicopathologically unique tumors. They are usually located within the supratentorial cortex, most often in the temporal lobe. These lesions are frequently associated with intractable complex partial seizures in children and young adults. DNTs may also arise outside of the cerebral cortex. We report a case of a 57-year-old woman who had a DNT in the caudate nucleus. During a 7-year follow-up period, the tumor did not recur. The literature on DNTs with atypical “ectopic” localizations is summarized.
CLINICAL PRESENTATION
A patient presented with a 1-year history of headaches, nausea and vomiting, and progressive visual disturbances.
INTERVENTION
Gross subtotal removal of the lesion was accomplished without further treatment.
CONCLUSION
Unlike diffuse gliomas, such as oligodendrogliomas and central neurocytomas, DNTs are benign lesions with a favorable prognosis after surgical resection. Therefore, recognition of DNTs at atypical ectopic locations is essential for predicting the clinical course and for making the right therapeutic decisions.
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Affiliation(s)
- Fulin Wang
- Department of Pathology, People's Liberation Army General Hospital, Beijing, China.
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Ishizawa K, Terao S, Kobayashi K, Yoshida K, Hirose T. A neuroepithelial tumor showing combined histological features of dysembryoplastic neuroepithelial tumor and pleomorphic xanthoastrocytoma a case report and review of the literature. Clin Neuropathol 2007; 26:169-75. [PMID: 17702498 DOI: 10.5414/npp26169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/18/2022] Open
Abstract
A neuroepithelial tumor showing combined histological features of dysembryoplastic neuroepithelial tumor (DNT) and pleomorphic xanthoastrocytoma (PXA) is described. The patient was a 60-year-old male with a long-standing temporal lobe tumor and seizures. After a long, dormant period, the tumor, which had been localized in the left uncus, re-grew rapidly and extended into the subarachnoidal space and brain stem. The post-operative specimens disclosed two distinct components: an intra-cortical, cystic lesion containing mucinous materials and an extra-cortical, nodular lesion involving the leptomeninges. The former contained oligodendroglia-like small, round cells placed along axonal processes, plus mature neurons situated against mucinous materials (DNT-like component, WHO Grade I). The latter contained spindle and/or pleomorphic cells expressing glial fibrillary acidic protein, having bizarre nuclei and atypical mitotic figures. A reticulin network was developed among the tumor cells (PXA-like component, WHO Grade III). This case illustrates an unusual composite brain tumor, combined DNT and PXA.
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Affiliation(s)
- K Ishizawa
- Department of Pathology, Saitama Medical University, Saitama, Japan.
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Abstract
PURPOSE Gliomatosis cerebri (GC) is a rare neoplastic disorder that may present as intractable epilepsy during early life. We report our experience regarding the evaluation and the surgical treatment of epilepsy in this population. METHODS All children evaluated between 1990 and 2006 for surgery of epilepsy (n = 741) with pathologically proven GC were selected. RESULTS We identified four male children with age at seizure onset ranging from 4 months to 11 years. Two had hemiparesis and one child with infantile spasms was developmentally delayed. Seizures occurred daily (n = 3) or monthly (n = 1). Ictal semiology was consistent with psychomotor seizures (n = 1), partial motor seizures (n = 2), and asymmetric epileptic spasms (n = 1). Surgery was symptomatic and aimed at debulking and controlling the epilepsy. Procedure was individually tailored based on the presurgical evaluation. Brain MRI revealed widespread hemispheric involvement (n = 3) or infiltration of the temporal lobe and basal ganglia (n = 1). Two patients were initially misdiagnosed as hemispheric cortical dysplasia and hemimegalencephaly. Scalp EEG was nonlocalizing in two cases, showed a right temporal focus in one case, and was not performed in one case. Interictal SPECT in one patient revealed widespread hemispheric hypoperfusion. Three cases were resected under ECoG guidance after a mean delay of 11 months after seizure onset. Following functional hemispherectomy (n = 1) or focal cortical resection (n = 2), all children were alive and seizure free with a mean follow-up of 48 months (2-5 years). No unexpected complication was reported. One nonoperated case was alive but still seizing after 15 months follow-up. Chemotherapy was associated in three cases. CONCLUSIONS GC is a rare cause of medically resistant epilepsy that may present in early life. The lack of a discrete lesion may lead to diagnostic uncertainty, especially in infancy. Epilepsy surgery is an effective therapy that can improve quality of life.
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Affiliation(s)
- Bruno Maton
- The Brain Institute, Miami Children's Hospital, 3200 S.W. 60th Court, Miami, FL 33155, USA
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Affiliation(s)
- Iqroop Chopra
- Department of Neurosurgery, Charring Cross Hospital, London, UK
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