|Year : 2019 | Volume
| Issue : 1 | Page : 75-86
|Date of Web Publication||3-Jun-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Poster Abstracts. Int J Neurooncol 2019;2:75-86
| Poster Abstracts|| |
Supratentorial extraventricular ependymomas: a series of three cases
Ashis Patnaik, Maruti Nandan, Arunav Sharma, Rabi Narayan Sahu, Sumit Bansal; Department of Neurosurgery, AIIMS, Bhubaneswar, Odisha, India
Ependymomas are uncommon primary intracranial neoplasms, accounting for only about 3%–5% of all gliomas. They usually originate from the ependymal lining the ventricles and central canal of spinal cord. Both supratentorial and extraventricular locations are extremely rare, and only few cases are reported in the literature. Radiologically, they resemble other malignant small round cell tumor, and the diagnosis is often difficult due to low index of suspicion. The recent WHO classification 2016 has proposed a nine subgroup molecular classification of ependymoma with prognostic implication based on the genetic profile, site, and age at presentation. We report three rare cases of primary supratentorial extraventricular ependymoma in relation to their clinic-radiologic picture, operative interventions, and long-term follow-up, with a special note to the histological and molecular profile. Due to their rarity, supratentorial extraventricular ependymoma is difficult to diagnose preoperatively. Only meticulous histological examination with high level of suspicion helps in their identification.
Retrospective review of primary brain tumors
Diptajit Paul; Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Aim and Objectives: We retrospectively reviewed the records of patients of primary brain tumors in our department to analyze patient characteristics, various treatment protocols, and their responses.
Materials and Methods: Retrospective analysis of the patients of primary brain tumors who presented in the Department of Radiation Oncology, PGIMS, Rohtak, from 2009 to 2012 was done for different radiotherapy schedules with or without chemotherapy and their response evaluation.
Results: A total of 123 patients of primary brain tumors were identified, which constituted approximately 1% of total cancer patients in the Department of Radiation Oncology, PGIMS, Rohtak. The median age at presentation was 41 years (range 9–70), the third decade of life being the most common presentation. The male-to-female ratio was 2.6:1. At the time of initial presentation, 61% of patients had fair-to-good general condition, i.e., Karnofsky performance status (KPS) >70, and 11% had very poor general condition, i.e., KPS <30. 63% of patients had a history of tobacco intake, while 53% were alcoholic. Mean duration of symptoms was 4 months. The most common presentation was headache (79%), vomiting (33%), seizure (27%), and altered sensorium (5%). 58% of patients were locally advanced (WHO Grade III and IV). Histopathologically, astrocytoma (50%) was the most common subtype followed by glioblastoma multiforme (31%), oligodendroglioma (10%), and mixed gliomas (9%). 8% patients did not report for treatment after initial investigations. 53% of the patients received chemoradiation, 88% received radiation therapy (RT), and 97% underwent surgery. Most common chemotherapeutic drug used was temozolomide, where nimotuzumab was given to 2% of patients. Radical radiotherapy was given in 84%; palliative radiotherapy and supplementary RT was given in 4% of patients. Radical radiotherapy with 60 Gy/30#/6 weeks was given in 46% and 54 Gy/30#/6 weeks in 44% of patients. Clinically, the response at the last follow-up was as follows: complete response in 29%, partial response in 41%, death in 23%, and 9% of patients lost to follow-up.
Discussion: Overall, newly diagnosed cases of primary brain and spinal cord cancer were 1.6% of all cancers worldwide that closely resembles our study. Survival and prognosis of different subtypes of primary brain cancer were also similar as per the data: whereas glioblastoma multiforme carries the worst prognosis, astrocytoma with lower WHO grade has good one. Clinical factors having significant role in prognosis of primary brain tumors include age, sex, smoking and alcohol habits, performance status, tumor location, and extent of resection. Use of concomitant chemotherapy especially oral temozolomide with radical radiotherapy is highly recommended in locally advanced cases (WHO Grade III and IV) particularly in glioblastoma. In low-grade diffuse astrocytoma, surgery followed by radical radiation is usually the standard treatment protocol.
Conclusion: In this retrospective analysis, astrocytoma constituted 50% of all reported cases. 58% of patients presented as locally advanced. 88% of patients were treated with radical intent. CR was observed in approximately one-third patients. It is recommended that different RT protocols should be explored alone or in combination depending on the general condition and affordability of the patients so as to prolong survival and improve the quality of life.
Keywords: Astrocytoma, glioblastoma multiforme, Karnofsky performance status, mixed gliomas, nimotuzumab, oligodendroglioma, palliative, primary brain tumors, radical, radiotherapy, temozolomide, WHO grade
Cerebellar high-grade gliomas: A report of two cases with deceiving radiology
Background: Primary cerebellar glioblastoma is a rare tumor in adults which accounts for just 1% of all cases of glioblastoma. Radiological features of cerebellar glioblastoma do not exhibit common features such as supratentorial glioblastoma. Here, we report two cases of cerebellar high-grade glioma.
Case 1: A 62-year-old male presented with sudden-onset slurring of speech and gait imbalance, which persisted for 3 months. Magnetic resonance imaging (MRI) brain with contrast showed an enhancing solid cystic mass in the right cerebellar hemisphere with a broad base to the tentorium, giving an extra-axial appearance. There were multiple flow voids and patchy areas of diffusion restriction. Positron emission tomography-computed tomography (PET-CT) whole body showed increased metabolic activity in the cerebellar lesion. No other lesions were seen.
Case 2: A 52-year-old female who was previously treated for pulmonary tuberculosis 5 years ago presented with headache and vomiting of 4 months duration. MRI brain with contrast showed an ill-defined area of edema and expansion involving the inferior aspect of vermis and right cerebellar hemisphere with leptomeningeal enhancement along the folia. In Case 1, the broad base of the tumor on tentorium was suggestive of tentorial meningioma. Intraoperatively, however, we found a highly vascular intra-axial tumor which breached the pia and infiltrating the tentorium. In Case 2, an inflammatory lesion was considered based on the leptomeningeal enhancement along the folia and a biopsy was planned. However, intraoperatively, the surface of vermis appeared normal with deeper parts being firm, rubbery, and moderately vascular. Presurgical planning was based on the radiological features in both these cases. Histopathology revealed that both these cases were of high-grade glial neoplasm (WHO Grade IV); in Case 1 – giant cell glioblastoma, IDH wild-type – and in Case 2 – high-grade glial neoplasm, not otherwise specified type.
Conclusion: Cerebellar high-grade gliomas can present with atypical radiological features mimicking an extra-axial tumor or an inflammatory lesion. Awareness of such entity will aid in appropriate surgical planning and treatment.
Anaplastic solitary fibrous tumor/hemangiopericytoma of the lumbar spine: A rare entity
P T Irwin; Christian Medical College, Vellore, Tamil Nadu, India
Introduction: Hemangiopericytomas (HPCs)/solitary fibrous tumors (SFTs) are tumors arising from Zimmerman’s pericytes that were first described in 1942 by Stout and Murray. They mostly occur in the musculoskeletal system and the skin and rarely in the central nervous system (CNS). CNS HPC/SFT forms around 1% of all CNS tumors. Most CNS HPCs are found in the cranial cavity; they rarely occur in the spinal canal.
Case Report: A 15-year-old female child presented with radicular pain in the right S1 dermatome for 4 months, which worsened at night, and back pain for 2 weeks. Except for an absent right ankle jerk, her examination was normal. Magnetic resonance imaging (MRI) lumbosacral spine with contrast showed an extradural heterogeneously enhancing mass at right S1, measuring 3 cm with extension into the neural foramina. There was scalloping of the S1-2 vertebral bodies. She underwent L5–S1 laminectomy and total excision of the lesion. Intraoperatively, a 3 cm-sized, yellowish red, firm, and highly vascular extradural tumor was seen at S1 level on the right side, arising from a root. Postoperatively, she had complete resolution of her pain and did not develop any neurological deficits. Histopathology was reported as anaplastic SFT/HPC, WHO Grade III, MIB-1 labeling index 10%. MRI done at 3 months follow-up showed no residual lesion, and she underwent adjuvant radiotherapy (RT) (59.4 Gy to planning target volume in 33 fractions).
Discussion: Spinal HPCs/SFTs are extremely rare, and around 90 cases are reported in English literature. Most common modality of treatment is total resection of tumor. Adjuvant RT is given if there is tumor residue or histopathology is of a higher grade. Our patient underwent RT after a total resection of tumor and was doing well until her last follow-up at 6 months.
Conclusion: Treatment of spinal HPC/SFT remains a challenge. Although different subtypes of spinal HPC/SFT are reported, complete excision and RT are the treatment of choice. Close follow-up is required in view of the risk of recurrence.
The diagnostic validity of serological markers in the diagnosis of intracranial germ cell tumors: A retrospective analysis
Julie Joseph; Christian Medical College, Vellore, Tamil Nadu, India
Background and Objectives: Serum and cerebrospinal fluid (CSF) levels of tumor markers are often the sole modalities utilized for diagnosis and treatment of intracranial germ cell tumors (GCTs). The present study analyzed the diagnostic validity of this modality.
Materials and Methods: A retrospective study was carried out on patients diagnosed with intracranial GCTs between January 2014 and December 2018 in Christian Medical College, Vellore. Clinical, serological, and histopathological data were reviewed. Association between raised serum and CSF tumor markers and histological diagnosis was analyzed.
Results: The 37 patients in the study included 20 that were biopsy proven. Seventeen out of 20 biopsy-proven cases were germinomas, of which 14 had elevated serum/CSF alpha-fetoprotein/human chorionic gonadotropin (hcg) and three were negative for serum/CSF parameters. The remaining three biopsy-proven cases were teratomas with no elevation of serum/CSF germ cell markers. Of the 17 cases who were diagnosed purely by biochemical parameters, 14 were diagnosed as germinomas based on elevated beta-hcg and three were diagnosed as nongerminomatous tumors based on elevated alpha-fetoprotein in the CSF/serum. The sensitivity of biochemical markers in diagnosing a GCT was 82.4% while the specificity was 100%.
Conclusions: While the assessment of biochemical parameters is a highly specific test, it is a poor screening tool for diagnosis of GCTs. Our analysis suggests that a biopsy is indicated for definitive diagnosis in cases with a high degree of clinical suspicion that is negative for biochemical parameters.
Keywords: Alpha-fetoprotein, cerebrospinal fluid, germ cell tumor, human chorionic gonadotropin
Third ventricular germinomas: The midline mirage
Ashutosh Kumar; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Introduction: The incidence of primary germ cell tumors (GCTs) of the neuraxis (central nervous system [CNS]) is uncommon, and they constitute a heterogeneous group of neoplasms with characteristic histological subtypes. Midline of the brain is their preferred location, and nearly 40% of these lesions involve the suprasellar region. In the present article, we would like to share the management of an adolescent girl with suprasellar mass lesion who presented with clinical and radiological features mimicking that of craniopharyngioma.
Case Report: A 13-year-old girl was brought by parents in altered sensorium. Her clinical history revealed multiple episodes of vomiting and features of raised intracranial pressure for the last 10 days. On examination, her Glasgow Coma Scale was E3M5V4 with sluggishly reacting pupils. Other systemic examinations were within normal limits. Her computerized tomography scan of the head was suggestive of gross ventriculomegaly with periventricular lucency and suprasellar hypodensity with variegated appearance within the lesion. She underwent urgent cerebrospinal fluid (CSF) diversion, and an external ventricular drain was inserted to buy time before tumor decompression. Her magnetic resonance imaging (MRI) brain which was done before this episode revealed a well-defined suprasellar lesion extending into the anterior third ventricle. The lesion was solid cystic and heterogeneously enhancing with contrast. The solid component of the lesion was isointense on T1-weighted images and hyperintense on T2-weighted images. It was reaching and obstructing the foramina of Monro which was causing proximal hydrocephalus at the time of admission. Blooming was seen on SWAN sequences suggesting highly vascular nature of the tumor. The clinical profile as well as radiological features points toward the working diagnosis of craniopharyngioma. The patient was taken up for emergency surgery and tumor decompression was planned via endoscopic endonasal trans-sphenoidal (EETS) approach. The standard steps of the endoscopic endonasal approach were followed and sella was reached after sphenoid drilling. However, to our surprise, on reaching the sella, the floor of the third ventricle was intact with no evidence of tumor in the sella. On table, decision was taken to abort the procedure through the endoscopic approach and transcranial decompression was planned. Hence, the tumor was then approached through left middle frontal gyrus with the endoscopic transcortical transventricular route. The tumor was well-defined, friable, vascular, grayish pink in appearance. The tumor was arising from the floor of the third ventricle and was filling the anterior half of the third ventricle. Anteriorly, the lesion was reaching the foramina of Monro and was blocking the outlet of both the lateral ventricles. Near-total decompression of the tumor was done. The dura was closed and the buttonhole craniotomy defect was closed in layers. The histology report was suggestive of mixed GCT (seminoma~30%, embryonal carcinoma~5% yolk sac tumor~5%) with immature teratoma (60%). On immunohistochemistry, the tumor cells were positive for seminomatous component, i.e., c-kit (membranous), PLAP (cytoplasmic), OCT3/4 (nuclear), and were negative for CD30, EMA, and AFP. Tumor cells were positive for OCT3/4 (nuclear), CD30 (membranous), and EMA (membranous) and were negative for c-kit, PLAP, and AFP. Postoperatively, the patient had improvement in sensorium. However, she had a stormy course due to the triple-phase response of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion. She was discharged in stable condition with hormone replacement therapy for panhypopituitarism. Follow-up MRI done after 6 weeks was suggestive of adequate decompression with a thin layer of tumor tissue adhered along the floor of the third ventricle. She has been registered in the department of radiotherapy for adjuvant therapy.
Discussion: GCTs are classified into germinomatous and nongerminomatous tumors with a myriad of cellular origin at various stages of development. Tumors originating at an early stage of histogenesis are supposed to be more malignant than their counterparts arising at the later stages of development. Primary CNS GCT involving the pediatric age group constitutes about 18% of cases. These tumors arise from embryonic cell rests in the midline located intracranially as well as extracranially. Malignant GCT represents up to 3% of neoplasm in the pediatric population, the second decade being the peak age group. Maximal safe surgical resection is the cornerstone to decrease the tumor load and maintain the CSF pathway. Surgical decompression prevents the mass effects as well as the sequel of raised intracranial pressure. Exact histopathological diagnosis forms the solid foundation for managing such tumors because pure germinomas are much more sensitive to chemotherapy and radiotherapy as compared to nongerminomatous GCT. Various theories have been postulated regarding the development of extragonadal GCT such as Telium’s germ cell theory and embryonic cell theory. Immunohistochemical markers are helpful in differentiating various types of GCT. SALL4, a recently introduced novel marker in the diagnostic armamentarium, helps to differentiate germinomas, embryonal carcinoma, and yolk cell tumor with 100% sensitivity.
Primary intracranial germ cell tumors: 10-year experience from a tertiary care center
S Patricia; Christian Medical College, Vellore, Tamil Nadu, India
Aims and Objectives: Intracranial germ cell tumors (IC-GCTs) occur in children and young adults, accounting for approximately 3% of pediatric brain tumors, and they are heterogeneous. Extragonadal germ cell tumors are included in the differential diagnosis of pineal and suprasellar intracranial tumors. The diagnosis of an IC-GCT is usually clinico-radiological along with serum and cerebrospinal fluid (CSF) tumor markers such as α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-HCG) and this may obviate the need for tissue diagnosis. Germ cell tumors are classified as germinomas constituting>80% of ICGCTs and nongeminomatous germ cell tumors (NGGCTs). As pure germinomas are highly sensitive to chemotherapy and radiotherapy, they have very good prognosis as compared to NGGCTs. Our aim and objective was to retrospectively analyze the clinical pattern and outcome of patients treated with radiation therapy and chemotherapy for IC-GCTs from January 2006 to June 2016 in our Institute.
Materials and Methods: Retrospectively, data were collected from electronic medical records of 51 patients who received treatment for primary IC-GCT from January 2006 to June 2016 in our Institute. The patient’s demographic, clinical, biochemical, and radiological information at presentation were collected. Information on pituitary hormone levels both at baseline and at follow-up was collected. Details of radiation therapy and chemotherapy and toxicity data were also noted. Progression-free survival (PFS), time to progression, and overall survival (OS) were analyzed using Kaplan–Meier curves.
Results/Discussion: Of the 51 patients diagnosed with primary IC-GCT, 32 (63%) were males and 19 (37%) were females. Their age ranged from 6 to 38 years (median 16 years). Headache and vomiting were the most common presentation followed by visual symptoms and neurological deficits. The location of the tumor was pineal/posterior third ventricular origin in 28 (55%) and suprasellar in 13 (25%) patients, and the rest were corpus callosum (2%), thalamic region (6%), brainstem (4%), and multifocal (8%). Seventeen patients (34%) including all suprasellar GCTs presented with endocrine abnormalities, and diabetes insipidus was the most common endocrine abnormality. Histopathological diagnosis was possible in 49% of patients only. Twenty-five patients were diagnosed as pure germinoma, 15 as germinoma with elevated markers (secreting germ cell tumors), and 11 as NGGCTs. Chemotherapy was given in 63% before RT and 21% received after radiation therapy. Cisplatin/etoposide regimen was the most commonly used regimen in adults and carboplatin/ifosfamide/etoposide in children. Common toxicities observed with chemotherapy were febrile neutropenia in 18.6% and dyselectrolytemia in 11.6%. Whole ventricular radiation therapy (median dose 30.6 Gy) followed by focal boost (median 19.8 Gy) was delivered to 76% of patients and craniospinal irradiation (median dose 36 Gy) followed by focal boost (median dose 18 Gy) in 24% of patients. All patients tolerated RT well but with Grade 3 neutropenia in two patients, while on craniospinal radiation, three patients experienced endocrine abnormality as late side effect. Median follow-up was 34 months (3–139 months). On follow-up, seven patients (14%) had disease recurrence/progression, and among them, three of them had pure germinomas, two of them had secretory germinomas, and two of them had NSGCT. Median PFS and OS were not reached. PFS at 2 years was 90% and at 5 years was 83%. OS at 2 years was 95% and at 5 years was 85%. For pure germinomas, secreting germinomas, and NGGCT, PFS at 5 years was 90%, 80%, and 81% and OS at 5 years was 100%, 75%, and 80%, respectively. Of the seven patients who recurred, four patients had local recurrence, two had extra CNS disease, and one had new multiple intracranial lesions. Time to recurrence was earlier in NGGCT than the other two groups. All patients who recurred were salvaged with second-line chemotherapy. Those with pure germinomas – three patients were successfully salvaged and are on follow-up. Carpio et al. (2017) reported 84% OS with germinomas and 60% with NSGCT with a median follow-up of 58 months. Takada et al. (2018) reported 5-year OS and PFS of 100% and 83.5%. When compared to published literature, we found similar outcomes in our cohort.
Conclusion: IC-GCTs can be diagnosed based on clinicoradiological features and tumor markers. RT and chemotherapy play a vital role in achieving local control. Germinomas have better local control and OS as compared to nongerminomatous tumors. Serial follow-up imaging is necessary for patients, especially in those who had normal serum markers, to begin with. Recurrence can be salvaged effectively.
Keywords: Craniospinal radiation, germ cell tumor, pineal, suprasellar, whole ventricular radiation therapy
Lymphocytic hypophysitis mimicking pituitary adenoma: A diagnostic challenge
Introduction: Lymphocytic hypophysitis is a rare autoimmune inflammatory disease of the pituitary gland, which commonly affects women during pregnancy. Sometimes, it mimics pituitary adenoma both clinically and radiologically. We present an unusual case of pituitary hypophysitis which pose a great diagnostic challenge.
Case Details: A 30-year-old female presented with complaints of headache for 1 year and loss of vision for 3 months. She also had a history of amenorrhea, polydipsia, and polyuria (approximately 9 L/day) along with easy fatigability and generalized weakness. On examination, she had bilateral vision loss with optic atrophy and diplopia. Radiological diagnosis was pituitary macroadenoma with parasellar extension. She underwent trans-sphenoidal excision and biopsy of the lesion. Final histopathological examination was suggestive of lymphocytic hypophysitis.
Conclusion: Lymphocytic hypophysitis is one of the rarely reported lesions of sellar and parasellar region which poses a difficult diagnostic dilemma. This differential diagnosis still needs to be considered as surgical excision may cause avoidable complications.
Value of immunohistochemistry for L1-cell adhesion molecule in detecting C11orf95-RELA fusions in supratentorial ependymomas
Geeta Chacko; Christian Medical College, Vellore, Tamil Nadu, India
Introduction: Ependymomas are tumors of the central nervous system, the majority of which arise from the ependymal lining of the ventricles or the central canal of the spinal cord. Extraventricular ependymomas have also been reported. A recurrent C11orf95-RELA fusion resulting from chromothripsis at 11q13 characterizes 70% of supratentorial pediatric ependymomas and about 20% of adult supratentorial ependymomas. Tumors with RELA fusion have a poor prognosis. Membranous staining on immunohistochemistry for L1-cell adhesion molecule (L1CAM) is considered a surrogate marker of RELA fusion.
Aim: The aim of the present study was to ascertain if membranous staining on immunohistochemistry for L1CAM is a good surrogate marker for RELA fusion.
Materials and Methods: All supratentorial ependymomas diagnosed between 2012 and 2018 with tumor tissue in the tumor bank were included in the study. The histopathology of all the cases was reviewed, and a representative section was chosen for immunohistochemistry with L1CAM. Real-time polymerase chain reaction (PCR) was performed to detect RELA type 1 fusions. The immunoexpression of L1CAM was compared to the results of real-time PCR.
Results: There were 31 cases of supratentorial ependymomas with tumor tissue in the tumor bank. Twenty-seven of these cases were anaplastic ependymoma, WHO Grade III and four of the cases were ependymomata, WHO Grade II. Twenty-two cases showed diffuse membrane immunopositivity for L1CAM. All four WHO Grade II neoplasms were negative for L1CAM. Using real-time PCR, seven cases had RELA Type 1 fusion, one of which was immunonegative for L1CAM.
Conclusion: Although L1 CAM has been considered a surrogate marker for RELA fusion, it has very low specificity in detecting RELA fusions. The high sensitivity of L1CAM immunohistochemistry in detecting RELA fusions makes it a good screening test.
Keywords: Ependymoma, L1-cell adhesion molecule, RELA fusion, Supratentorial
Funding: Department of Science and Technology supported the study.
Astroblastoma: A rare case and its treatment challenges
Shashank Joshi, Paramjeet Kaur, Ashok K Chauhan
Aim and Objectives: To report a rare case of astroblastoma in an elderly patient.
Materials and Methods: We report a case of astroblastoma in a 58-year-old female who had complaints of multiple episodes of loss of consciousness from 3 months and right-sided weakness and difficulty in speech from 2 months. The patient was investigated and diagnosed as a case of a left frontoparietal intracranial space-occupying lesion. The patient underwent left frontoparietal craniotomy with gross tumor excision. A histopathological assessment showed features suggestive of astroblastoma progressing to high grade. Immunohistochemistry showed tumor to be CD34+ and GFAP+. The patient presented to us after surgery. On presentation, Glasgow Coma Scale was 13 (E4V3M6), speech was incomprehensible, and right-sided hemiparesis with power 2/5 was noted. Postoperative NCCT head was apparently normal showing postoperative changes. The patient was given radical whole-brain radiation therapy 60Gy/30# over 6 weeks by Cobalt-60 teletherapy machine with concomitant capsule temozolomide 100 mg OD before radiation. Adjuvant chemotherapy with capsule temozolomide 250 mg OD day 1–5 was advised following chemoradiation. The patient tolerated chemoradiation well but reported after 2 months in poor general condition. On examination, the patient was disoriented and responded to pain only, and right-sided hemiplegia was noted and pupils were semi-dilated and sluggishly reacting to light. The patient was admitted, investigated, and managed conservatively and was stabilized. Contrast-enhanced magnetic resonance imaging brain (postchemoradiation) was suggestive of residual/recurrent lesion over the same region. The patient was referred to a neurosurgeon but was declared inoperable and was advised best supportive care with close follow-up.
Results: High-grade astroblastomas and poor patient compliance have again proved to be a burden on the work of oncologist. As despite of such aggressive approach, the patient developed recurrence.
Conclusion: Astroblastomas are rare primary brain tumors affecting children, adolescents, and young adults. They are difficult to diagnose and manage and have an unpredictable course with a tendency of recurrence. The rarity of this tumor limits the world literature and hence the knowledge regarding its accurate diagnosis and proper management. Although treatment of astroblastoma is not well established because of its rarity, yet complete surgical resection plays an important role in its management, especially in low-grade cases. Higher grades require adjuvant treatment with radiotherapy and temozolomide-based chemotherapy because of higher recurrence rates and rapid progression as observed in our report. Further studies are needed to establish definitive diagnostic and treatment guidelines.
Keywords: Astroblastoma, high grade, temozolomide, elderly
Stereotactic Ommaya Reservoir System placement as an option for treatment of recurrent cystic craniopharyngioma
Sourabh Dixit, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
Aims and Objective: To study the efficacy of stereotactic Ommaya Reservoir placement and repeated aspirations as a treatment option for recurrent cystic craniopharyngioma.
Materials and Methods: The current study includes three cases in which stereotactic Ommaya Reservoirs were placed, and sequential aspiration of cystic fluid was done . The patients were in follow-up for >6 months for control of symptoms.
Results: The most common symptoms that responded to repeated aspirations were headache and visual blurring. The field of vision did not showed any progressive deterioration in the follow-up. The endocrine symptoms did not showed any change in the follow-up period.
Conclusion: The stereotactic Ommaya Reservoir system placement is a valuable and cost-effective option in the treatment of recurrent cystic craniopharyngioma.
Correlation of magnetic resonance imaging features with molecular marker in high-grade gliomas or high-risk low-grade gliomas
Manan Sarupria, Shikha Goyal, Jayesh Modi, Ishani Mohapatra, Tejinder Kataria, Shyam S Bisht, Deepak Gupta
Objective: To improve the prognostic value of imaging in high-grade gliomas or high-risk low-grade gliomas by determining correlation of magnetic resonance imaging (MRI) features with molecular marker (isocitrate dehydrogenase [IDH-1]).
Materials and Methods: Patients with histopathologically proven gliomas treated with adjuvant radiation therapy (with or without concurrent and adjuvant chemotherapy) in the Division of Radiation Oncology from January 2017 to December 2018 were taken retrospectively. Patient demographics, signs and symptoms, preoperative MRI, and histopathological reports were reviewed. IDH-1 mutation status was correlated with MRI features (location, hemisphere, enhancement, proportion of enhancement >33%, tumor border delineation, diffusion restriction within tumor, and significant midline shift >5mm).
Results: Of total 20 patients (16 males and 4 females), 10 underwent gross total excision (GTE), 9 underwent subtotal excision (STE), and 1 patient had stereotactic biopsy. Eight patients in GTE group, six in STE group, and the only patient with biopsy were IDH-1-mutant. Others (5) were IDH-1 wild type. Of 15 IDH-1-mutant patients, 2 were Grade II (oligodendroglioma-1, astrocytoma-1), 7 were Grade III (oligodendroglioma-4, astrocytoma-3), and 6 were Grade IV (glioblastoma). Of 5 IDH-1 wild-type cases, 2 were Grade III (astrocytoma-2) and 3 were Grade IV (glioblastoma). Frontal lobe tumors were 73.3% and 80% in IDH-1 mutant and IDH-1 wild type, respectively. Right-sided location was seen in 46.6% of IDH-1-mutant and 40% of IDH-1 wild-type tumors. Tumor enhancement with contrast (gadolinium) was present in 53.3% of IDH-1-mutated tumors and 80% of IDH-1 wild-type tumors. Volume of tumor and volume of enhancement were analyzed separately, and proportion of enhancement was calculated (high enhancement proportion ≥33% or low enhancement proportion <33%). High enhancement proportion was seen in 20% of IDH-1-mutated and 80% of IDH-1 wild-type tumors. Mass effect with tumor crossing midline was seen in 73.3% of IDH-1-mutant tumors, while 60% of IDH-1 wild-type crossed midline. Significant midline shift (>5 mm) was seen in 33.3% of IDH-1-mutated tumors and 40% of IDH-1 wild type. Tumor border delineation on T1 contrast was present in 40% of IDH-1-mutated and 20% of IDH-1 wild-type cases. Diffusion restriction within the tumor was seen in 66.6% of IDH-1-mutated tumors while 100% of IDH-1 wild type showed diffusion restriction.
Conclusion: There is some suggestion of differentiation between IDH-1 mutant and non-mutant gliomas based on imaging. We were unable to appreciate the magnitude of difference due to small patient numbers but intend to explore it in a larger cohort to appreciate any meaningful discrimination between imaging characteristics of the two groups.
Recurrent cervical spine meningioma: A case report
Jyothi K Thomson; Regional Cancer Centre, Thiruvananthapuram, Kerala, India
Objective: The objective of the study is to present the case report of a 49-year-old female with recurrent cervical spine meningioma after total excision.
Background: Meningioma accounts for 25%–45% of primary spinal neoplasms. Spinal meningiomas have a favorable outcome with surgery. Tumor recurrence occurs between 10% and 15% of patients undergoing curative surgery at 5-year follow-up and 25% and 37% of patients at 10-year follow-up.
Findings: We present a case of 49-year-old female evaluated for complaints of progressive weakness of all four limbs of 6 months duration and bowel and bladder incontinence. She gives a similar history in 2015 while she was evaluated for left-hand weakness and numbness, for which she underwent C1–C3 laminectomy and total excision of spinal tumor in May 2016 at a local hospital, and histopathology was suggestive of transitional meningioma WHO Grade I. Her symptoms improved over 6 months. Now, examination showed no cranial nerve deficit. Normal tone and bulk of muscle were observed. Power– grade 2/5 proximally and 3/5 distally in all four limbs. Grip weakness – present. Bilateral extensor plantar. There was mild sensory deficit present in both upper limbs. No cerebellar signs were noted. Magnetic resonance imaging spine was taken on August 2017. A heterogeneous enhancing mass lesion (4 cm × 1.2 cm × 1.6 cm) was noted in the left upper cervical cord extending from C1-C3, broad-based to dura with edema. She underwent re-exploration and completion C3 laminectomy and excision of tumor with augmentation duraplasty on November 2017 at a local hospital. Pathological review from our institution was suggestive of atypical meningioma, WHO Grade II. Postoperatively, she had neurological deficit. She underwent postoperative radiation treatment with 52.2 Gy in 29 fractions which was completed in April 2018 and is under regular follow-up.
Conclusion: After a follow-up period of 8 months of postradiation treatment, she has not shown any worsening of neurological symptoms. Radiotherapy can control unexcised or recurrent meningioma. Reoperation followed by radiation therapy is a treatment option for meningioma recurrence.
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A rare case of conus cauda mature teratoma in adult male
Kamlesh Kumar Singh; Kasturba Hospital, Manipal, Karnataka, India
Introduction: Spinal teratomas are very rare tumors in adults. Majority of them are located in the thoracolumbar region. They can either be intramedullary, extramedullary, or extradural in location. Clear consensus regarding management and prognosis of these lesions is not yet available.
Case Illustration: A 26-year-old male presented with acute-onset weakness (within 48 h) of both lower limbs 1½ months back, associated with urinary retention and constipation. Neurological examination revealed flaccidity in both lower limbs and complete paraplegia (MRC grade 0/5). Sensation was absent below L1 dermatomes. No cutaneous stigmata of spinal dysraphism were evident. Magnetic resonance imaging (MRI) of the spine showed a heterogeneous solid-cystic fat containing lesion extending from L1 to L2 vertebral levels at the conus-cauda region. Laminectomy and subtotal tumor resection were performed. Histopathological examination showed features suggestive of mature teratoma. At 15 months of follow-up, he had modest improvement in his power and was able to stand with support. However, his urinary problem persisted and was on a catheter for voiding.
Conclusions: Adult-onset spinal teratomas are rare. Total surgical resection is the standard treatment and is beneficial in terms of outcome and recurrence. Recurrences are rare and can be managed by re-surgery.
An atypical case of carcinoma cervix with brain metastasis: A case report and discussion
Baljit Singh, Faraz Khan, Diptajit Paul, Anil Kumar Dhull, Rajeev Atri, Rakesh Dhankhar, Vivek Kaushal; Department of Radiation Oncology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Aim and Objectives: The aim and objective of the study is to present an atypical case of squamous cell carcinoma cervix with brain metastasis in a postmenopausal married female.
Materials and Methods: A 66-year-old married female presented in August 2017 with a history of single episode vaginal bleeding 2 months back and foul-smelling vaginal discharge, which was moderate in amount, thick, associated with lower abdominal pain, mild-to-moderate in intensity, nonradiating, relieved on medication. She was nonsmoker, nonalcoholic, multipara (P5L4A0) with all spontaneous vaginal delivery and had no significant past illness. She had normal menstrual history with menarche at 14 years and menopause at 53 years of age. General physical and systemic examination was normal at the time of the first presentation. On local examination, an ulceroproliferative growth of size 5 cm × 5 cm replacing the whole cervix, involving all four fornices, and upper two-third vagina was found. Rectal examination revealed bilateral parametrium involvement with growth extending up to the left pelvic wall. Lower one-third vagina was normal. Complete hemogram and biochemical profile of the patient at the first visit were within normal limits. Histopathology from above-mentioned growth at uterine cervix showed moderately differentiated squamous cell carcinoma (MDSCC, large cell nonkeratinizing type).
Results: The patient was diagnosed as carcinoma cervix (MDSCC) FIGO stage IIIB. She was treated with radical external beam radiation therapy 50 Gy/25 Fr/5 weeks, 5 days in a week with 2 Gy per fraction, concomitantly with weekly intravenous injection docetaxel 30 mg and cisplatin 50 mg based chemotherapy (total 5 cycles). Then, she was given three fractions of intracavitary brachytherapy, 6 Gy each on a weekly basis. After that, the patient was on regular monthly follow-up. There was no significant residual or recurrent disease for the next 6 months. In February 2018, she complained of headache which was involving the whole brain, throbbing type, severe, continuous, and not relieving by medication. Contrast-enhanced magnetic resonance imaging brain was done which revealed multiple metastatic lesions in bilateral parietal, temporal lobes, and cerebellum. She was treated with palliative whole-brain radiation therapy (WBRT) 800 cGy single session. The patient was symptomatically better after 1-month of WBRT and was given one more single session WBRT 800 cGy. After that, the patient’s condition deteriorated and she expired in April 2018.
Discussion: Carcinoma cervix is the seventh most common cancer among all sexes, with approximately 3.2% incidence per year worldwide. It is the fourth most common cancer in females in respect of both incidence (6.6%) and mortality (7.5%) out of all neoplasm worldwide. Cervical cancer typically spreads to pelvic and para-aortic nodes via lymphatic system. Distant metastasis is through hematogenous pathway commonly to lungs (most common), liver, bone, and supraclavicular lymph nodes. Metastasis to brain in carcinoma cervix is an unusual presentation and is rare. Various studies and case reports have shown that patients diagnosed with brain metastasis in carcinoma cervix do not demonstrate favorable outcomes and carries poor prognosis. Surgery and stereotactic radiosurgery are preferred approach if there is single metastatic brain lesion. In case of multiple metastatic brain lesions, radiation therapy is preferred approach followed by chemotherapy in systemic disease. In our case, after radical treatment, there was complete locoregional response and the patient was disease-free for 6 months. Palliative WBRT to metastatic brain lesions led to symptomatic relief and improved quality of life.
Conclusion: Brain metastasis in carcinoma cervix is a rare occurrence with only approximately 100 reported cases of intracranial metastasis of carcinoma cervix in the literature. There is no standard treatment for this condition, and the goal of treatment is usually providing symptomatic relief and improving quality of life. It demonstrates unfavorable outcome and carries poor prognosis with reported median survival of 2–8 months. Therefore, future efforts through large prospective randomized trial are warranted to better describe the clinical presentation and identify more effective treatment plans.
Keywords: Carcinoma cervix, cerebellum, cisplatin, concomitant, docetaxel, external beam radiotherapy, FIGO stage, intracavitary brachytherapy, metastasis, moderately differentiated squamous cell carcinoma, palliative, parametrium, parietal lobe, pelvic wall, postmenopausal, radical, recurrent, residual, single session, stereotactic radiosurgery, temporal lobe, whole brain radiotherapy.
Impact of rotational intensity-modulated radiation therapy-based tumor bed boost for medulloblastoma on doses for hippocampus, cochlea, and pituitary
Naziba Khondekar; Tata Memorial Centre, Mumbai, Maharashtra, India
Aims and Objectives: We hereby report the doses received by the organs at risk (OARs,: hippocampus [H], cochlea [C], and pituitary [P]) and their relation to the distance from planning target volume (PTV)-tumor-bed boost (PTV-TBB) and volume of PTV-TBB (PTV-TBB-vol) in pediatric medulloblastoma patients treated with rotational intensity-modulated radiation therapy (IMRT)-based tumor bed boost (I-TBB) and comparison with conventional bilateral portals (CBPs).
Methods: Thirty consecutive patients treated with conventional supine craniospinal irradiation and I-TBB in 2018 were reviewed for mean doses (Dmean) to OARs, PTV-TBB-vol, and the minimum distance (dmin) between the edge of PTV-TBB and OARs. Furthermore, posterior fossa volume (PTV-PFB-vol) was estimated and CBPs were used to estimate the OAR Dmean. Other than descriptive statistics, correlation of Dmean with dmin and PTV-TBB-Vol was evaluated using Spearman’s correlation coefficient. Dmean for respective OARs in IMRT was compared with Dmean by CBP using paired t-test.
Results: There was a significant difference in mean PTV-TBB-vol (cc) + standard deviation (SD) and PTV-PFB-vol (cc) + SD for 17 standard-risk (SR) and 13 high-risk (HR) patients, (133 + 57 versus 309 + 33; P < 0.001 and 205 + 110 versus 325 + 34; P < 0.001, respectively). The mean volumes (cc) of right H, left H, right C, and left C and P were 2 (0.9), 2.1 (0.9), 0.12 (0.04), 0.12 (0.04), and 0.2 (0.1), respectively. There was a significant difference (P < 0.001) in mean Dmean + SD for SR and HR in I-TBB versus CBP (SR: right_H [12.7 + 5.9 vs. 30.4 + 0.3], left_H [14.9 + 7.8 vs. 30.4 + 0.3], right_C [11 + 5.3 vs. 31 + 0.3], left_C [13.5 + 7.8 vs. 31 + 0.3], P [9.7 + 3.6 vs. 27.3 + 3.4]; HR: right_H [11.5 + 5.5 vs. 19.4 + 1.5], left_H [10.9 + 5.5 vs. 19.3 + 1.5], right_C [12 + 6 vs. 19.5 + 1.6], left_C [9.9 + 5.2 vs. 19.5 + 1.6], P [8.9 + 5.5 vs. 17.7 + 2.8]). A significant negative correlation between Dmean C, P and H with dmin (p=0.01) and significant positive correlation of PTV-TBB-vol with Dmean (right and left H [P = 0.01], right_C [P = 0.05], left_C [P = 0.01], and P [P = 0.05]) was observed.
Conclusion: I-TBB leads to a significant reduction in doses to OARs as compared to the conventional portals and may help in reducing long-term morbidity.
Keywords: Conventional bilateral portal, intensity-modulated radiation therapy-based tumor bed boost, mean dose, minimum distance, planning target volume-tumor-bed boost, posterior fossa volume, volume of planning target volume-tumor-bed boost.
Collision tumors of sella: our experience
Satya Shiva Munjal; PGIMER and RMC Hospital, Chandigarh, India
The concomitant presence of a pituitary adenoma with a second sellar lesion in patients operated upon for pituitary adenoma is an uncommon entity. A great variety of lesions have been reported coexisting with pituitary adenomas. We present our series of three collision sellar lesions. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions.
Keywords: Adenoma, collision tumors, nonadenomatous sellar lesions, pituitary
Microcystic meningioma: A diagnostic dilemma during intraoperative squash smear study
Rahul Karode, Sukhpreet Kaur1, V Hanni2; BMHRC, 1Memorial Hospital, 2Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
Objective: To find out the features that favor and those against the diagnosis of microcystic meningioma (MM) at the time of intraoperative diagnosis on squash smears.
Materials and Methods: Detailed radiological findings, crush smear preparations, and histological slides of all the cases of MM that were received in the Department of Pathology, BMHRC, were reviewed.
Results/Discussion: There were four cases of MM. In all the cases intraoperative squash smears were made. There were two males and two females and the age ranges between 35 and 75 years. All the tumors were dura based and on magnetic resonance scanning showed high-signal intensity on T2-weighted images and low-signal intensity on T1-weighted images. The crush smear preparation showed mild-to-moderate cellularity with nuclear pleomorphism; in one case, pink globules were noted. Whorling, psammoma bodies, mitosis, necrosis, and vascular proliferation were absent. MMs are known to be unusual morphologic variation of meningioma. These tumors are also described as myxomatous, humid, or vacuolated meningioma. Common differentials are high-grade glial tumors and metastatic tumors because in all of these we can get solid cystic appearance radiologically.
Conclusion: MMs are rare and distinct morphological variant of meningioma which may pose difficulty while diagnosing it intraoperatively as they have unusual imaging characteristics and microscopic features on crush cytology. To avoid misdiagnosis, we must look for the absence of high cellularity, atypical mitoses, vascular proliferation, and necrosis.
Keywords: Crush, meningioma, microcystic
Radiomics-Based Discrimination of supratentorial ependymoma and glioblastoma
Jitendra Saini; NIMHANS, Bengaluru, Karnataka, India
Purpose: The current study aims to discriminate two important categories of supratentorial brain tumors, namely glioblastomas and ependymoma using routine clinical scans and radiomics. The discrimination is important as the natural history and treatment strategy for the two types of tumor differ significantly.
Methods: Clinical image data – magnetic resonance imaging (MRI) scans of 26 patients with Grade IV Glioblastoma and 26 patients with supratentorial ependymoma were used for this study. These patients were scanned on a 3T MRI scanner. Each patient was scanned for four different contrasts – T1ce, FLAIR, T1, and T2, i.e., a total of 104 images for each type of tumor. T1ce scans were obtained as three-dimensional (3D) isotropic scans whereas the other contrasts were axial 2D scans. We used affine registration to co-register each subject’s scans to their T1ce MRI scan, which had a higher spatial resolution – usually 1 mm × 1 mm × 1mm. Manual annotation of tumor regions of interest was performed on FLAIR volumes to include edema; the segmentations were cross-checked on T2 and T1ce images. Preprocessing involved N4 Bias Field Correction. Radiomics feature extraction was performed using PyRadiomics1 library. Radiomic features include shape-based features, statistical features, and gray-level co-occurrence matrix (GLCM). Various filters such as wavelet filter and Laplacian of Gaussian filter were applied to extract more features from the images. These features were normalized and fed to a Random Forest Classifier and an XGBoost Classifier. In both cases, 15 glioblastoma patients and 15 ependymoma patients were used for training and the remaining 11 of each were used for testing. A 5-fold cross-validation was performed to evaluate the models.
Results: Figure 1a shows the comparison of the two classifiers over 5 folds of cross-validation. The Random Forest Classifier proved to be superior with an accuracy of 75% ± 6% and mean area under regions of characteristic curve (AUC-ROC) of 82%. However, the XGBoost Classifier provided a mean accuracy of 74% ± 15% and mean AUC-ROC of 75% for discriminating glioblastoma multiforme from supratentorial ependymomas.
Discussion: In Figure 2a, seven of the top ten important features are obtained from T2 contrast, and in Figure 2b, five out of ten features are from T1 contrast. Indicating that, of the total four contrasts used for the study, T2 contrast is most important for classification followed by T1 contrast. Furthermore, for Random Forest classifier, four out of the most important five features are GLCM based features and the other feature is first-order statistics-based feature – first-order variance. A similar trend is observed in XGBoost where three out five features are GLCM based and one is based on gray-level run length matrix and the other is based on first-order statistics. The difference between mean values of some important features is shown in Figure 3. Based on that, GLCM IMC2 and IDM – which indicate texture complexity and homogeneity – are greater in ependymoma. However, first-order statistical variance is greater in Grade IV tumors.
- van Griethuysen JJ, Fedorov A, Parmar C, Hosny A, Aucoin N, Narayan V, et al. Computational radiomics system to decode the radiographic phenotype. Cancer Res 2017;77:e104-7.
Identification of molecular regulatory networks in glioma subtypes
Raja Anand; Department of Research, BMHRC, Bhopal, Madhya Pradesh, India
Introduction: Despite decennium of intense research and treatments in glioma, patients still have a poor prognosis with a progression-free survival (PFS) of 7–8 months, a median survival (MS) of 14–16 months, and a 5-year overall survival (OS) of 9.8%. The current overall focus is still on “survival,” not on “survival with preserved quality of life.” In addition, the World Health Organization (WHO) classification (2016) of central nervous system (CNS) tumors raises the need for characterizing glioma subtypes at a molecular level as opposed to only histological diagnosis.
Aim: Molecular regulators play many essential functions and hold promise, their complete potential in glioma-specific inflammation, growth suppression, proliferation, cell death, metastasis, and resistance is unexplored, and there is a lack of prospective marker validation studies. To understand better the complexities in glioma biology and identify novel drug targets, it is of paramount importance to delineate the complete interactomics of the molecular regulators in each subtype.
Methods: WHO (2016) guidelines are used to catalog molecular regulators that are specific for glioma subtypes such as diffuse astrocytic and oligodendroglial tumors (WHO staging categories from 9400/3 to 9382/3), other astrocytic tumors (9421/1 to 9424/2), ependymal tumors (9383/1 to 9392/3), and other gliomas (9444/1 to 9430/3). The following key terms were used in PubMed, Medline, and Cochrane databases: “Regulators” and “Glioma subtypes” (arose 33 articles), “Astrocytoma” (480 articles), “Astroblastoma” (1336 articles), “Astrocytic Diffuse Glioma” (4 articles), “Angiocentric Glioma” (1 article), “Cardioid Glioma” (0 article), “Ependymoma” (7 articles) and “Ependymal” (46 articles), “Glioblastoma” (681 articles), “Midline Glioma” (1 article), “Oligodendroglioma” (11 articles), “Oligodendrocytoma” (0 article), “Oligoastrocytoma” (11 articles). Each of these subtypes were cross-searched with the following 11 cellular functional term – tumor related “Inflammation,” growth suppression (“Tumor Suppressors”), “Proliferation,” “Cell Death,” “Apoptosis” and “Autophagy,” “Metastasis” and “Resistance,” “Replication” and “Cancer Stem Cells” (CSCs), and recurrence. Articles from the years 2010 to 2019 were utilized. Only articles in English were used. Reviews and in vitro studies were excluded.
Results: A total of 1446 studies were analyzed. We cataloged our findings molecular regulators (nucleic acid and proteins) and clinical relevance with each corresponding distinct subtypes. Among the catalog, regulators include receptor tyrosine kinases, novel relationship between WHO recommended IDH1/2 mutations and expression, microRNA and long-noncoding RNA, novel interactions between stemness transcriptional regulator and microRNA axis. Apart from aiding in the classification of molecular subtype, some regulators also serve as novel additional prognostic markers, which may represent a potential novel target to treat patients suffering from the challenging glial tumor.
Conclusion: To validate the regulatory molecules and increase the clinical utility, Clinical Trials (US), Pathways and Interactomics Databases (Human Cancer Metastasis Database, Molecular Signature Database, CO-Regulation Database, Molecular Brain Neoplasia Data [US], Human Gene-Disease Associations Database, Oncogenes, and Tumour Suppressors Databases) were utilized. The precise mechanisms based “connectome” poster provides insights into understand and uncover Hallmark characteristic molecular regulators and their interaction in distinct glioma subtypes and advance personalized medicine and enhance “survival with preserved quality of life.”
Keywords: Diagnostic markers, glioma subtypes, hallmark of cancer, molecular regulators, prognostic markers, targeted therapy, World Health Organization
To study risk of glioma with the use of mobile phone
Prateek Malpani, I D Chaurasia1; Departments of Surgery and 1Neurosurgery, GMC, Bhopal, Madhya Pradesh, India
Introduction: Long-term use of both mobile and cordless phones is associated with an increased risk for glioma. The new study shows that the risk for glioma was tripled among those using a wireless phone for more than 25 years.
Aims and Objectives: To conduct a meta-analysis of available epidemiologic studies of glioma and mobile phone use.
Materials and Methods: The study took place in the GMC, Bhopal. Patients aged 18–69 years living in the study area and had the first diagnosis with a glioma.
Results: [Table 1].
Discussion: Data were taken from the Hardell Research Group and the International Cancer Research Department. Mobile phone use was associated with increased odds of low-grade glioma. WHO Grade II glioma has long latency period and high-grade disease has short latency period.
Conclusion: Long-term mobile phone use may be associated with an increased risk of glioma. There was an association between mobile phone use and low-grade glioma in regular use or long-term use.
- Marumoto T, Saya H. Molecular biology of glioma. Adv Exp Med Biol 2012;746:2-11.
- Hardell L, Carlberg M, Söderqvist F, Mild KH, Morgan LL. Long-term use of cellular phones and brain tumours: Increased risk associated with use for > or =10 years. Occup Environ Med 2007;64:626-32.
Life expectancy with glioblastoma
Neeraj Mane, I D Chaurasia; Department of Surgery, GMC, Bhopal, Madhya Pradesh, India
Introduction: Glioblastoma is the most common type of malignant brain tumor in adults. Treatments help to ease symptoms. The median survival time with glioblastoma is 15 months.
Materials and Methods: The study included patient referred to GMC, Bhopal, from January 2018 to June 2019. For statistical analysis, we used SPSS software package.
Results: [Table 1] and [Table 2].
Discussion: Techniques associated with functional NMR use of substances such as 5-aminolevulinic acid hydrochloride, which mark and thus make tumoral tissue easier to identify during operation. Therapy was evolved by the introduction of monoclonal chemotherapy and temozolomide treatment combined with radiotherapy.
- Available from: https://www.healthline.com/health/brain-tumor/glioblastomatypes.
- Stark AM, van de Bergh J, Hedderich J, Mehdorn HM, Nabavi A. Glioblastoma: Clinical characteristics, prognostic factors and survival in 492 patients. Clin Neurol Neurosurg 2012;114:840-5.
- Kubben PL, ter Meulen KJ, Schijns OE, ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H. Intraoperative MRI-guided resection of glioblastoma multiforme: A systematic review. Lancet Oncol 2011;12:1062-70.
- Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: A randomised controlled multicentre phase III trial. Lancet Oncol 2006;7:392-401.
- McLendon RE, Halperin EC. Is the long-term survival of patients with intracranial glioblastoma multiforme overstated? Cancer 2003;98:1745-8.
[Table 1], [Table 2], [Table 3]
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