RESUMO
The most common mixed glioma encountered in routine surgical practice is oligoastrocytoma (OA); however, its is currently considered a vanishing entity. The 2016 classification of the World Health Organization (WHO) discourages the diagnosis of tumors as mixed glioma. The recommendations are that diffuse gliomas, including those withmixed or ambiguous histological features, should be subjected tomolecular testing. Dual-genotype OAs are not yet a distinct entity or variant in the classification. We report a case ofmixed glioma: a pleomorphic xanthoastrocytoma (PXA)mixed with an oligodendroglioma. The immunohistochemistry (IHC) pattern of isocitrate dehydrogenase 1 (IDH1) negativity with retained nuclear expression of the alpha-thalassemia x-linked intellectual disability syndrome (ATRX) protein, and 1p19q co-deletion negativity in both the components enabled its identification as a mixed glioma rather than a collision tumor. To the best of our knowledge, the case herein presented is the fourth case of PXA with oligodendroglioma. Out of the other three reported cases, only one was of a collision tumor with a dual genotype, and the other two showed similar molecular signatures in both components. The present article discusses the histological, immunohistochemical and molecular features of the aforementioned case.
Assuntos
Humanos , Masculino , Adulto , Oligodendroglioma/cirurgia , Astrocitoma/cirurgia , Neoplasias Encefálicas/terapia , Neoplasias Primárias Múltiplas/cirurgia , Oligodendroglioma/patologia , Oligodendroglioma/diagnóstico por imagem , Astrocitoma/patologia , Lobo Temporal/cirurgia , Aconitato Hidratase/genética , Cromossomos Humanos Par 1 , Cromossomos Humanos Par 19 , Deleção Cromossômica , Telomerase/genética , Craniotomia/métodosRESUMO
BACKGROUND: Management of WHO grade II gliomas (LGG) can include a combination of observation, surgery, radiotherapy (RT), and chemotherapy; however, optimal management remains unclear in regards to RT. OBJECTIVE: The current study seeks to investigate the usage of RT in LGG and its effect on survival outcomes. METHODS: Patients with diagnosis codes specific for LGG were queried from the National Cancer Database (NCDB) during the years 2004-2016. Kaplan-Meier curves with log-rank testing, univariate and multivariate Cox regression analysis, and comparisons of estimated 3- and 7-year survival were performed to investigate the effect of RT on overall survival. RESULTS: 19,382 patients with LGG were identified with histologically confirmed disease. Kaplan-Meier testing demonstrated RT impacted survival in patients undergoing biopsy or no surgery (p < 0.0001), no chemotherapy (p < 0.0001), and in regimens with early RT (p < 0.0001) and high-dose RT (p < 0.0001). Cox multivariate regression demonstrated RT and age less than 40 (HR 0.93, 95% CI 0.89-0.97, p = 0.001), no chemotherapy (HR 0.82, 95% CI 0.77-0.87, p < 0.001), and astrocytoma histology (HR 0.72, 95% CI 0.66-0.79, p < 0.001) were associated with improved survival. 3-year survival of RT versus non-RT groups showed increased survival rates for age less than 40 years (+ 5.7%, p < 0.0001), no surgery or biopsy (+ 8.1%, p < 0.0001), no chemotherapy (+ 10.3%, p < 0.0001), mixed glioma (+ 6.7%, p < 0.0001), astrocytoma (+ 7.1%, p < 0.0001), and in regimens with early RT (+ 7.6%, p < 0.0001) and high-dose RT (+ 4.7%, p < 0.0001). CONCLUSION: This nationwide analysis of LGG patients found that RT was associated with improved survival outcomes in patients less than 40 years of age, with histology subtypes of astrocytoma and mixed glioma, undergoing biopsy or no surgery, and in regimens with early RT and high-dose RT.
Assuntos
Astrocitoma/radioterapia , Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Oligodendroglioma/radioterapia , Adulto , Fatores Etários , Astrocitoma/mortalidade , Astrocitoma/patologia , Astrocitoma/cirurgia , Biópsia , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/mortalidade , Glioma/patologia , Glioma/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Gradação de Tumores , Oligodendroglioma/mortalidade , Oligodendroglioma/patologia , Oligodendroglioma/cirurgia , Análise de Regressão , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Anaplastic oligodendrogliomas (AOs) correspond to 23% of all oligodendrogliomas. They correspond to a tumor with malignant histological characteristics, focal or diffuse, associated with a worse prognosis. In the present case report, we describe the case of a 30-year-old female submitted to resection of a right parietal lesion whose histology showed to be an AO. She underwent complementary treatment with chemotherapy and radiotherapy according to the Roger Stupp protocol. Four years after the initial diagnosis, there was tumor recurrence within the superior sagittal sinus, with no evidence of recurrence elsewhere. In the literature, we have found no similar published case reinforcing the rarity of this condition.
Assuntos
Humanos , Feminino , Adulto , Oligodendroglioma/cirurgia , Oligodendroglioma/complicações , Oligodendroglioma/radioterapia , Oligodendroglioma/diagnóstico por imagem , Seio Sagital Superior/anormalidadesRESUMO
Ovarian mature cystic teratoma (OMCT) is an ovarian benign neoplasm with excellent prognosis presenting components of the three germinal layers. However, transformation into a malignant neoplasm is a rare event (so-called somatic transformation). In most of the cases, the malignant component expresses as epidermoid carcinoma, but occasionally central nervous system tumors occur. Some of the previously reported tumors are astrocytoma, glioblastoma, and ependymoma. Somatic transformation of OMCT into an oligodendroglioma is exceptional. We report a 19-year-old female with a left OMCT with an area of oligonedroglial cells proliferation characterized by immunohistochemical studies with positivity for GFAP and S100, with a low Ki67 index (5%). Additionally, electron microscopy revealed oligodendrocytes with parallel bundles of cytoplasmic intermediate filaments, confirming the oligodendroglial nature of the proliferation. The patient was treated only with left oophorectomy, and three and half years after surgery, there is no evidence of disease.
Assuntos
Biomarcadores Tumorais/análise , Proliferação de Células , Imuno-Histoquímica , Microscopia Eletrônica , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Oligodendroglioma/diagnóstico , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Feminino , Humanos , Neoplasias Císticas, Mucinosas e Serosas/química , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Neoplasias Císticas, Mucinosas e Serosas/ultraestrutura , Oligodendroglioma/química , Oligodendroglioma/cirurgia , Oligodendroglioma/ultraestrutura , Neoplasias Ovarianas/química , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/ultraestrutura , Ovariectomia , Valor Preditivo dos Testes , Salpingectomia , Teratoma/química , Teratoma/cirurgia , Teratoma/ultraestrutura , Resultado do Tratamento , Adulto JovemRESUMO
Low-grade supratentorial astrocytomas and oligodendrogliomas in adults are uncommon tumors of the central nervous system. We analyzed retrospectively 23 patients with this type of neoplasia, who were operated on between 1986 and 2002. There were no post-operative deaths. The survival rate at 5 and 10 years post-surgery for the entire sample was 67 and 30% respectively, similar to other outcomes. With 14 patients we achieved a complete removal of the lesion (60.8%) and with 9 (39.2%) partial removal of the tumor. In the sub-group which underwent total resection of the tumor, 89% survived 5 years and 45% attained 10 years of survival, in contrast with the sub-group that underwent partial removal in which only 35% attained 5 years of survival and none 10 years. Due to the deleterious effects of radiation therapy, we preferred to prescribe it only in cases of tumor recurrence.
Assuntos
Glioma/cirurgia , Neoplasias Supratentoriais/cirurgia , Adolescente , Adulto , Idoso , Astrocitoma/mortalidade , Astrocitoma/cirurgia , Intervalo Livre de Doença , Feminino , Glioma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Oligodendroglioma/mortalidade , Oligodendroglioma/cirurgia , Estudos Retrospectivos , Neoplasias Supratentoriais/mortalidadeRESUMO
Os astrocitomas e oligodendrogliomas supratentoriais dos adultos são tumores infrequentes. Analisamos retrospectivamente 23 pacientes com este tipo de neoplasia que foram operados entre 1986 e 2002. Não ocorreu nenhum óbito no pós-operatório. A sobrevida de 5 e 10 anos de todo o grupo foi 67 e 30 por cento respectivamente, semelhante a outras experiências. Em 14 pacientes obtivemos a remoção completa da lesão (60,8 por cento) e em 9 (39,2 por cento) ocorreu remoção parcial do tumor. No subgrupo da ressecção total do tumor, 89 por cento sobreviveram 5 anos e 45 por cento alcançaram 10 anos de sobrevida, em contraste com o subgrupo da remoção parcial em que somente 35 por cento alcançaram os 5 anos de sobrevida e nenhum, 10 anos. Devido aos efeitos deletérios da radioterapia, nós preferimos prescrevê-la apenas nos casos de recorrência tumoral.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Glioma/cirurgia , Neoplasias Supratentoriais/cirurgia , Astrocitoma/diagnóstico , Astrocitoma/cirurgia , Intervalo Livre de Doença , Glioma/diagnóstico , Imageamento por Ressonância Magnética , Oligodendroglioma/diagnóstico , Oligodendroglioma/cirurgia , Estudos Retrospectivos , Neoplasias Supratentoriais/diagnósticoRESUMO
Focal somatosensory epileptic seizures ipsilateral to a brain tumor is reported and the literature reviewed. It is an exceptional occurrence, having been described only six cases, with several mechanisms being proposed. The proximity of the lesions with the low cerebral convexity (perisylvian) suggests the compromising of the secondary somatosensorial area, seeming to prove the experimental observation of somatosensorial crises originating in this area.
Assuntos
Neoplasias Encefálicas/complicações , Epilepsias Parciais/etiologia , Oligodendroglioma/complicações , Córtex Somatossensorial , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Oligodendroglioma/diagnóstico , Oligodendroglioma/cirurgiaRESUMO
Oligodendrogliomas usually arise in the cerebral hemispheres, less frequently they are found in the cerebellar hemispheres and very rarely they adopt an intraventricular location. The authors describe two cases of intraventricular oligodendroglioma. Case No. 1: 18-year old woman with a clinical history of headache, vertigo and dizziness of 6 months duration. Central Nervous System imaging revealed a right lateral ventricle tumor. Case No. 2: 38 year old man with a chief complaint of positional headache and visual impairment. C.N.S. imaging showed a third ventricular lesion. The medical literature was reviewed and theories on the genesis of this peculiar location are offered.
Assuntos
Neoplasias do Ventrículo Cerebral , Oligodendroglioma , Adolescente , Adulto , Neoplasias do Ventrículo Cerebral/diagnóstico , Neoplasias do Ventrículo Cerebral/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Oligodendroglioma/diagnóstico , Oligodendroglioma/cirurgia , PrognósticoRESUMO
A case of a patient operated on twice for a temporoparietal anaplastic oligondendroglioma, followed by radiotherapy, is reported. Although no intracranial recurrence has happened, a biopsyproven extracranial cervical lymphnode metastasis was diagnosed 15 months later. Surgical manipulation of the primary lesion by lymphatic and/or blood vessel invasion seem to be the main suspected factors in the development of CNS tumors metastasis in the head and neck region.
Assuntos
Humanos , Masculino , Adulto , Neoplasias Encefálicas/patologia , Linfonodos/patologia , Metástase Linfática , Neoplasias de Cabeça e Pescoço/secundário , Oligodendroglioma/patologia , Lobo Parietal/patologia , Lobo Temporal/patologia , Anaplasia , Neoplasias Encefálicas/cirurgia , Pescoço , Oligodendroglioma/cirurgia , Lobo Parietal/cirurgia , Lobo Temporal/cirurgiaRESUMO
Säo poucos os estudos sobre gliomas <