A Unique Case Report of Infant-Type Hemispheric Glioma (Gliosarcoma Subtype) with TPR-NTRK1 Fusion Treated with Larotrectinib.

Herein, we present a rare case of a nine-month-old boy diagnosed with infant-type hemispheric glioma (gliosarcoma subtype) at the left frontal lobe. Following subtotal resection, the patient started chemotherapy with the BABY POG protocol. We describe the clinical diagnosis, histological characteristics, radiological features, molecular aspects, and management of this tumor. A comprehensive molecular analysis on the tumor tissue showed a TPR-NTRK1 gene fusion. The patient was treated with a TRK inhibitor, larotrectinib, and exhibited a stable disease with residual lesion following 8 months of target therapy. The present study is the first report of an infantile gliosarcoma harboring NTRK1 rearrangement treated with larotrectinib.

Meningioma of the Fourth Ventricle: Literature Review

Meningiomas are among the most common central nervous system tumors, with an incidence that ranges from 15% to 40% of intracranial tumors. Of these, only 0.5% to 3% are intraventricular, and the rarest of them occurs in the fourth ventricle. Fourth-ventricle meningiomas originate generally fromthe choroid plexus and have no dural adhesions. Most often, they manifest in young patients, around 41 years of age, with a possible predominance in females, through intracranial hypertension and cerebellar syndromes. The treatment consists of surgical resection, which commonly presents good results due to the characteristics of the tumor. So, for better preoperative planning, the radiological differentiation of the most frequent tumors in this location is important. Themost common histologic subtypes are fibroblastic and meningothelial, both grade I according to the World Health Organization (WHO), although there are reports of tumors of grades II and III. We report a case ofmeningioma of the fourth ventricle operated in our institution, and we have conducted a literature review, through which we found that 57 cases have been reported so far, with the first one reported in 1938.

Brachial plexus schwannoma mimicking advanced breast carcinoma.

BACKGROUND: Schwannoma is an extremely rare benign tumour of the peripheral nervous system; its association with breast cancer is sporadic, and its association with the brachial plexus is extremely rare. CASE DESCRIPTION: The authors report a case of a patient with breast cancer associated with nodulation in the left supraclavicular fossa, and due to the clinical and radiological features, it was considered metastatic lymph node disease. The patient underwent neoadjuvant chemotherapy, with partial response of the breast. Surgical treatment included resection of the supraclavicular nodule, which was found to be a supraclavicular fossa schwannoma. The correct diagnosis, influences the radiotherapeutic planning. The unusual presentation led to diagnostic confusion in the present case, a fact that changed the breast treatment. CONCLUSION: The best of our knowledge it is the third description of brachial plexus schwannoma associated with breast cancer and the first with a synchronous association. The knowledge of this pathology and its potential to alter treatment justify the reporting of the present case.

Lack of KBTBD4 Mutations in Molecularly Classified Brazilian Medulloblastomas.

Medulloblastoma is the most frequent malignant brain tumor in children, representing 20% of all childhood brain tumors. Currently, medulloblastomas are molecularly classified in 4 subgroups that are associated with distinctive clinicopathological features. KBTBD4 mutations were recently described in a subset of MBGRP3 and MBGRP4 medulloblastomas subgroups. However, no other studies reported KBTBD4 mutations in medulloblastomas. Thus, our aim was to investigate KBTBD4 mutations in a Brazilian series of medulloblastoma. We evaluated 128 medulloblastoma patients molecularly classified from 4 Brazilian reference centers. DNA from formalin-fixed, paraffin-embedded samples was screened for KBTBD4 hotspot mutations by Sanger sequencing. Most of the patients were male, average age was 16.5 years old and average overall survival was 55.9 months. The predominant histological subtype was the classic subtype, followed by nodular/desmoplastic, and the predominant medulloblastoma molecular subtype was the MBSHH subgroup (46%), followed by MBGRP3 and MBGRP4 (19%/each), and MBWNT (16%). Among the 128 samples, 111 were successfully sequenced. No KBTBD4 mutations were identified in 111 samples. Our findings suggest that KBTBD4 mutations are uncommon in Brazilian MBGRP3 and MBGRP4 medulloblastomas subgroups. Further studies in a larger series of MBGRP3 and MBGRP4 medulloblastomas are warranted to better assess role of KBTBD4 mutations.

Tratamento intracístico de craniofaringioma com interferon alfa: relato de caso / Intracystic Treatment of Craniopharyngiomas with Interferon Alpha: A Case Report

Craniofaringiomas são tumores histologicamante benignos, extrínsecos ao parênquima cerebral. Visando ao controle da doença, preconiza-se, como tratamento padrão, a tentativa de ressecção completa, meticulosamente planejada com vistas a preservar as funções habituais do paciente. Outras formas de terapias podem ser utilizadas como alternativas ou comoadjuvantes à cirurgia. Considerando-se quemuitos craniofaringiomas apresentam componente cístico, a utilização de cateteres posicionados no interior do lúmen cístico para aplicação de agentes quimioterapêuticos, como o interferon alfa (IFNa), tem-se mostrado promissora. Administração intratumoral de 3 milhões de unidades de IFNa em dias alternados, totalizando doze ciclos, tem sido utilizada empiricamente. Relatamos o caso de uma paciente de 12 anos de idade, com diagnóstico de craniofaringioma de predomínio cístico, tratada no Hospital de Câncer de Barretos (HCB) utilizando a aplicação de IFNa semanalmente, que apresentou evolução favorável.

Craniopharyngiomas are histologicaly benign tumors, whose ideal brain treatment requires its complete surgical resection, while preserving most of the usual functions of the patient. Due to the complexity of the surgical procedure, related to location (surrounded by paraselar structures), it is often difficult to achieve its complete resection. Thus, alternative therapies have been reported, including the use of intracystic IFNa on alternate days. We report the case of a 12 year-old female, diagnosed with cystic craniopharyngioma, weekly treated with intracystic IFNa, for a total of 12 cycles, with favorable outcome.

Orientação da atenção em pacientes portadores de tumor do lobo parietal / Orientation of attention in patients with parietal lobe tumor

Atenção consiste em conjunto de processos que leva à seleção ou priorização no processamento de certas categorias de informação, em detrimento de outras, possibilitando um processamento mais eficiente do que seria possível caso o sistema nervoso processasse os estímulos presentes no ambiente simultaneamente. A atenção participa da maioria das funções cognitivas humanas. Depende, portanto, de região cerebral com privilégios anátomo-fisiológicos, como o lobo parietal, cujo padrão de conectividade (áreas unimodais, córtex pré-motor, colículo superior, giro cingulado, giro parahipocampal, insula, córtex orbitofrontal) possibilita a integração sensório-motora e cognitiva necessária à atenção. Desde o início da década de 80 estudos sobre o lobo parietal tem sugerido uma reavaliação de suas funções, modificando a percepção comum de que esteja relacionado exclusivamente a desempenhar funções espaciais, incluindo uma suposta especialização do lobo parietal direito na distribuição da atenção no espaço. No entanto, a base fisiológica para a especialização do lobo parietal na orientação atencional é mal compreendida pelas seguintes razões: 1- lesão unilateral do lobo parietal direito determina deficiência de processamento atencional em relação ao hemiespaço contralateral, e raramente ocorre após lesão do lobo parietal esquerdo; 2- o processamento das informações pelo sistema visual humano varia sensivelmente em relação aos campos visuais, e a metodologia dos testes atencionais tradicionais não considera que o desempenho dos voluntários pode ser limitado pela visibilidade dos estímulos; a localização dos estímulos tem sido avaliada independentemente da disposição dos alvos no campo visual. Nossa proposta é padronizar as condições de estimulação no teste de Posner para orientação da atenção, considerando os limiares específicos de cada voluntário e avaliar as deficiências de orientação da atenção endógena e exógena nos planos horizontal, vertical e diagonal, em (...)

... pacientes portadores de dano nos lobos parietais direito e esquerdo, secundário a neoplasia, e compará-las entre si e com voluntários saudáveis. Desse modo poderíamos contribuir para o conhecimento sobre as bases neurais da atenção e para o desenvolvimento de estratégias eficazes e individualizadas de reabilitação

Attention consists of processes that lead to selection or prioritization in processing certain categories of information over others, allowing more efficient processing than would be possible if the nervous system had to process the stimuli in the environment simultaneously. Attention integrates most of human cognitive functions. Therefore it depends on specific brain regions with anatomical and physiological privileges, such as the parietal lobe, which pattern of connectivity (unimodal areas, premotor cortex, superior colliculus, cingulate gyrus, parahippocampal gyrus, insula, orbitofrontal cortex) enables sensorimotor and cognitive integration required for attention. Since early of 1980´s the common perception that parietal lobe is related solely to performance of spatial tasks, including a supposed specialization of the right parietal lobe for the distribution of attention in space is changing. The physiological basis for the specialization of the parietal lobe in orienting of attention is poorly understood for the following reasons: 1 - unilateral lesion of the right parietal lobe attentional determines disability in attention processing of information which comes from the contralateral space, and rarely occurs after injury of the left parietal lobe 2 - the processing of information by the human visual system varies considerably in relation to visual fields, and traditional attentional testing methodology does not consider that performance of the volunteers may be limited by the visibility of the stimuli; the location of the stimuli has been evaluated independently on the targets position in the visual field. Our proposal is to standardize the conditions of stimulation in the Posner test for orienting of attention, considering the specific visual thresholds of each subject and evaluate exogenous and endogenous orientation of attention deficiencies in horizontal, (...)

... vertical and diagonal plans, in patients with damage to the right and left parietal lobes, secondary to brain tumor, and compare them among themselves and with healthy volunteers. Thereby this approach could contribute for the knowledge about the neural bases of attention and therefore help to develop effective strategies for rehabilitation