RESUMO
Glioblastoma (GBM) are high-grade gliomas that severely impact on overall survival (OS). GBM cell motility and the breakdown of the blood-brain barrier could favor GBM cell communication with the systemic circulation. In spite of this, extracranial GBM metastases are rare. Here, we describe two YKL-40-positive GBM patients with extra-CNS (central nervous system) metastases, and we present a meta-analysis of 94 cases. The analysis concluded that extra-CNS metastases occurred 8.5 months after first GBM diagnosis and OS was 12 months; surgical GBM excision was associated at a longer interval to extra-CNS metastasis than biopsy only, and even longer if followed by radiotherapy and chemotherapy. Both our case reports were adult males who developed extra-CNS, YKL-40-positive metastases at lymph nodes, lung and subcutaneous sites, after 86 and 24 months from initial diagnosis of GBM. At first GBM local recurrence, they were treated with bevacizumab (BV), an anti-vascular endothelial growth factor antibody. They died after 4 and 1 month from the occurrence of metastases. Both cases expressed YKL-40 and lacked EGFR amplification, suggesting a mesenchymal phenotype, and maintained such profile at extra-CNS recurrence; they did not show MGMT promoter methylation, IDH1/2 mutations, or c-Met upregulation. Our two cases and the meta-analysis support the idea that prolonged survival of GBM patients increases the probability of GBM cells shedding to lymphatic and hematic system. Interestingly, the present two cases showed the features of mesenchymal profile, usually related with worst prognosis that was maintained in extracranial metastases.
Assuntos
Adipocinas/genética , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Neoplasias do Sistema Nervoso Central/genética , Neoplasias do Sistema Nervoso Central/secundário , Glioblastoma/genética , Glioblastoma/patologia , Lectinas/genética , Adipocinas/metabolismo , Adulto , Neoplasias Encefálicas/cirurgia , Neoplasias do Sistema Nervoso Central/cirurgia , Proteína 1 Semelhante à Quitinase-3 , Terapia Combinada , Evolução Fatal , Glioblastoma/cirurgia , Humanos , Lectinas/metabolismo , Masculino , Procedimentos Neurocirúrgicos , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: This study is aimed to describe the observable anatomical variants of the innervation of extensor hallucis longus muscle (EHLM) in order to have the surgical coordinates to perform neurotomy on the targeted branches of its innervation and to give a valuable alternative to the commonly used technique of fascicular subepineurial neurotomy in patients affected by toe hyperextension dystonia. METHODS: In 15 fresh cadavers of adults, 29 lower limbs (14 right and 15 left) were studied. Anatomical dissections to isolate the innervating branches of EHLM were performed. Each branch from EHLM was analyzed by microscopical opening of the epineurium to observe the number of nerve fascicles. Various measurements were made to obtain anatomical coordinates for surgery. RESULTS: The distance between the most prominent point of the head of the fibula and the origin of the nervous branches innervating the EHLM is not proportional to the length of the leg. In 72.4% of the studied legs, the distance between the origin of the first branch innervating the EHLM and the origin of the deep peroneal nerve is 7 +/- 2 cm. In 80% of legs, the distance between the origin of the second branch and the origin of the deep peroneal nerve is 10 +/- 1.1 cm. In only one limb with double innervation, two fascicles were found, while in six limbs (25%) only one fascicle was found. CONCLUSIONS: This anatomical study traced some valuable surgical coordinates useful for the execution of a selective peripheral neurotomy on the nerve branch innervating the EHLM.