Expression of isocitrate dehydrogenase-1 in glioblastoma, Bangladesh perspective

Background: Glioblastoma is the most frequent malignant brain tumor in adults. Various studies have identified IDH (isocitrate dehydrogenase) mutation as a hallmark genetic alteration in glial tumors. The World Health Organization (WHO) has classified glioblastoma based on IDH mutation status, including IDH-mutant glioblastoma, IDH-wildtype glioblastoma along with its variants and glioblastoma, NOS (not otherwise specified) (where IDH mutation status cannot be evaluated). Methods: It was a cross-sectional observational study, conducted on 35 histologically diagnosed cases of glioblastoma, within the period of March, 2018 to December 2019. Results: Among the 35 glioblastoma cases, 6 (17.14%) were found to be IDH-mutant (positive for IDH1 immunostain), while the remaining 29 cases were negative for IDH1 immunostain (therefore designated as IDH-wildtype glioblastoma). In the IDH-mutant group, 3 out of 6 patients were in the younger age group (?40 years). On the other hand, IDH-wildtype glioblastoma was more common in elderly and most frequent was in the age group of 51-60 years (11 out of 29 cases). Conclusions: In this study, IDH1 expression was observed in 17.14% of all glioblastoma cases (designated as IDH-mutant glioblastoma). Whereas, most (~82.86%) of the glioblastoma cases did not express IDH1 (designated as IDH-wildtype).

The epidemiology and prediction of brain tumors incidence and mortality in China / 基础医学与临床

Objective To describe the incidence and mortality of brain tumors in China in 2020 and to predict the disease burden up to 2040.Methods The brain tumor incidence and mortality in 2020 were recorded based on the data from International Agency for Cancer Research(IARC),Cancer Today database.The incidence and mortality were standardized by age using Segi's world standard population.The burden of brain tumors in 2040 was predicted with assuming that national rates remained constant in 2020.Results It was estimated there were approximately 79 600 new brain tumors cases and 65 200 deaths in China in 2020.The age-standardized incidence and mortality rates of brain tumors in China were 4.1/100 000 and 3.2/100 000,respectively,which were lower than the United States of America,most of European countries and Australia.The incidence and mortality were higher than Africa,central America,and the Caribbean.From 2020 to 2040,the brain tumors cases and deaths are predicted to have an increase as 32.1%and 41.5%respectively.Conclusions The disease burden of brain tumors was still heavy in China.Further studies are urgently needed to clarify the epidemic trend of tissue typing and risk factors of brain tumors,which may support the development of effective prevention strategies.

Apport de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques chez l'adulte à Abidjan / Contribution of multimodal MRI in the management of brain tumors in adults in Abidjan

Dans le monde, le nombre de nouveaux cas de tumeurs encéphaliques était de 14 millions en 2014 avec environ 8 millions de personnes décédées. Objectif: déterminer l'efficacité diagnostique de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques dans notre contexte. Matériels et Méthodes: Etude rétrospective à visée descriptive, multicentrique sur une période de 2 ans allant de février 2017 à mars 2019, dans 2 services de radiologie et 2 services de Neurochirurgie, à Abidjan. Nous nous sommes intéressés àtous les patients ayant réalisé une IRM multimodale pour suspicion d'un processus tumoral encéphalique, et qui ont eu une exérèse chirurgicale suivie d'un examen anatomopathologique de la pièce opératoire. Les examens d'IRM multimodale encéphaliques ont été réalisés selon un protocole standard sur des appareils de 1,5 Tesla, et lus par des radiologues séniors. Nous avons confronté les résultats anatomopathologiques aux diagnostics posés à l'imagerie IRM multimodale.Résultats: Ont été retenu 18 dossiers. On notait une prédominance masculine avec un sex-ratio de 1,57. L'âge moyen était de 42,8 ans avec des extrêmes de 20ans et 61ans et un écart type de 10,75.La corrélation diagnostique entre l'examen anatomopathologique et l'IRM a été de6 sur 7 cas, 4 sur 5 cas, 2 sur 2 cas, 2 sur 2 cas et 1 sur 1 cas respectivement pour le méningiome, le gliome, les métastases, l'adénome hypophysaire, le lymphome cérébral primitif.Conclusion:Les tumeurs encéphaliques dans notre étude, étaient variéeset concernaient la population jeune. Les motifs d'erreur diagnostique étaient essentiellement en rapport avec la variété de présentations des tumeurs à l'IRM et l'expérience récente de nos radiologues sur l'utilisation efficace des séquences avancées.

Worldwide, the number of new cases of brain tumors was 14 million in 2014 with approximately 8 million people dying.Objective: determine the diagnostic effectiveness of multimodal MRI in the management of brain tumors in our context.Methods: Retrospective study with a descriptive aim, multicenter over a period of 2 years from February 2017 to March 2019, in 2 radiology departments and 2 neurosurgery departments, in Abidjan. We were interested in all patients who had a multimodal MRI for suspicion of a brain tumor process, and who had a surgical excision followed by an pathological examination of the surgical specimen. The multimodal brain MRI examinations were carried out according to a standard protocol on 1.5 Tesla devices, and read by seniorradiologists. We compared the pathological results with the diagnoses made on multimodal MRI imaging.Results:18 files were retained. There was a male predominance with a sex ratio of 1.57. The average age was 42.8 years with extremes of 20 and 61 years and a standard deviation of 10.75. The diagnostic correlation between the pathological examination and MRI was 6 out of 7 cases, 4 out of 5 cases, 2 out of 2 cases, 2 out of 2 cases and 1 out of 1 case respectively for meningioma, glioma, metastases, pituitary adenoma, primary cerebral lymphoma.Conclusion: The brain tumors in our study were varied and concerned the young population. The reasons for diagnostic error were mainly related to the variety of tumor presentations on MRI and the recent experience of our radiologists on the effective use of advanced sequences.

Usefulness of Intraoperative Infrared Thermography in Intracranial Surgeries: Past, Present, and Future / Utilidade da termografia infravermelho em cirurgias intracranianas: Passado, presente e futuro

With the advancement of technology in Neurosurgery, imaging guidance for surgical planning and intraoperative assessment has become relevant. Currently, two major methods of imaging guidance are generally explored in the literature, namely based on imaging and fluorescence. These techniques, however, are not without limitations. Thermal imaging has potentially broad applications in clinical practice, especially for intracranial diseases. Infrared thermography (IT) has been an underestimated tool with few reports on its usefulness during intracranial surgeries. In this article, we aim to provide a brief discussion on the limitations of current intraoperative imaging techniques for intracranial surgeries and to provide an in-depth state-of-the-art review on intraoperative IT (IIT) for intracranial lesions. High-resolution IIT is a non-invasive alternative imaging method that provides real-time estimation of regional cerebral blood flow. For brain tumors, the studies were mostly directed to diagnostic purposes and occasionally for lesion-localization. The use of IIT to address the extent of resection is a potential new application. Clinical data in this issue suggests that IIT might detect residual tumors, occasionally not assessed by other imaging technologies. Thermographic measurements during vascular and epilepsy surgeries comprise an interesting field for future research with potential clinical implications. Further experimental and clinical studies should be addressed to provide technical refinements and verify the usefulness of this noninvasive technology in neurosurgery.

Com o avanço da tecnologia em neurocirurgia, a orientação do planejamento cirúrgico e da avaliação intraoperatória por métodos de imagem se tornaram extremamente relevantes. Atualmente, dois métodos principais de cirurgia guiada por imagem são geralmente explorados na literatura, ou seja, baseados em imagens e em fluorescência. Essas técnicas, no entanto, apresentam limitações. A termografia infravermelha (TI) tem aplicações potencialmente amplas na prática clínica, especialmente para doenças intracranianas. A TI tem sido uma ferramenta subestimada, com poucos relatos sobre a sua utilidade durante cirurgias intracranianas. Neste artigo, pretendemos fornecer uma breve discussão sobre as limitações das atuais técnicas de imagem intraoperatória para cirurgias intracranianas e fornecer uma revisão aprofundada do estado da arte sobre a TI intraoperatória (TII) para lesões intracranianas. A TII de alta resolução é um método de imagem alternativo não invasivo que fornece estimativa em tempo real do fluxo sanguíneo cerebral regional. Para tumores cerebrais, os estudos foram direcionados principalmente para fins diagnósticos e, ocasionalmente, para localização das lesões. O uso da TII para avaliar a extensão da ressecção é uma nova aplicação em potencial. Os dados clínicos sugerem que a TII pode detectar tumores residuais, ocasionalmente não avaliados por outras tecnologias de imagem. Medidas termográficas durante cirurgias vasculares e de epilepsia constituem um campo interessante para pesquisas futuras com potenciais implicações clínicas. Novos estudos experimentais e clínicos devem ser realizados para fornecer refinamentos técnicos e verificar a utilidade dessa tecnologia não invasiva em neurocirurgia.

Glioneuronal and neuronal tumors: A review with special reference to the new types in the WHO CNS5 classification

Glioneuronal and neuronal tumors (GNTs) are slow-growing lower-grade neuroepithelial tumors with mature neuronal and, less consistently, glial differentiation. Their identification has relied solely on histological proof of neuronal differentiation, which was considered to represent the well-differentiated nature of GNTs. However, after discovering the genetic alterations in GNTs, particularly those in the MAP-kinase pathway, it became evident that histological diagnoses are not always concurrent with genetic alterations and vice versa. Furthermore, since several inhibitors mediating the MAP-kinase pathway are available, at least for clinical trials, molecular-based classification is now warranted. Thus, the upcoming WHO Classification of Central Nervous System Tumors, 5th edition (WHO5CNS) applied DNA methylation profiling to segregate low-grade neuroepithelial tumors. This review gives an overview of the pathological features of GNTs with particular reference to the newly listed tumor types in WHO5CNS. The knowledge and awareness of each tumor type are essential to make a correct diagnosis and avoid unnecessary radical resection and chemoradiotherapy, as GNTs are relatively indolent and have a prolonged clinical course. In addition, being distinctive in location, age group, and histology, the integration of clinicopathological information will help identify relevant tumor types of GNTs without genetic testing, even in resource-limited settings.

Application of "locate the asset" emergency care in the rescue of patients with brain tumor-related epilepsy / 国际生物医学工程杂志

Objective:To explore the effect of the "locate the asset" emergency care, which is to determine the emergency care according to patients and their locations, in the emergency care of patients with brain tumor-related epilepsy.Methods:Ninety-five patients with brain tumor-associated epilepsy were selected for the study, of which 44 patients were in the control group and were resuscitated with traditional emergency care, while 51 patients were in the experimental group and were resuscitated with "locate the asset" emergency care. The resuscitation time, the incidence of secondary injuries and the satisfaction of patients with epilepsy resuscitation in the two groups were compared.Results:The resuscitation time of the experimental group was (175.00±0.09) s that is lower than that of the control group (420.00±1.08) s ( P<0.05). The incidence of secondary injury in the experimental group was 5.88% that is lower than that of the control group (15.90%) ( P<0.05). All indicators of physician satisfaction with emergency care in the experimental group were higher than those in the control group (all P<0.05). Conclusions:The "locate the asset" emergency care can help standardize the management of epilepsy resuscitation care, improve the quality of resuscitation, and achieve the optimization of nursing resources.

Craneotomía despierta para tumores cerebrales / Awake craniotomy for brain tumors

Resection of tumoral lesions anatomically related to motor, sensitive and language areas of the brain, have the main goal of sparing those areas. For that purpose, Neurosurgery on awake patients helps in reducing the size of growing brain tumors in a safe manner, which leads to extending and improving quality of life. Therefore, the greatest benefit lies in maximizing tumor ex- traction while minimizing neurological injury. In this article, we review current evidence of the application of awake craniotomy, and we describe the anesthetic management that we perform during this type of procedures.

La resección de lesiones tumorales relacionadas anatómicamente con las áreas motoras, sensitivas y especialmente las del lenguaje, tiene como objetivo principal la preservación de éstas. Para ello la neurocirugía con el paciente despierto puede ayudar a reducir de manera segura el tamaño de tumores cerebrales en crecimiento, lo que suele prolongar y mejorar la calidad de vida, verificando en tiempo real el resultado del acto quirúrgico. El mayor beneficio radica entonces en maximizar la extracción tumoral minimizando el daño neurológico. En este artículo revisamos la evidencia actual de la aplicación de la craneotomía en el paciente despierto y describimos el manejo anestésico que realizamos durante este procedimiento.

Caracterización clínica, epidemiológica y anatomopatológica de los tumores cerebrales supratentoriales y su morbilidad posanestésica / Clinical, Epidemiological and Anatomopathological Characterization of Supratentorial Brain Tumor and its Post-Anesthetic Morbidity

Introducción: Los tumores cerebrales no son frecuentes, pero tienen efectos devastadores. Objetivo: Caracterizar según criterios clínicos y anatomopatológicos a los pacientes con tumor cerebral supratentorial. Métodos: Se realizó un estudio observacional y descriptivo de casos clínicos en el período de enero 2017 - enero 2019, en el Hospital Provincial Saturnino Lora de Santiago de Cuba. El universo estuvo constituido por la totalidad de los 117 pacientes a los que se les realizó una tomografía computarizada de cráneo y con diagnóstico histológico postoperatorio de neoplasia primaria del sistema nervioso central (supratentorial) y metástasis cerebral, a los que se les realizó neurocirugía transcraneal. Resultados: Predominó el sexo masculino y las edades entre 40 a 59 años, clínicamente la mayoría de los casos presentó cefalea como signo de hipertensión endocraneana 76,1 por ciento. El 87,2 por ciento presentó la tumoración en los hemisferios cerebrales. El glioblastoma multiforme fue el tipo histológico prevaleciente con 45,3 por ciento. La hipopotasemia fue la complicación post anestésica más frecuente (21,4 por ciento). Conclusiones: Los tumores cerebrales supratentoriales en la edad adulta constituyen un problema de salud, principalmente en los hombres después de los 45 años de edad; la cefalea, las convulsiones y los vómitos son los síntomas cardinales. Durante la excéresis de los tumores supratentoriales los pacientes presentaron diversas complicaciones anestésicas(AU)

Introduction: Brain tumors are not frequent, but they have devastating effects. Objective: To characterize patients with supratentorial brain tumor, according to clinical and pathological criteria. Methods: An observational and descriptive study of clinical cases was carried out, in the period from January 2017 to January 2019, at Saturnino Lora Provincial Hospital in Santiago de Cuba. The universe consisted of the 117 patients who underwent computed tomography of the skull and with a postoperative histological diagnosis of primary neoplasia of the central nervous system (supratentorial) and brain metastases, who underwent transcranial neurosurgery. Results: The male sex predominated, together with the ages 40-59 years old. Clinically, most of the cases (76.1 percent) presented headache as a sign of intracranial hypertension. 87.2 percent presented the tumor in the cerebral hemispheres. Glioblastoma multiforme was the prevalent histological type, accounting for 45.3 percent. Hypokalemia was the most frequent post-anesthetic complication, accounting for 21.4 percent. Conclusions: Supratentorial brain tumors in adulthood constitute a health concern, mainly in men after 45 years of age; headache, seizures and vomiting are the cardinal symptoms. During excision of supratentorial tumors, the patients presented various anesthetic complications(AU)

Psicosis secundaria a meningioma: revisión a propósito de un caso / Secondary psychosis due to meningioma: review about a case

Resumen Los meningiomas son los tumores primarios más frecuentes del sistema nervioso central, tienden a ser benignos y de lento crecimiento. Pueden ser asintomáticos o incluso manifestarse únicamente con síntomas psiquiátricos, incluyendo un cuadro psicótico. No existen estudios clínicos controlados randomizados que estudien la relación entre meningioma y cuadros psicóticos. La evidencia disponible se basa en series y reportes de casos. Existe una relación entre la magnitud del edema perilesional y la presencia de síntomas psicóticos. Por otra parte, el tamaño de la lesión o su localización neuroanatómica específica tendrían menor relevancia. La resección quirúrgica de la lesión, en conjunto con el manejo psiquiátrico adecuado, usualmente conduce al cese de la sintomatología psicótica. En la evaluación de pacientes con síntomas psicóticos se debe tener un elevado índice de sospecha, en particular en cuadros de reciente inicio, con manifestaciones atípicas o resistentes al tratamiento. En estos casos se recomienda un estudio con neuroimágenes. Este artículo presenta el caso de una paciente evaluada en nuestro hospital diagnosticada con un meningioma frontal izquierdo de gran tamaño, que presentó sintomatología psicótica secundaria, y se expone una revisión bibliográfica actualizada de esta asociación.

Meningiomas are the most frequent central nervous primary tumors, which tend to be benign and present a slow growth. They may be asymptomatic or present clinically just with psychiatric symptoms including a psychotic state. There are no clinical randomized controlled trials that study the relationship between meningioma and a psychotic episode. Available evidence is based on case reports and series. There is a relationship between the magnitude of perilesional edema and the presence of psychotic symptoms. On the other hand, the size of the tumor or its specific neuroanatomic location would have less relevance. Surgical resection of the tumor associated with psychiatric management usually leads to the cessation of psychotic symptoms. In the assessment of patients with psychotic symptoms, there must be a high index of suspicion, particularly in first psychotic episodes, atypical manifestations and resistance to treatment. In these cases, a neuroimaging study is recommended. This article presents the case of a patient evaluated in our hospital and diagnosed with a large left frontal meningioma with secondary psychotic symptoms, and an updated bibliographic review of this association is presented.

Children with brain tumors: a study of nutritional status on hospital admission / Crianças com tumores cerebrais: um estudo do estado nutricional na admissão hospitalar

Objective: to assess the nutritional status of children with brain tumors on hospital admission and to verify whether the nutritional status varies according to the type of tumor. Methods: anthropometric data of 30 children between 2 and 10 years old, of both sexes, with brain tumors and admitted to a hospital in the city of São Paulo, Brazil, were evaluated. Secondary data collection allowed to assess and classify the Z-scores of the body mass index, percentage of adequacy of the triceptal skinfold and the arm muscle circumference, carried out between the years 2004 and 2011. Results: the frequencies of brain tumors were: 33.3% astrocytic, 40% embryonal, 10% of the seal region and 16.6% ependimals. The median age and body mass index Z scores were 5.5 years (4.0 and 7.0) and 0.66 SD (- 1.41 and 0.87), respectively. The median percentage of adequacy of arm muscle circumference was 98% (88.9 and 103.2) and the triceptal skinfold was 83.2% (57.0 and 106.6). As for nutritional status, 21 (70%) of the children were eutrophic; 7 (23.3%) overweight and 2 (6.7%) with malnutrition/wasting showing no significant difference between groups of brain tumors (p = 0.721). The percentages of adequacy of the triceptal skinfold and of the arm muscle circumference also showed no significant difference between the different types of brain tumors (p = 0.865 and p = 0.860, respectively). Conclusion: at the time of hospital admission, the children were in good nutritional status, regardless of the type of brain tumor. (AU)

Objetivo: avaliar o estado nutricional de crianças com tumores cerebrais na admissão hospitalar e verificar se o estado nutricional varia de acordo com o tipo de tumor. Métodos: avaliou-se os dados antropométricos de 30 crianças entre 2 e 10 anos, de ambos os sexos, com tumores cerebrais e admitidas em um hospital na cidade de São Paulo, Brasil. A coleta secundária de dados permitiu avaliar e classificar os escores Z do índice de massa corporal, percentual de adequação da dobra cutânea triceptal e da circunferência muscular do braço, realizados entre os anos de 2004 e 2011. Resultados: as frequências dos tumores cerebrais foram: 33,3% astrocíticos, 40% embrionários, 10% da região selar e 16,6% ependimais. As medianas de idade e dos escores Z do índice de massa corporal foram, respectivamente, 5,5 anos (4,0 e 7,0) e 0,66 DP (- 1,41 e 0,87). A mediana do percentual de adequação da circunferência muscular do braço foi de 98% (88,9 e 103,2) e da dobra cutânea triceptal foi 83,2% (57,0 e 106,6). Quanto ao estado nutricional, 21 (70%) das crianças apresentaramse eutróficas; 7 (23,3%) com excesso de peso e 2 (6,7%) com desnutrição/magreza, não mostrando diferença significante entre os grupos de tumores cerebrais (p=0,721). Os percentuais de adequação da dobra cutânea triceptal e da circunferência muscular do braço também não mostraram diferença significante entre os diferentes tipos de tumores cerebrais (p=0,865 e p=0,860, respectivamente). Conclusão: no momento da admissão hospitalar as crianças se encontravam em bom estado nutricional, independentemente do tipo de tumor cerebral. (AU)

Genomic and transcriptomic characterization of the human glioblastoma cell line AHOL1

Cancer cell lines are widely used as in vitro models of tumorigenesis, facilitating fundamental discoveries in cancer biology and translational medicine. Currently, there are few options for glioblastoma (GBM) treatment and limited in vitro models with accurate genomic and transcriptomic characterization. Here, a detailed characterization of a new GBM cell line, namely AHOL1, was conducted in order to fully characterize its molecular composition based on its karyotype, copy number alteration (CNA), and transcriptome profiling, followed by the validation of key elements associated with GBM tumorigenesis. Large numbers of CNAs and differentially expressed genes (DEGs) were identified. CNAs were distributed throughout the genome, including gains at Xq11.1-q28, Xp22.33-p11.1, Xq21.1-q21.33, 4p15.1-p14, 8q23.2-q23.3 and losses at Yq11.21-q12, Yp11.31-p11.2, and 15q11.1-q11.2 positions. Nine druggable genes were identified, including HCRTR2, ETV1, PTPRD, PRKX, STS, RPS6KA6, ZFY, USP9Y, and KDM5D. By integrating DEGs and CNAs, we identified 57 overlapping genes enriched in fourteen pathways. Altered expression of several cancer-related candidates found in the DEGs-CNA dataset was confirmed by RT-qPCR. Taken together, this first comprehensive genomic and transcriptomic landscape of AHOL1 provides unique resources for further studies and identifies several druggable targets that may be useful for therapeutics and biologic and molecular investigation of GBM.

Tumores cerebrales en pacientes menores de 3 años: 10 años de experiencia / Brain tumors in patients younger than 3 years: 10 years of experience

Introducción: Los primeros 3 años de vida son cruciales en el desarrollo del sistema nervioso central (SNC). Un tumor en dicha localización, en este período, está asociado a un severo deterioro de la calidad de vida y alta mortalidad. El objetivo del trabajo es realizar un análisis de la evolución y tratamiento en estos pacientes. Material y métodos: Análisis retrospectivo de las historias clínicas y el archivo de imágenes de pacientes menores de 36 meses de edad con diagnóstico de tumor en SNC tratado quirúrgicamente en el Hospital de Niños Ricardo Gutiérrez, CABA, Argentina. Periodo: 01/03/2009-01/01/2020. Se dividieron en 3 grupos según edad: 1 (0-12 meses), 2 (13-24 meses) y 3 (25-35 meses).Resultados: Se incluyeron 71 pacientes, 36 varones y 35 mujeres. El síndrome de hipertensión endocraneana se presentó al debut en 42 pacientes (59%) luego alteraciones de la motricidad en 13 (18%). 46 (65%) presentaron hidrocefalia, de los cuales 20 presentaron post-resección tumoral. Se observó predominio de localización supratentorial en los grupos 1 (69%) y 2 (58%), e infratentorial en el grupo 3 (86%). Se realizó resección completa en 18 pacientes (25%), subtotal en 6 (11%), parcial en 38 (54%), y biopsia en 7 (10%). 27 (38%) pacientes requirieron reoperaciones, de los cuales 19 (70%) pertenecieron al grupo 1. Los diagnósticos anatomopatológicos más frecuentes fueron astrocitomas (20), meduloblastomas (12), papilomas de plexos coroideos (9), ependimomas anaplásicos (8), tumores teratoides rabdoides atípicos (8) y otros (14). En el estudio de calidad de vida, 15 pacientes (21%) presentaron un severo retraso psicomotor, y 23 pacientes (32%) presentaron desarrollo normal. La mortalidad a los 5 años fue 38% y a los 10 años 50%. Conclusión: Los tumores de SNC en menores de 3 años son de difícil manejo, con pronóstico reservado. Debido a que la radioterapia está contraindicada, la cirugía tiene una importancia fundamental en el tratamiento junto a la quimioterapia.

Introduction: The first three years of life are critical for the central nervous system (CNS) development. A tumor in this location at this stage will be associated with severe impairment of the quality of life and high mortality. The objective of the paper is to analyze the evolution and treatment of these patients. Material and methods: The records of all the patients under 3 years of age who were operated for intracranial brain tumors at our institution from March 2009 to January 2020 were retrospectively reviewed. Patients were divided into three groups depending on their age at onset: under 1 year of age (group 1), between 13-24 months (group 2), and between 25-35 months (group 3). Results: We included 71 patients (36 male and 35 female). 42 patients (59%) presented with an increase of intracranial pressure at the onset, followed by gait disturbance in 13 (18%). 46 patients (65%) suffered hydrocephalus, of whom 20 were post-resection. The predominance of supratentorial localization was observed in group 1 (69%) and 2 (58%), and infratentorial localization in group 3 (86%). Total resection of the tumor was accomplished in 18 patients (25%), subtotal in 6 (11%), partial in 38 (54%), and biopsy in 7 (10%). 27 patients (38%) required re-intervention. Of these, 19 (70%) corresponded to group 1. The principal histological diagnoses were astrocytoma (20), medulloblastoma (12), choroid plexus papilloma (9), anaplastic ependymoma (8), atypical teratoid rhabdoid tumor (8), and others (14). The quality of life analysis showed 23 patients (32%) with normal development and 15 (21%) with severe psychomotor retardation. 5-years mortality was 38% and 10-years mortality was 50%. Conclusion: CNS tumors in children younger than 3 years are difficult to handle and have a guarded prognosis. Surgery, along with chemotherapy, is very important to treat these patients

Comparación dosimétrica en radiocirugía intracraneal entre Cyberknife y un bisturí de rayos gamma y su puesta en marcha Centroamérica / Dosimetric comparison in intracranial radiosurgery between Cyberknife and a gamma knife and its implementation Central America

Introducción: La dupla Cyberknife y bisturí de rayos gamma (Infini) que se describe es la primera en Latinoamérica. Ambas máquinas han mostrado ser los mejores equipos para radiocirugía intracraneal. Se describe la experiencia inicial de Cyberknife en Centroamérica y su incorporación a un programa existente de bisturí de rayos gamma por vía de análisis comparativos dosimétricos. Material y método: En el año 2019 se realizaron planes comparativos y se trataron 180 pacientes con radiocirugía intracraneal con ambos sistemas tanto en patología tumoral, como vascular y funcional. Resultados: En el análisis dosimétrico comparativo en el gradiente de dosis de Infini mostró ser superior a Cyberknife en todos los casos. Para una esfera utilizando el colimador de 4 mm en Infini y de 5 mm en Cyberknife utilizando un plan isocéntrico con el -Trigeminal Path- el gradiente de dosis para Infini fue de 1.5 y para Cyberknife de 1.66. Para los casos de patología el gradiente de dosis media para Infini fue de 3 mm y para Cyberknife de 3.8 mm. Dando un puntaje de gradiente de dosis (Gradient Score Index) si Infini fuese de 100, Cyberknife obtuvo 87.3. Cyberknife mostró mejor conformalidad y cobertura (97% versus 96%) para todos los targets. Entre enero 2019 y enero 2020 se realizaron 180 radiocirugías, 60 con Cyberknife y 120 con Infini, 60 pacientes recibieron 146 sesiones con Cyberknife, radiocirugía fraccionada 39 (65%) y 21 (35%) en sesión única. Las dosis medias en tumores en dosis única fue 15 Gy (12.5 a 25 Gy) y en radiocirugía fraccionada 21 Gy (18 y 35). Ningún paciente ha experimentado toxicidad mayor a grado dos. Conclusiones: El bisturí de rayos gamma rotatorio reveló superioridad en gradiente de dosis con relación al Cyberknife. En su primer año Cyberknife ha mostrado ser una herramienta segura en el tratamiento de patología intracraneal. Más seguimiento clínico y radiológico es necesario para verificar su efectividad comparativa

Introduction: The match between Cyberknife and Infini here described in this article is the first in Latinamerica. Both machines have proven to be the best for intracranial radiosurgery, we describe our initial experience with Cyberknife in Central America and how it was incorporated in an existing gamma ray program by ways of dosimetry comparisons. Methods: During 2019 comparative plans were made and a total of 180 patients received intracranial radiosurgery with both technologies, patients were treated for tumors, vascular anomalies, and functional pathology. Results: Basic dosimetry analysis regarding dose gradient the Infini proved superior to Cyberknife in all plans. For a sphere using the 4 mm collimator in Infini and the 5 mm in Cyberknife along with an isocentric plan using the -Trigeminal Path- dose gradient was 1.5 for Infini and 1.66 for Cyberknife. For the pathology cases Infini was 3 mm and for Cyberknife 3.8 mm on mean. Giving a Gradient Score Index (GSI) if Infini would be 100, Cyberknife would be 87.3. Cyberknife showed better conformality and coverage for all pathology targets (97% versus 96%). From January 2019 to January 2020, 180 intracranial radiosurgeries were done, 60 with Cyberknife and 120 with Infini, 60 patients received 146 sessions with Cyberknife, fractionated scheme 39 (65%) and 21 (35%) single dose. The median dose for tumors was 15 Gy (12.5 a 25 Gy) for single session and 21 Gy (18 y 35) for fractionated scheme. No patient experienced a higher toxicity tan grade two. Conclusions: In its first year Cyberknife has shown to be safe in treating intracranial pathology. Infini had a better dose gradient than Cyberknife. Longer clinical and radiological follow-up is needed to verify its comparative effectiveness.

Choroid plexus papilloma: case report / Papiloma do plexo coroide: relato de caso

ABSTRACT Choroid plexus papillomas (CPP) are a rare oncological condition. They affect mostly the pediatric population, and the diagnosis is associated with clinical findings, imaging and anatomopathological methods. We report the case of a 49-year-old woman who underwent neurosurgical evaluation for chronic headache and emotional stress. CPP is a rare central nervous system tumor in the adult population. We present, therefore, a case in an adult female, whose diagnosis was confirmed by histopathology methods. Surgical treatment is the gold standard, showing full resolution in almost all cases.

RESUMEN Los papilomas de los plexos coroideos (PPC) son una condición oncológica bastante rara. Acometen mayormente la población pediátrica; su diagnóstico implica un análisis clínico asociado a los métodos de imagen y anatomopatológico. Reportamos el caso de una mujer de 49 anos atendida para evaluación neuroquirúrgica con cefalea crónica y estrés emocional. El PPC es un tumor delsistema nervioso central sumamente raro en la población adulta. Así, presentamos un caso raro en una mujer adulta, cuyo diagnóstico fue confirmado por métodos histopatológicos. El tratamiento quirúrgico es el estándar de oro, ya que muestra resolución completa en casi todos los casos.

RESUMO Os papilomas do plexo coroide (PPC) são uma condição oncológica bastante rara. Acometem majoritariamente a população pediátrica; seu diagnóstico envolve uma análise clínica associada aos métodos de imagem e anatomopatológico. Relatamos o caso de uma mulher de 49 anos atendida no Hospital das Clínicas da Universidade Federal de Goiás (UFG) para avaliação neurocirúrgica com clínica de cefaleia crônica e estresse emocional. O PPC é um tumor do sistema nervoso central extremamente raro na população adulta. Apresentamos, portanto, um caso raro em uma mulher adulta, cujo diagnóstico foi confirmado por métodos histopatológicos. O tratamento cirúrgico é o padrão-ouro, pois mostra resolução completa em quase todos os casos.

Radioterapia en pacientes con tumores cerebrales primarios. Hospital V.I. Lenin, noviembre 2014 - mayo 2017 / Radiation therapy in patients with primary brain tumors. V.I. Lenin, November 2014 - May 2017 / Radioterapia em pacientes com tumores cerebrais primários. V.I. Lenin, novembro de 2014 - maio de 2017

RESUMEN Los tumores primarios del cerebro constituyen un grupo heterogéneo de neoplasias con comportamiento biológico y con pronóstico muy diferente. Su incidencia se ha incrementado en los últimos años en todos los grupos de edades. Se realizó un estudio descriptivo prospectivo de 58 pacientes con tumores cerebrales primarios, atendidos en la consulta de Radioterapia del Centro Oncológico del Hospital Vladimir Ilich Lenin en el período de Noviembre del 2014 a Mayo del 2017, con el objetivo de determinar los síntomas físicos y las manifestaciones cognitivas en pacientes tratados por tumores cerebrales primarios. Se caracterizaron las variables de edad y sexo, diagnóstico histológico, tratamiento oncológico, síntomas físicos y manifestaciones cognitivas. El grupo de edad entre los 40 y 59 años fue el más afectado (51,72%), siendo en el sexo masculino más frecuente esta patología (65,52%). El tipo histológico que predominó fue el astrocitoma en un 77,11 %. Se empleó la radioterapia en el 100% de los pacientes, y concurrente al nimotuzumab en 43 pacientes. Los síntomas físicos más frecuentes fueron los trastornos del sueño (39,28%), y dentro de las manifestaciones cognitivas identificadas los problemas visuales alcanzaron el 35%. Los síntomas físicos y las manifestaciones cognitivas producidas, ya sea por el tumor primario o por el tratamiento oncológico en pacientes con tumores cerebrales primarios, son factores que influyen negativamente en la calidad de vida de estos pacientes.

ABSTRACT Primary tumors of the brain constitute a heterogeneous group of neoplasms with biological behavior and with a very different prognosis. Its incidence has increased in recent years in all age groups. A prospective descriptive study of 58 patients with primary brain tumors was performed, attended in the Radiotherapy office of the Vladimir Ilich Lenin Hospital Oncology in the period from November 2014 to May 2017, with the objective of determining the physical symptoms and Cognitive manifestations in patients treated for primary brain tumors. The variables of age and sex, histological diagnosis, cancer treatment, physical symptoms and cognitive manifestations were characterized. The age group between 40 and 59 years was the most affected (51.72%), being in the most frequent male sex this pathology (65.52%). The histological type that predominated was astrocytoma in 77.11%. Radiation therapy was used in 100% of patients, and concurrent to nimotuzumab in 43 patients. The most frequent physical symptoms were sleep disorders (39.28%), and within the cognitive manifestations identified visual problems reached 35%. The physical symptoms and cognitive manifestations produced, either by the primary tumor or by the cancer treatment in patients with primary brain tumors, are factors that negatively influence the quality of life of these patients.

RESUMO Os tumores primários do cérebro constituem um grupo heterogêneo de neoplasias com comportamento biológico e com prognóstico muito diferente. Sua incidência aumentou nos últimos anos em todas as faixas etárias. Foi realizado um estudo prospectivo descritivo de 58 pacientes com tumores cerebrais primários, atendidos no serviço de Radioterapia do Hospital Vladimir Ilich Lenin Oncologia no período de novembro de 2014 a maio de 2017, com o objetivo de determinar os sintomas físicos e Manifestações cognitivas em pacientes tratados por tumores cerebrais primários. Foram caracterizadas as variáveis ​​idade e sexo, diagnóstico histológico, tratamento do câncer, sintomas físicos e manifestações cognitivas. A faixa etária entre 40 e 59 anos foi a mais afetada (51,72%), sendo no sexo masculino mais frequente essa patologia (65,52%). O tipo histológico que predominou foi o astrocitoma em 77,11%. A radioterapia foi usada em 100% dos pacientes e concomitante ao nimotuzumabe em 43 pacientes. Os sintomas físicos mais frequentes foram distúrbios do sono (39,28%) e, nas manifestações cognitivas, os problemas visuais identificados atingiram 35%. Os sintomas físicos e as manifestações cognitivas produzidas, seja pelo tumor primário ou pelo tratamento do câncer em pacientes com tumores cerebrais primários, são fatores que influenciam negativamente a qualidade de vida desses pacientes.

Epidemiological analysis of central nervous system tumors in pediatric patients from a tertiary care centre in India

Background: Tumors of the nervous system are the second most common childhood cancer after leukemia. The diagnosis of CNS tumors is challenging due to non-specific symptoms in children which mimic other less serious illness.Methods: This was a retrospective analysis of case records of patients from 0-18 years of age, who were diagnosed with CNS tumors for a period of 7 years.Results: Out of total 64 patients included in this study, 32 were females and 24 were males. The mean age was 13.2 years. The most common clinical presentation in patients with brain tumors was headache (92.3%) followed by visual symptoms in the form of blurring or loss of vision (42.3%) and swaying while walking (32.6%). The overall mean symptom interval for all patients was 274.8 days (approx. 9 months) ranging from 7-1820 days. In the present study out of total 64 patients, 54 were brain tumors (35 supratentorial and 19 infratentorial) and 10 were spinal tumors. The most common tumor location was cerebellum (21.8%) followed by cerebral cortex, spine and sellar area. Based on histopathology the most common tumor type in our study was astrocytoma. There was no significant correlation of symptom interval with age and gender but was significantly associated with location and tumor grade.Conclusions: Early referral to centers with appropriate facilities will help, as many pediatric CNS tumors are low grade with better survival.

Comportamiento de los gliomas de alto grado en el servicio Neurocirugía de Matanzas. 2017-2019 / Behavior of high-grade gliomas at Matanzas Neurosurgery service. 2017-2019

RESUMEN Introducción: el astrocitoma anaplásico y el glioblastoma multiforme son las formas más agresivas de glioma maligno. Existen avances en radioterapia, quimioterapia y tratamientos de resección quirúrgica agresiva. Esto último incluye métodos como los de tomografía de coherencia óptica, cirugía guiada por fluorescencia, craneotomía de vigilia, terapia térmica intersticial con láser para la ablación por glioblastoma multiforme, microscopía intraoperatoria confocal y espectrometría de masas intraoperatoria, pero a pesar de todo ello el pronóstico resulta sombrío. Objetivo: determinar el comportamiento de los gliomas de alto grado en el Servicio de Neurocirugía de la provincia Matanzas. Materiales y métodos: estudio observacional, descriptivo, transversal, con los pacientes diagnosticados de gliomas de alto grado, en el Servicio Neurocirugía, de la provincia Matanzas, en el período de 1ero de enero del 2017 a 1ero de enero del 2019, para un total de 40 casos. Resultados: la edad media de las lesiones fue de 52 años, la cefalea fue el síntoma predominante, con el 72,2 %. La sintomatología se presentó con una evolución de menos de un mes. Conclusiones: en el 62 % predominaron los gliomas frontales y la variedad histológica glioblastoma multiforme. La excéresis subtotal se aplicó en la mayor cantidad de cirugías, la calidad de vida al egreso fue superior que al ingreso (AU).

ABSTRACT Introduction. Anaplastic astrocytoma (AA) and Glioblastoma multiforme (GBM) are the most aggressive forms of malignant glioma. Despite advances in radiotherapy, chemotherapy and aggressive surgical resection treatments, such as optical coherence tomography, fluorescence-guided surgery, waking craniotomy, laser interstitial thermal therapy for GBM ablation, intraoperative confocal microscopy and intraoperative mass spectrometry, the prognosis remains bleak. Objective: to determine the behavior of high grade gliomas in the Neurosurgery Service of the province of Matanzas. Materials and methods: cross-sectional, descriptive, observational study with patients diagnosed with high-grade gliomas in the Neurosurgery Service of the province of Matanzas, in the period from January 1, 2017 to January 1, 2019, for a total of 40 cases. Results: the average age of the lesionated patients was 52 years; headache was the predominant symptom, with 72.2 %; the evolution at the presentation of symptoms was less than a month. Conclusions: frontal gliomas predominated in 62 % of the cases, and predominated also glioblastoma multiforme histological variety. Subtotal excision was used in most surgeries. Life quality at discharging was higher than at the moment of admission (AU).

Linfocitos T modificados por ingeniería genética: ¿Una nueva esperanza para el tratamiento del glioblastoma? / Genetically modified T lymphocytes: A new hope for glioblastoma treatment?

Resumen El glioblastoma es uno de los tumores primarios del sistema nervioso central más agresivos, debido a su alta capacidad de generar resistencia a la mayoría de los tratamientos oncológicos disponibles actualmente. Asimismo, este tumor tiene un elevado potencial de recidiva y genera una mortalidad alta entre los individuos afectados. Por lo tanto, existe una urgente necesidad por contar con nuevas estrategias terapéuticas que permitan lograr una mayor tasa de remisión y una mejor sobrevida en los pacientes con glioblastoma. Novedosos avances en inmunoterapia, como la generación de linfocitos T autólogos modificados por ingeniería genética, prometen ser agentes terapéuticos capaces de proveer un grado considerable de control sobre diferentes tipos de cánceres. En el presente artículo, se comentan los resultados de algunas investigaciones recientes sobre el uso específico de esta estrategia para el manejo de individuos con glioblastoma.

Abstract Glioblastoma is among the most aggressive primary tumors of the central nervous system due to its high capacity to acquire resistance to many of the currently available oncologic treatments. Likewise, this tumor possesses an elevated potential for recurrence generating a high mortality among affected individuals. Therefore, there is an urgent necessity for new therapeutic strategies to achieve a higher remission rate and a better survival rate in patients with glioblastoma. New advances in immunotherapy, such as the production of autologous T lymphocytes modified by genetic engineering, are promissory therapeutic agents capable of providing a considerable degree of control over different types of cancers. In this article, we discuss the results of some recent studies

Efficacy of pilates based group therapy on fatigue and quality of life in brain tumor survivors – A randomized control trial

Introduction: Fatigue is one of the most common problems experienced by the cancer patients. It is a normal and necessary instrument of physiologic self-regulation and protects the body from exaggerated or harmful efforts. It becomes pathologic when it appears during normal activities and does not improve after rest. It is one of the prevalent symptoms of the patients receiving radiation therapy, cytotoxic chemotherapy or biological response modifiers. Fatigue is inversely associated with activity level and functional capacity. Aim: To evaluate the effectiveness of the pilates based group therapy on the reduction of the levels of fatigue, symptom burden and the improvement in the domain the global functioning, functional component of the EORTC QLQ C30. Materials and methods: Interventional experimental Randomized control trial was used in this study. The study included brain tumor survivors both genders (male and female) with age group ranging from 18 – 65 and completion of the treatment with surgery, radiotherapy, chemotherapy with or without current hormone treatment and overall kps score >70 were randomly allocated into two groups. Group A and Group B. Group A performed pilates exercises and Group B performed conventional therapy which includes ROM exercises and strengthening exercises to the upper limb, lower limb back and both the groups advised walking for 15 min daily. Sathish Kumar Jakkula, Sai Gayathri Mangavelli, Vani Reddy Manchi, Amita Samal, K. Sukavya Reddy. Efficacy of pilates based group therapy on fatigue and quality of life in brain tumor survivors – A randomized control trial. IAIM, 2019; 6(10): 74-81. Page 75 Results: The experimental group A performing a pilates exercises showed statistically significant improvement in the reduction of the fatigue levels and the symptom burden and improvement in the global functioning and functional components of the EORTC QLQ C30 Questionnaire with the probability of <0.005. Conclusion: Pilates based group therapy found to be effective in reducing fatigue levels and symptom burden there by improving the quality of life in brain tumor survivors according to the statistical data available.

ASSOCIATION OF TUMOR ANGIOGENIC CELLS (CD133+/VEGFA+) AND CIRCULATING CANCER STEM CELLS (CD133+/VEGFR2-) IN ASTROCYTIC GLIOMA PATIENTS

@#Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin. The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells homing towards tumor site. Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+ and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson correlation were used for the data analysis.Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue (Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson correlation, r = 0.42, p = 0.049).Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.