Clinical Significance of Fractional Anisotropy Measured in Peritumoral Edema as a Biomarker of Overall Survival in Glioblastoma: Evidence Using Correspondence Analysis.

INTRODUCTION: Fractional anisotropy (FA), a diffusion tensor image (DTI) derived biomarker is related to invasion, infiltration, and extension of glioblastoma (GB). We aimed to evaluate FA values and their association with intervals of overall survival (OS). MATERIALS AND METHODS: Retrospective study conducted in 36 patients with GB included 23 (63.9%) males, 46 ± 14 y; and 13 (36.1%) females, 53 ± 13; followed up for 36 months. We measured FA at edema, enhancing rim, and necrosis. We created two categorical variables using levels of FA and intervals of OS to evaluate their relationships. Kaplan-Meier method and correspondence analysis evaluated the association between OS (grouped in 7 six-month intervals) and FA measurements. RESULTS: Median FA values were higher in healthy brain regions (0.351), followed by peritumoral edema (0.190), enhancing ring (0.116), and necrosis (0.071). Pair-wise comparisons among tumor regions showed a significant difference, P < 0.001. The median OS for all patients was 19.3 months; variations in the OS curves among subgroups was significant χ2 (3) = 8.48, P = 0.037. Correspondence analysis showed a significant association between FA values in the edema region and the survival intervals χ2 (18) = 30.996, P = 0.029. CONCLUSIONS: Alternative multivariate assessment using correspondence analysis might supplement the traditional survival analysis in patients with GB. A close follow-up of the variability of FA in the peritumoral edema region is predictive of the OS within specific six-month interval subgroup. Further studies should focus on predictive models combining surgical and DTI biomarkers.

Hydrolyzed Rutin Decreases Worsening of Anaplasia in Glioblastoma Relapse.

BACKGROUND: Gliomas are aggressive and resilient tumors. Progression to advanced stages of malignancy, characterized by cell anaplasia, necrosis, and reduced response to conventional surgery or therapeutic adjuvant, are critical challenges in glioma therapy. Relapse of the disease poses a considerable challenge for management. Hence, new compounds are required to improve therapeutic response. As hydrolyzed rutin (HR), a compound modified via rutin deglycosylation, as well as some flavonoids demonstrated antiproliferative effect for glioblastoma, these are considered potential epigenetic drugs. OBJECTIVE: The purpose of this study was to determine the antitumor activity and evaluate the potential for modifying tumor aggressivity of rutin hydrolysates for treating both primary and relapsed glioblastoma. METHODS: The glioblastoma cell line, U251, was used for analyzing cell cycle inhibition and apoptosis and for establishing the GBM mouse model. Mice with GBM were treated with HR to verify antitumor activity. Histological analysis was used to evaluate HR interference in aggressive behavior and glioma grade. Immunohistochemistry, comet assay, and thiobarbituric acid reactive substance (TBARS) values were used to evaluate the mechanism of HR action. RESULTS: HR is an antiproliferative and antitumoral compound that inhibits the cell cycle via a p53- independent pathway. HR reduces tumor growth and aggression, mainly by decreasing mitosis and necrosis rates without genotoxicity, which is suggestive of epigenetic modulation. CONCLUSION: HR possesses antitumor activity and decreases anaplasia in glioblastoma, inhibiting progression to malignant stages of the disease. HR can improve the effectiveness of response to conventional therapy, which has a crucial role in recurrent glioma.

Survival Analysis in Elderly Patients with Glioblastomas: The Influence of Clinical Status, Tumor and Surgical Features

Introduction Glioblastomas are malignant neoplasms, notorious for their poor prognosis. We have conducted a survival analysis in a sample of elderly patients with glioblastomas. Methods The sample of the present study consisted of elderly patients consecutively admitted from January 2014 to January 2016 (24 months) at the Hospital do Servidor Público Estadual de São Paulo. We have evaluated the impact of age, Karnofsky scale (KS) score, tumor location, and occurrence of perioperative complications. Results A total of 42 patients were analyzed. Of these, 23 (54.7%) were men, and 19 (45.3%) were women. Patients > 60 years old, with low KS score, deep-seated tumors, and those with perioperative complications had worst outcomes. Discussion and conclusion Surgery, perioperative chemotherapy and radiotherapy add survival time and quality of life to these patients. In patients with low KS score, isolated radiotherapy and/or chemotherapy might be adequate. Decreasing perioperative complications is essential to adequately deliver adjuvant therapy in elderly patients.

Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma.

Epilepsy is a common symptom in patients with glioblastoma (GB). 213 patients with GB from RedLANO follow-up registry were included. All patients underwent surgery, if feasible, followed by chemoradiation based on temozolomide (Stupp platform). Information was recorded regarding demographics, seizure timing, anti-epileptic drugs (AEDs), dosage, time to next seizure, total seizures in 6 months, and main side effects of AEDs. The relationship between epilepsy treatment and overall survival (OS) was evaluated. Mean age was 53 years old and 56.8% were male. Seventy-eight patients (37%) were treated with levetiracetam (LEV), 27% were given another AED and 36% did not require any AED. Choice of AED was not associated with age (p = 0.67), performance status (p = 0.24) or anatomic tumor site (p = 0.34). Seizures and AED requirement were greater in those having primary GB (p = 0.04). After starting an AED, the mean time until next crisis was 9.9 days (SD ± 6.3), which was shorter in those receiving LEV (p = 0.03); mean number of seizures during the first 3 and 6 months were 2.9 and 4, respectively. Most patients treated with LEV (n = 46) required less than two medication adjustments compared to those treated with other AEDs (p = 0.02). Likewise, less patients exposed to LEV required a coadjuvant drug (p = 0.04). Additionally, patients receiving LEV had significantly less adverse effects compared to patients treated with another AED. OS was significantly higher in the group treated with LEV compared to other AEDs (25.5 vs. 17.9 months; p = 0.047). Patients treated with LEV had better seizure control and longer OS compared to other AEDs.

Role of the CHD7 chromatin remodeler protein in glioblastoma multiformePalavras-chave em inglês Cell motility / Papel do remodelador de cromatina CHD7 em glioblastoma multiforme

Chromatin remodeler proteins exert an important function in promoting dynamic modifications in the chromatin architecture, rendering the transcriptional machinery available to the condensed genomic DNA. Due to this central role in regulating gene transcription, deregulation of these molecular machines may lead to severe perturbations in the normal cell functions. Loss-of-function mutations in the CHD7 gene, a member of the chromodomain helicase DNA-binding (CHD) family, are the major cause of the CHARGE syndrome in humans. The disease is characterized by a variety of congenital anomalies, including malformations of the craniofacial structures, peripheral nervous system, ears, eyes and heart. In this context, several studies have already shown the importance of CHD7 for proper function of the neural stem cells (NSCs). Interestingly, we found that CHD7 mRNA levels are upregulated in gliomas, when compared to normal brain tissue, therefore, we hypothesized that CHD7 might have a role in the pathogenesis of these tumors. To investigate the possible oncogenic role of CHD7 in glioblastoma (GBM), we adopted gain- and loss-of-function approaches in adherent GBM cell lines. Using CRISPR_Cas9 genome editing, we found that CHD7 deletion suppresses anchorage-independent growth and reduces spheroid invasion in human LN-229 cells. Moreover, deletion of CHD7 delayed tumor growth and improved overall survival in an orthotopic xenograft glioma mouse model. Conversely, ectopic overexpression of CHD7 in LN-428 and A172 cells was found to increase cell motility and invasiveness in vitro and LN-428 tumor growth in vivo. RNAseq analysis showed that alterations of CHD7 expression levels promote changes in several molecular pathways and modulate critical genes associated with cell adhesion and locomotion. However, the mechanisms underlying the effects of CHD7 overexpression in glioma tissue are still not understood. Here, we also generated recombinant plasmid with functional CHD7 promoter activity reported by luciferase assay. This powerful tool should enable future studies to determine the direct targeting relationship between different signal transduction pathways and CHD7 geneexpression. In summary, our findings indicate that GBM cells expressing a high level of CHD7 may exist and contribute to tumor infiltration and recurrence. Further studies should warrant important clinical-translational implications of our findings for GBM treatment

As proteínas remodeladoras de cromatina exercem importante papel, promovendo modificações dinâmicas na arquitetura da cromatina e dando acesso à maquinaria transcricional ao DNA genômico condensado. Devido à esta função central na regulação da transcrição gênica, a desregulação dessas máquinas moleculares pode levar a perturbações graves na função normal das células. Assim, por exemplo, mutações do tipo perda de função no gene CHD7, um membro da família "chromodomain helicase DNA-binding" (CHD), são a principal causa da síndrome de CHARGE em humanos. A doença é caracterizada por uma variedade de anomalias congênitas, incluindo malformações das estruturas craniofaciais, sistema nervoso periférico, orelhas, olhos e coração. Neste contexto, vários estudos já mostraram a importância da proteína CHD7 para o funcionamento normal de células-tronco neurais (NSCs). Curiosamente, descobrimos que os níveis de mRNA de CHD7 estão mais fortemente expressos em gliomas, quando comparados ao tecido cerebral normal, portanto, nós hipotetizamos que CHD7 poderia ter um papel na patogênese desses tumores. Para investigar o possível papel oncogênico de CHD7 em glioblastoma (GBM), utilizamos enfoques de ganho e perda de função em linhagens celulares aderentes de GBM. Utilizando a técnica de CRISPR_Cas9 para edição do genoma, demonstramos que a deleção do gene CHD7 suprime o crescimento independente de ancoragem e reduz a invasão de esferóides em células LN-229 humanas de GBM. Além disso, a deleção de CHD7 reduziu o crescimento do tumor e melhorou a sobrevida em modelo de injeção ortotópica xenográfica em camundongo. Por outro lado, verificou-se que a super-expressão ectópica de CHD7 nas células LN-428 e A172 aumenta não só a motilidade celular e a capacidade de invasão in vitro, mas, também, o crescimento do tumor de LN-428 in vivo. A análise de RNA-seq mostrou que o nocauteamento da sequência codificadora de CHD7 e sua super-expressão promovem alterações em diversas vias moleculares, modulando genes críticosassociados à adesão e locomoção celular. No entanto, os mecanismos subjacentes aos efeitos da super-expressão de CHD7 em tecidos de glioma ainda não são compreendidos. Neste trabalho, geramos um plasmídeo recombinante contendo um fragmento da região promotora de CHD7, o qual se mostrou funcional em ensaios de luciferase. Esta ferramenta permitirá que estudos futuros possam identificar a relação direta entre as diferentes vias de transdução de sinal e a expressão do gene CHD7. Em resumo, nossos achados indicam que células de GBM expressando um alto nível de CHD7 podem existir e contribuir para a infiltração e recorrência do tumor. Estudos posteriores deverão avaliar as possíveis implicações dos resultados apresentados neste trabalho para a translação clínica no tratamento de pacientes com GBM

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

Objective Glioblastoma multiforme (GBM) is an aggressive primary tumor with frequent recurrences that leaves patients with a short survival time and a low quality of life. The aim of this study was to review the prognostic factors in patients with glioblastoma multiforme. Material and Methods The focus of this retrospective study was a group of 153 patients with supratentorial GBM tumors, who were admitted to a tertiary-care referral academic center from 2005 to 2013. The factors associated with survival and local recurrence were assessed using the hazard ratio (HR) function of Cox proportional hazards regression and neural network analysis. Results Out of the 153 patients, 99 (64.7%) weremale. The average age of the patients was 55.69 15.10 years. The median overall survival (OS) and progression-free survival (PFS) rates were 14.0 and 7.10 months respectively. In the multivariate analysis, age (HR » 2.939, p < 0.001), operative method (HR » 7.416, p < 0.001), temozolomide (TMZ, HR » 11.723, p < 0.001), lomustine (CCNU, HR » 8.139, p < 0.001), occipital lobe involvement (HR » 3.088, p < 0.001) and Karnofsky Performance Status (KPS, HR » 4.831, p < 0.001) scores were shown to be significantly associated with a higher OS rate. Furthermore, higher KPS (HR » 7.292, p < 0.001) readings, the operative method (HR » 0.493, p » 0.005), the use of CCNU (HR » 2.047, p » 0.003) and resection versus chemotherapy (HR » 0.171, p < 0.001) were the significant factors associated with the local recurrence of the tumor. Conclusion Our findings suggest that the use of CCNU and TMZ, the operative method and higher KPS readings are associated with both higher survival and lower local recurrence rates.

Objetivo Glioblastoma multiforme (GBM) é um tumor primário agressivo com recorrências frequentes que deixam pacientes com uma curta sobrevida e baixa qualidade de vida. O objetivo deste estudo é rever fatores de prognóstico em pacientes com glioblastoma multiforme. Material e Métodos O foco deste estudo retrospectivo foi um grupo de 153 pacientes com tumores GBM supratentoriais, os quais deram entrada em um centro acadêmico de atendimento de referência de 2005 a 2013. Fatores associados com a sobrevivência e a recorrência local foram avaliados usando a razão de risco (RR) da regressão de risco proporcional de Cox e análise de redes neurais. Resultados Dos 153 pacientes, 99 (64,7%) eram homens. A média de idade foi de 55,69 15,10 anos. A sobrevida geral (SG) mediana e a sobrevida de livre progressão (SLP) foram 14,0 e 7,10 meses, respectivamente. Na análise multivariada, idade (RR » 2,939, p < 0,001), método operatório (RR » 7,416, p < 0,001), temozolomida (TMZ, RR » 11,723, p < 0,001), lomustina (CCNU, RR » 8,139, p < 0,001), envolvimento do lobo occipital (RR » 3,088, p < 0,001) e Índice de Desempenho de Karnofsky (IDK, RR » 4,831, p < 0,001) foram identificados como significativamente associados a uma SG maior. Além disso, leituras maiores de IDK (RR » 7,292, p < 0,001), o método operatório (RR » 0,493, p » 0,005), o uso de CCNU (RR » 2,047, p » 0,003) e ressecção versus quimioterapia (RR » 0,171, p < 0,001) foram fatores significativos associados à recorrência local de tumor. Conclusão Nossos resultados sugerem que o uso de CCNU e TMZ, o método operatório e leituras maiores de IDK estão associados tanto à maior sobrevida quanto à menor recorrência local.

Mecanismos moleculares da interação entre betalaínas cumarínicas fluorescentes e células de glioma humano / Molecular mechanisms of interaction between fluorescent coumarinic betalains and human glioma cells

Moléculas orgânicas fluorescentes são uma importante ferramenta para biologia celular. Compostos ideais para esta aplicação devem ter alto brilho (produto do coeficiente de atenuação molar e do rendimento quântico de fluorescência), ser fotoestáveis e internalizáveis, não comprometer a viabilidade celular e interagir com biomoléculas com algum grau de especificidade. Nesta Tese de Doutorado é apresentado o estudo do uso de cBeet120, uma betalaína cumarínica artificial, e células de glioma humano da linhagem U87-MG. Betalaínas são pigmentos de plantas que apresentam alta biocompatibilidade que servem como material de partida para o desenvolvimento de derivados funcionais. A sonda se acumula principalmente no núcleo das células U87- MG e marca principalmente nucléolos via interação com proteínas. A presença de DNAse ou RNAase elimina a marcação nuclear, sem afetar a fraca marcação citoplasmática de fundo. Estudos de inibição de transporte sugerem que cBeet120 é internalizada por transportadores de L-glutamato da família de transportadores de amino ácidos excitatórios (EAAT). O uso de artemisinina para inibição Ca2+-ATPases aumenta a velocidade de internalização de cBeet120 em células U87-MG. Quando irradiada com luz de cor ciano, cBeet120 no interior do núcleo de células vivas é fotoativada, resultando em um aumento da intensidade de fluorescência com o tempo (monitorado por 90 min) e o deslocamento hipsocrômico do máximo de emissão. Em células fixadas com paraformaldeído, o padrão de marcação da célula se torna mais difuso e a sonda emite fluorescência sem fotoativação. Medidas de tempo de vida de fluorescência em solução e imageamento por microscopia de tempo de vida de fluorescência permitem inferir a ocorrência da formação de um complexo proteína-cBeet120 ou um produto de transiminação que pode estar sujeito a isomerização cis/trans

Fluorescent organic molecules are an important tool for cell biology. Ideal compounds for this application must have high brightness (product of the molar attenuation coefficient and fluorescence quantum yield), be photostable and internalizable by cells, do not compromise cellular viability and interact with biomolecules with some degree of specificity. In this Doctorate Thesis, we describe the interaction of cBeet120, an artificial coumarinic betalain, and human glioma cells of line U87-MG. Betalains are plant pigments that exhibit high biocompatibility that serve as starting material for the development of functional derivatives. The probe accumulates mainly in the nucleus of the U87-MG cells and mainly marks nucleoli via interaction with proteins. The presence of DNAse or RNAase eliminates nuclear labeling, without affecting the poor background cytoplasmic labeling. Transport inhibition studies suggest that cBeet120 is internalized by L-glutamate transporters from the excitatory amino acid transporter (EAAT) family. The use of artemisinin for inhibition Ca2+-ATPases increases the rate of cBeet120 internalization in U87-MG cells. When irradiated with cyan colored light, cBeet120 within the nucleus of living cells is photoactivated, resulting in an increase in fluorescence intensity over time (monitored for 90 min) and the hypochromic shift of the emission maximum. In cells fixed with paraformaldehyde, the labeling pattern of the cell becomes more diffuse and the probe emits fluorescence without photoactivation. Fluorescence life-time measurements in solution and fluorescence life-time imaging microscopy allows to infer the occurrence of the formation of a protein-cBeet120 complex or the formation of a transimination product that may be subject to cis/trans isomerization

Sarcoma radioinduzido pós-tratamento de glioblastoma: relato de caso / Radiation induced sarcoma after treatment of glioblastoma: case report / Sarcoma inducido por la radiación después del tratamiento de glioblastoma: reporte de un caso

Introdução: O glioblastoma multiforme é a neoplasia de sistema nervoso central mais letal, com sobrevida média em torno de 13 meses e a de pior prognóstico dentre todos os gliomas. A abordagem terapêutica do glioblastoma consiste em neurocirurgia com ressecção máxima possível do volume tumoral, seguida de radioterapia e quimioterapia. A radioterapia reduz o risco de recidiva tumoral por meio de lesão direta e indireta ao ácido desoxirribonucleico tumoral. Os efeitos em longo prazo da radioterapia incluem necrose tecidual, vasculopatia e neoplasia induzida pela radiação. Os tumores malignos intracranianos secundários mais reportados incluem meningiomas, gliomas e sarcomas. O período de latência entre a radioterapia de crânio e o surgimento de lesões radioinduzida varia na literatura entre seis meses a 47 anos, com média de 18,7 anos. Relato de caso: O presente relato descreve o surgimento de sarcoma fusocelular de alto grau radioinduzido após dez meses em paciente que recebeu tratamento de glioblastoma no Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo. Conclusão: A raridade dessa associação se deve provavelmente à baixa sobrevida dos pacientes com glioblastoma, limitando assim o tempo para desenvolvimento de neoplasias secundárias.

Introduction: Glioblastoma multiforme and neoplasia is the deadliest cancer of the central nervous system, with survival rates averaging around 13 months and it shows the worst prognosis among all gliomas. The therapeutic approach of glioblastoma is based on a full neurosurgical resection of the tumor volume followed by radiotherapy and chemotherapy. Radiotherapy reduces the risk of recurrence by direct and indirect deoxyribonucleic acid damage of the tumor. The long-term effects of radiotherapy include tissue necrosis, vascular injury and neoplasia induced by radiation. The majority of secondary intracranial tumors and most commonly reported include meningiomas, gliomas and sarcomas. The latency period between the cranial radiotherapy and the onset of radiation-induced injuries in the literature varies between six months to 47 years, with an average of 18.7 years. Case report: This report describes the onset of spindle cell sarcoma of highly radiation-induced after ten months in a patient who received treatment of Glioblastoma at the General Hospital of the University of Sao Paulo Medical School, Ribeirao Preto. Conclusion: The rarity of this association is probably due to poor survival of patients with Glioblastoma, thus limiting the time for development of secondary malignancies.

Introducción: El glioblastoma multiforme es el cáncer más mortal del sistema nervioso central, con una supervivencia media acerca de 13 meses, y tiene el peor pronóstico entre todos los gliomas. El enfoque terapéutico del glioblastoma es la resección neurocirugica completo del volumen del posible tumor, seguido por radioterapia y quimioterapia. La radioterapia reduce el riesgo de reincidencia debido a daño directo e indirecto para el ácido desoxirribonucleico del tumor. Los efectos a largo plazo de la terapia de radiación incluyen necrosis de los tejidos, lesión vascular y el cáncer inducido por radiación. Los tumores intracraneales malignos secundarios más comunes incluyen meningiomas, gliomas y sarcomas. El período de latencia entre la radioterapia craneal y la aparición de las lesiones inducidas por radio en la literatura varía entre seis meses a 47 años, con una media 18,7 años. Caso clínico: Este caso describe la aparición de sarcoma de células fusiformes de grado alto inducida por radiación después de diez meses en un paciente que recibió tratamiento de glioblastoma en el Hospital das Clínicas de Ribeirão Preto, de la Universidad de Sao Paulo. Conclusión: Esta asociación poco común es probablemente debida a la mala supervivencia de los pacientes con glioblastoma, lo que limita el tiempo para el desarrollo de neoplasias malignas secundarias.

Vasculitis paraneoplásica. Presentación de 2 casos clínicos / Paraneoplastic vasculitis. Presentation of two clinical case

Las vasculitis constituyen un grupo heterogéneo de enfermedades que se definen por un proceso inflamatorio de la pared vascular, con obstrucción y necrosis distal. Son poco frecuentes y pueden ser primarias o asociadas a infecciones, enfermedades sistémicas o excepcionalmente a neoplasias. La asociación de vasculitis y neoplasia es infrecuente; la vasculitis se presentaantes, de forma concomitante o posteriormente al diagnóstico de la neoplasia. Las más frecuentemente asociadas son las de origen hematooncológico y luego, en menor medida, los tumores sólidos. Las manifestaciones cutáneas por afectación de “pequeño vaso” son las más habituales, y dentro de ellas las leucocitoclásticas. Se presentan 2 casos clínicos excepcionales de vasculitis paraneoplásicas, el primer caso se trata de una paciente de 57 años con lesiones vasculíticas de pequeño vaso asociadas a cáncer broncopulmonar y el segundo caso se trata de una paciente de 79 años con diagnóstico previo de glioblastoma encefálico de alto grado y lesiones en miembros inferiores con características de vasculitis de pequeño vaso.

Vasculitis paraneoplásica. Presentación de 2 casos clínicos / Paraneoplastic vasculitis. Presentation of two clinical case

Las vasculitis constituyen un grupo heterogéneo de enfermedades que se definen por un proceso inflamatorio de la pared vascular, con obstrucción y necrosis distal. Son poco frecuentes y pueden ser primarias o asociadas a infecciones, enfermedades sistémicas o excepcionalmente a neoplasias. La asociación de vasculitis y neoplasia es infrecuente; la vasculitis se presentaantes, de forma concomitante o posteriormente al diagnóstico de la neoplasia. Las más frecuentemente asociadas son las de origen hematooncológico y luego, en menor medida, los tumores sólidos. Las manifestaciones cutáneas por afectación de “pequeño vaso” son las más habituales, y dentro de ellas las leucocitoclásticas. Se presentan 2 casos clínicos excepcionales de vasculitis paraneoplásicas, el primer caso se trata de una paciente de 57 años con lesiones vasculíticas de pequeño vaso asociadas a cáncer broncopulmonar y el segundo caso se trata de una paciente de 79 años con diagnóstico previo de glioblastoma encefálico de alto grado y lesiones en miembros inferiores con características de vasculitis de pequeño vaso.

Vasculitis paraneoplásica: presentación de 2 casos clínicos / Paraneoplastic vasculitis: presentation of two clinical case

Las vasculitis constituyen un grupo heterogéneo de enfermedades que se definen por un proceso inflamatorio de la pared vascular, con obstrucción y necrosis distal. Son poco frecuentes y pueden ser primarias o asociadas a infecciones, enfermedades sistémicas o excepcionalmente a neoplasias. La asociación de vasculitis y neoplasia es infrecuente; la vasculitis se presentaantes, de forma concomitante o posteriormente al diagnóstico de la neoplasia. Las más frecuentemente asociadas son las de origen hematooncológico y luego, en menor medida, los tumores sólidos. Las manifestaciones cutáneas por afectación de “pequeño vaso” son las más habituales, y dentro de ellas las leucocitoclásticas. Se presentan 2 casos clínicos excepcionales de vasculitis paraneoplásicas, el primer caso se trata de una paciente de 57 años con lesiones vasculíticas de pequeño vaso asociadas a cáncer broncopulmonar y el segundo caso se trata de una paciente de 79 años con diagnóstico previo de glioblastoma encefálico de alto grado y lesiones en miembros inferiores con características de vasculitis de pequeño vaso.

Vasculitis constitutes a heterogeneous group of diseases that are defined by an inflammatory process of the vascular wall, with occlusion and distal necrosis. They are rare and may be primary or secondary infections, systemic disease or exceptionally to neoplasic disease. The association of vasculitis and neoplasia is uncommon; vasculitis occurs before, concomitantly or subsequently to the diagnosis of neoplasia. The most frequently associated are the hemato-oncology and then to a lesser extent the solid tumors. Cutaneous manifestations by affectation of “small vessel” are the most common. We present 2 exceptional clinical cases of vasculitis associated with cancer, the first case is about a 57 years old patient with lesions of small vessel associated with bronchopulmonary cancer and the second case is a 79 years old patient diagnosed with brain glioblastoma of high-grade and injuries in lower limbs with characteristics of small vessel vasculitis.

The growth of glioblastoma orthotopic xenografts in nude mice is directly correlated with impaired object recognition memory.

Cognitive dysfunction is found in patients with brain tumors and there is a need to determine whether it can be replicated in an experimental model. In the present study, the object recognition (OR) paradigm was used to investigate cognitive performance in nude mice, which represent one of the most important animal models available to study human tumors in vivo. Mice with orthotopic xenografts of the human U87MG glioblastoma cell line were trained at 9, 14, and 18days (D9, D14, and D18, respectively) after implantation of 5×10(5) cells. At D9, the mice showed normal behavior when tested 90min or 24h after training and compared to control nude mice. Animals at D14 were still able to discriminate between familiar and novel objects, but exhibited a lower performance than animals at D9. Total impairment in the OR memory was observed when animals were evaluated on D18. These alterations were detected earlier than any other clinical symptoms, which were observed only 22-24days after tumor implantation. There was a significant correlation between the discrimination index (d2) and time after tumor implantation as well as between d2 and tumor volume. These data indicate that the OR task is a robust test to identify early behavior alterations caused by glioblastoma in nude mice. In addition, these results suggest that OR task can be a reliable tool to test the efficacy of new therapies against these tumors.

High prevalence of HCMV and viral load in tumor tissues and peripheral blood of glioblastoma multiforme patients.

Glioblastoma multiforme is the most prevalent and malignant tumor of the central nervous system. In the last few years, accumulating evidence has suggested an association between human cytomegalovirus (HCMV) infection and glioblastoma multiforme. In this study, tumor tissues and peripheral blood of patients with glioblastoma multiforme were examined for the presence of HCMV DNA. Twenty-two fresh surgical brain specimens and 20 peripheral blood samples were analyzed by real-time PCR (qPCR) and hemi-nested PCR (nPCR) for the presence of pp65 and (glycoprotein B) gB viral genomic regions, respectively. HCMV DNA was detected in the majority of the tumor samples analyzed (95% by qPCR and 91% by nPCR). About half of the patients with tumors positive for HCMV also had detectable viral DNA in their peripheral blood (47% by qPCR and 61% by nPCR). Genome copy numbers were determined and in the majority of the tumor samples cellular DNA outnumbers viral DNA (average of 1 infected cell in 33 cells). The gB genotypes were determined in HCMV-positive samples and gB2 was the most prevalent genotype in the tumor and blood samples. The results show a high prevalence of HCMV in glioblastoma multiforme samples reinforcing a possible association between HCMV infection and tumor development.

Cisto assintomático em região da valécula: relato de caso / Asymptomatic vallecular cyst: case report / Quiste valecular asintomático: relato de caso

Paciente do sexo masculino, 56 anos, apresentou-se para excisão de glioblastoma intracraniano multiforme. Após ser rotineiramente monitorado, o paciente foi pré-oxigenado. Anestesia e paralisia foram induzidas com propofol (200 mg), fentanil (50 µg) e vecurônio (9 mg). Laringoscopia direta com lâmina Macintosh número 3 revelou um cisto pedunculado de 2x2 cm, que surgia do lado direito da valécula e impedia a intubação endotraqueal. Enquanto o paciente permanecia anestesiado, consultamos rapidamente um otorrinolaringologista e o cisto foi aspirado por uma seringa com agulha de calibre 22G sob laringoscopia direta. Aspiramos 10 cc de líquido. Intubação traqueal foi feita em seguida sem intercorrências com sonda de 9,0 aramada e com balão. Uma opção para a intubação com fibra óptica pode ser a aspiração cuidadosa do cisto para facilitar a intubação.

A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 µg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.

Un paciente del sexo masculino, de 56 años, llegó para una resección de glioblastoma intracraneal multiforme. Posteriormente a la rutina de monitorización, el paciente fue pre-oxigenado. La anestesia y la parálisis se indujeron con propofol (200 mg), fentanilo (50 µg) y vecuronio (9 mg). La laringoscopia directa con lámina 3 Macintosh arrojó un quiste pedunculado de 2x2 cm que surgía al lado derecho de la valécula e impedía la intubación endotraqueal. Mientras el paciente permanecía anestesiado, consultamos rápidamente un otorrinolaringólogo y el quiste fue aspirado por una jeringa con una aguja calibre 22G bajo laringoscopia directa. Aspiramos 10 cc de líquido. La intubación traqueal se hizo enseguida sin intercurrencias con una sonda de 9,0 y un alambre en espiral y con balón. Una opción para la intubación con fibra óptica puede ser la aspiración cuidadosa del quiste para facilitar la intubación.

Síndrome de Turcot: relato de caso e achados da imunoistoquímica / Turcot's syndrome: case report and immunohistochemical findings

A síndrome da polipose intestinal associada a tumor cerebral também é conhecida como síndrome de Turcot. Relata-se o caso de um paciente de 65 anos portador de polipose colônica hereditária e que desenvolveu sinais e sintomas neurológicos devido a glioblastoma multiforme cerebral. Destacam-se os achados imunoistoquímicos da lesão cerebral.

Intestinal polyposis syndrome associated with brain tumor, also known as Turcot's syndrome. We report a patient of 65 years old with hereditary colonic polyposis and developed neurological signs and symptoms due glioblastoma multiforme. We highlight the immunohistochemical findings of brain injury.

Desarrollo de glioblastoma multiforme tras una hemorragia intracerebral: reporte de un caso / Development of glioblastoma multiforme after intracerebral hemorrhage: case report

Varios factores han sido implicados como posibles causantes del desarrollo de tumores cerebrales; son pocos los autores que han proporcionado evidencia de la etiología traumática de un tumor cerebral. Presentamos el caso de un paciente masculino de 30 años quien se presento con un cuadro clínico de cefalea intensa de 15 días de evolución. Los estudios imagenológicos (TAC, RMN) revelaron lesión frontal intra axial. Se le realizo resección total de la lesión, cuyo resultado de patología fue compatible con glioblastoma multiforme. El paciente tenía antecedente de hemorragia intracerebral espontanea hacia 7 meses en el mismo lugar del tumor. Basados en la literatura en relación a glioblastoma multiforme y lesión traumática o vascular cerebral, hacemos una revisión crítica de ella.

Glioblastoma multiforme e infecção pelo HIV: associação coincidente ou possível influência oncogênica? / Glioblastoma multiforme and Acquired Immunodeficiency Syndrome: coincidental association or a possible oncogenic influence?

O glioblastoma multiforme é o tumor cerebral primário glial mais maligno em adultos e de altaincidência dentre os tipos de astrocitomas, mas geralmente não é incluído no diagnóstico diferencial das lesões do sistema nervoso central em pacientes com o vírus da imunodeficiência humana (HIV). Alguns estudos têm descrito a associação entre glioblastoma e HIV. Relato do caso: Trata-se de glioblastoma em um homem de 31 anos de idade com HIV. Outras possíveis lesões, como o linfoma, foram sugeridas como diagnóstico diferencial, mas a investigação histopatológica confirmou tratar-se de glioblastoma. Esse paciente, submetido à cirurgia, evoluiu bem, sem déficits neurológicos no pós-cirúrgico imediato, e exames clínicos e de neuroimagem não mostraram sinais de recorrência até três meses de pós--operatório. Terapia adjuvante com radiação externa foi recomendada para o paciente.

Glioblastoma multiforme is the most malignant primary brain glial tumour in adults with high incidence among astrocytomas, but usually it is not included in the differential diagnosis of the central nervous system lesions in patients with Human Immunodeficiency Virus (HIV). Some studies have described the association of glioblastoma and HIV. Case report: It is reported a case of glioblastomas in a 31 year old man with HIV. Mass lesions such as lymphoma were suggested as differential diagnosis, but the histopathology confirmed the diagnosis of glioblastoma. This patient was operated with good neurological evolution immediately after surgery; no clinical or neuroimaging signs of recurrence were observed up to 3 months post-operatively. Adjuvant external radiation therapy was commenced for the patient.