Recurrent non-functioning pituitary adenomas: a review on the new pathological classification, management guidelines and treatment options.

At least 50% of surgically resected non-functioning pituitary adenomas (NFPA) recur. Either early or late adjuvant radiotherapy is highly efficacious in controlling recurrent NFPA but associates potentially burdensome complications like hypopituitarism, vascular complications or secondary neoplasm. Reoperation is indicated in bulky tumor rests compressing the optic pathway. To date, no standardized medical therapy is available for recurrent NFPA although cabergoline and temozolomide show promising results. Guidelines on the management of recurrent NFPAs are now available. The new 2017 WHO pituitary tumor classification, based on immunohistochemistry and transcription factor assessment, identifies a group of aggressive NFPA variants that may benefit from earlier adjuvant therapy. Nevertheless, NFPA patients exhibit a reduced overall life expectancy largely due to hypopituitarism and treatment-related morbidity. The management of recurrent NFPA benefits from a multidisciplinary teamwork of surgeons, endocrinologists, radiation oncologists, ophthalmologists, pathologists and neuro-radiologists in order to provide individualized therapy and anticipate deterioration.

Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies.

The management of diffuse supratentorial WHO grade II glioma remains a challenge because of the infiltrative nature of the tumor, which precludes curative therapy after total or even supratotal resection. When possible, functional-guided resection is the preferred initial treatment. Total and subtotal resections correlate with increased overall survival. High-risk patients (age >40, partial resection), especially IDH-mutated and 1p19q-codeleted oligodendroglial lesions, benefit from surgery plus adjuvant chemoradiation. Under the new 2016 WHO brain tumor classification, which now incorporates molecular parameters, all diffusely infiltrating gliomas are grouped together since they share specific genetic mutations and prognostic factors. Although low-grade gliomas cannot be regarded as benign tumors, large observational studies have shown that median survival can actually be doubled if an early, aggressive, multi-stage and personalized therapy is applied, as compared to prior wait-and-see policy series. Patients need an honest long-term therapeutic strategy that should ideally anticipate neurological, cognitive and histopathologic worsening.

[Neurosarcoidosis. Apropos of a case and review of the literature]. / Neurosarcoidosis. A propósito de un caso y revisión de la literatura.

INTRODUCTION: Sarcoidosis is a disease of unknown cause, characterized by the presence of non-caseating granulomas in many organs. Neurological involvement is rare and only occurs in 5-7% of the patients, usually during the first two years after onset of the disease. The neurological findings vary depending on the site of the lesions. The treatment of choice is with glucocorticoids for at least 6-12 months. Some patients in whom this treatment fails or leads to intolerable side-effects may respond well to immunosuppressive drugs and/or radiotherapy. CLINICAL CASE: We present the case of a 31 year old man who complained of severe headache. He was referred to our department with the diagnosis of neurosarcoidosis and progressive neurological deterioration on conventional treatment. Holocranial radiotherapy with Co60 (30 Gy in 10 sessions) was given. Three months after this treatment had been given there was clinical improvement. CONCLUSIONS: Radiotherapy may be an effective alternative when other treatment fails or glucocorticoids cause intolerable toxicity. The recommended dose is between 12 and 30 Gy, divided into 150-300 cgy/day.

[Transtympanic ventilation tubes and serous otitis media. Study of 100 cases]. / Tubos de ventilación transtimpánicos y otitis media serosa. Estudio en 100 casos.

The purpose of this study has been to evaluate the use of 100 ventilation tubes in the treatment of 60 patients with secretory otitis media. A study of the course, the complications and the sequelae has been realized. It is concluded that the use of ventilation tubes is justified in our patients.