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1.
J Forensic Sci ; 65(1): 314-317, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31361917

RESUMO

Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.


Assuntos
Neoplasias Encefálicas/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias Vasculares/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Erros de Diagnóstico , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Linfoma Difuso de Grandes Células B/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/diagnóstico , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia
3.
J Pediatr Ophthalmol Strabismus ; 56: e79-e83, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31821513

RESUMO

Russell diencephalic syndrome is a condition in which infants become emaciated in the setting of a decreased or normal caloric intake as the result of a hypothalamic astrocytoma. The diagnosis may be delayed if providers initially attribute the symptoms to a behavioral disorder. The detection of nystagmus, which is present in many patients, may be a critical diagnostic clue. The authors describe two patients in whom the discovery of nystagmus months after the onset of emaciation led to the diagnosis of Russell diencephalic syndrome. [J Pediatr Ophthalmol Strabismus. 2019;56:e79-e83.].


Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Nistagmo Patológico/etiologia , Astrocitoma/diagnóstico , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Nistagmo Patológico/diagnóstico , Síndrome
4.
Medicine (Baltimore) ; 98(50): e18194, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852075

RESUMO

OBJECTIVE: To date, there are several published studies on the value of IDH-1 (isocitrate dehydrogenase-1) mutation and MGMT (O6-Methylguanine-DNA methyltransferas) promoter methylated status on the diagnosis of pseudoprogression (PSP) and true tumor progression after or within chemo-radiotherapy of high grade glioma (HGG). We performed a meta-analysis about the significant value of these 2 molecular markers on the diagnosis of PsP in high- grade glioma. METHODS: We searched the eligible studies from PubMed, Medline, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wan Fang Database. The relevant studies published before October 2018 were identified. ORs (odds ratios) with 95%CIs (confidence intervals) were used to evaluate the value using fixed- or random-effect model. RESULTS: Thirteen studies about MGMT promoter methylated status and 4 studies about IDH-1 mutations were found eligible for this present meta-analysis. Significant value of MGMT promoter methylation status (OR = 4.02, 95%CI = 2.76-5.87, P < .001) and IDH-1 mutations (OR = 12.78, 95%CI = 3.86-42.35, P < .001) were observed. CONCLUSIONS: This meta-analysis provided evidences that MGMT promoter methylation status and IDH-1 mutations could distinguish PSP from true tumor progression.


Assuntos
Neoplasias Encefálicas/genética , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , DNA de Neoplasias/genética , Glioma/genética , Isocitrato Desidrogenase/genética , Mutação , Estadiamento de Neoplasias , Proteínas Supressoras de Tumor/genética , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/metabolismo , Metilação de DNA , Metilases de Modificação do DNA/metabolismo , Enzimas Reparadoras do DNA/metabolismo , DNA de Neoplasias/metabolismo , Progressão da Doença , Glioma/diagnóstico , Glioma/metabolismo , Humanos , Isocitrato Desidrogenase/metabolismo , Regiões Promotoras Genéticas , Proteínas Supressoras de Tumor/metabolismo
5.
Medicine (Baltimore) ; 98(50): e18306, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852112

RESUMO

This retrospective analysis of patients aims to show the blood levels of preoperative inflammatory markers in patients with glioblastoma and brain metastasis and to provide the diagnostic accuracy of the neutrophil-lymphocyte (NLR), lymphocyte-monocyte (LMR), and platelet-lymphocyte (PLR) ratios between the 2 groups of patients.The retrospective reviews of the neutrophil, lymphocyte, monocyte, and platelet counts were analyzed in 80 patients with newly diagnosed glioblastoma and 70 patients with brain metastasis. The NLR, LMR, and PLR were calculated in each group. The differences in all the parameters were compared between the 2 groups.Although the neutrophil, monocyte, and platelet counts were higher and the lymphocyte count was lower in patients with metastasis, the difference was not significant. A significantly higher PLR (P = .004) and a lower LMR (P = .01) were found in patients with brain metastasis. Although both PLR and LMR had diagnostic accuracy in differentiating glioblastoma from brain metastasis, LMR showed the highest diagnostic accuracy. NLR showed no diagnostic accuracy.Systemic inflammation is more severe in glioblastoma than in brain metastasis, and LMR is more sensitive and/or specific than PLR in differentiating glioblastoma from brain metastasis. Therefore, LMR (less likely PLR) can be used as an index for differentiating between glioblastoma and brain metastasis before surgery.


Assuntos
Plaquetas/patologia , Neoplasias Encefálicas/secundário , Glioblastoma/diagnóstico , Linfócitos/patologia , Monócitos/patologia , Procedimentos Neurocirúrgicos , Neutrófilos/patologia , Biomarcadores Tumorais/sangue , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Feminino , Seguimentos , Glioblastoma/cirurgia , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Contagem de Plaquetas , Período Pré-Operatório , Estudos Retrospectivos
7.
Pan Afr Med J ; 33: 194, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692738

RESUMO

Mass lesions of the brain are not always a tumor. We report the case of a patient followed for Behcet syndrome presenting with expansive intracranial process revealed by right hemiparesis associated with signs of intracranial hypertension. Brain magnetic resonance imaging (MRI) showed a lesion suggesting glial tumor. Clinical and radiological assessments as well as laboratory tests helped to establish the diagnosis of pseudo-tumor form of neuro-Behçet disease. This study report is followed by a clinical analysis based on the available literature on this disorder.


Assuntos
Síndrome de Behçet/diagnóstico , Neoplasias Encefálicas/diagnóstico , Pseudotumor Cerebral/diagnóstico , Síndrome de Behçet/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
8.
Pan Afr Med J ; 34: 23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762892

RESUMO

Central nervous system tuberculosis is a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is rare and is one of the most severe cases of tuberculosis. We present two cases. The first one is about a girl of 7 years, followed for 5 months for lymph nodes tuberculosis on anti-TB treatment that presents generalized tonic-clonic seizures associated with progressive intracranial hypertension syndrome. Brain MRI has objectified necrotic nodules in left hemisphere. The surgical approach of the lesions was direct with complete excision. The diagnosis of tuberculoma was confirmed by anatomopathological examination. The second case is about a 6-year-old girl with no particular medical history, which presents for three months progressive and treatment-resistant cervico-occipital headaches associated with walking difficulties. The MRI objectified left cerebellar tumor process interpreted preoperatively as medulloblastoma. The patient was operated on intraoperative, appearance was that of a nodular lesion. Anatomopathological examination confirmed the diagnosis. The intracranial tuberculoma is an unusual variety of the central nervous system tuberculosis and remains a topical issue in Morocco. The prognosis depends on prompt diagnosis, quality of surgical resection and anti-TB treatment. The diagnostic confirmation is histological and should therefore be evoked infront of any intracranial process mimicking a brain tumor.


Assuntos
Antituberculosos/administração & dosagem , Neoplasias Encefálicas/diagnóstico , Tuberculoma Intracraniano/diagnóstico , Criança , Terapia Combinada , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Meduloblastoma/diagnóstico , Convulsões/etiologia , Tuberculoma Intracraniano/terapia
9.
World Neurosurg ; 131: 328-338, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658576

RESUMO

Glioblastomas are the most common malignant brain tumor and despite extensive research have a dismal prognosis. This review focuses on the current treatment paradigms of glioblastoma and highlights current advances in surgical approaches, imaging techniques, molecular diagnostics, and translational efforts. Several promising clinical trials in immunotherapy and personalized medicine are discussed and the importance of quality of life in the patients and their caregivers both during active treatment and survivorship is also commented on.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Ensaios Clínicos como Assunto , Fracionamento da Dose de Radiação , Feminino , Previsões , Glioblastoma/diagnóstico , Humanos , Imunoterapia/métodos , Imunoterapia/tendências , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Masculino , Terapia de Alvo Molecular/tendências , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/tendências , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Qualidade de Vida , Fatores de Risco
10.
Medicine (Baltimore) ; 98(42): e17515, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626111

RESUMO

Glioblastoma multiforme (GBM) is difficult to be separated from solitary brain metastasis (sBM) in clinical practice. This study aimed to distinguish two entities by the histogram analysis of absolute cerebral blood volume (CBV) map.From March 2016 to June 2018, 24 patients with GBM and 18 patients with sBM were included in this retrospective study. The enhancing area was first segmented on the post-contrast T1WI, then the segmentation was copied to the absolute CBV map and histogram analysis was finally performed. Unpaired t test was used to select the features that could separate two entities and receiving operating curve was used to test the diagnostic performance. Finally, a machine learning method was used to test the diagnostic performance combing all the selected features.Six of 19 features were feasible to distinguish GBM from sBM (all P < .001), among which energy had the highest diagnostic performance (area under curve, 0.84; accuracy, 88%), while a machine learning method could improve the diagnostic performance (area under curve, 0.94; accuracy, 95%).Histogram analysis of the absolute CBV in the enhancing area could help us distinguish GBM from sBM, in addition, a machine learning method with combined features is preferable. It is quite helpful in the condition that the biological nature of peritumoral edema could not separate these two entities.


Assuntos
Neoplasias Encefálicas/diagnóstico , Volume Sanguíneo Cerebral , Glioblastoma/diagnóstico , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Aprendizado de Máquina/estatística & dados numéricos , Idoso , Neoplasias Encefálicas/secundário , Diagnóstico Diferencial , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos
11.
Anticancer Res ; 39(9): 4905-4909, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519594

RESUMO

BACKGROUND/AIM: The differentiation between cerebral metastases (CM) and high-grade gliomas (HGG) can be difficult on magnetic resonance imaging (MRI). The aim of this study was to evaluate the usefulness of searching two MRI signs (signal alteration in the adjacent cortex, SAAC, and peripheral rim sign, PRS), in order to distinguish between these entities. PATIENTS AND METHODS: A total of 61 patients were retrospectively enrolled (28 HGG, 33 CM). Fluid Attenuated Inversion Recovery (FLAIR) sequences were used to assess SAAC and contrast-enhanced T1-weighted sequences for PRS. RESULTS: A positive SAAC sign was present in 61% of HGG, and 12% of CM. Conversely, in SAAC-negative lesions, PRS was observed in 78% of CM and in 32% of HGG. Their association had a higher frequency in HGG than in the CM group (21 vs. 3%). CONCLUSION: While SAAC is specific for HGG and PRS, in the absence of SAAC, is relatively specific for CMs, their combined presence is highly suggestive of HGG.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Córtex Cerebral/patologia , Glioma/diagnóstico , Imagem por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Curva ROC , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes
12.
Br J Radiol ; 92(1104): 20190216, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556332

RESUMO

OBJECTIVE: Magnetic resonance spectroscopy (MRS) has been useful in radiotherapy treatment planning (RTP) especially in tumor delineation. Routinely, 2D/3D MRSI data are used for this application. However, not all centers have access to 2D/3D MRSI. The objective of this study was to introduce a method of using single-voxel spectroscopy (SVS) data in target delineation and assess its reliability. METHODS: A gel-based phantom containing Creatine (Cr), N-acetyl-l-aspartic-acid (NAA), and Choline (Cho) was designed and built. The metabolite ratios simulate the normal and tumoral part of the brain. The jMRUI software (v. 6.0) was used to simulate a 1.5 T GE MRI scanner. The metabolite spectra provided by different time of echos (TE)s of the Point-RESolved Spectroscopy pulse-sequence (PRESS), different data-points, and post-processings were quantized by jMRUI. PseudoMRSI maps of Cho/Cr, NAA/Cr, and Cho + Cr/NAA were created. A conformity index (CI) was used to determine which metabolite-ratio isolines are more appropriate for tumor delineation. RESULTS: The simulation accuracy was verified. There were no differences > 4% between the measured and simulated spectra in peak regions. The pseudoMRSI map of Cho + Cr/NAA smoothly followed the complicated geometry of the tumor inside the gel-based phantom. The results showed that the single-voxel spectra produced by the PRESS pulse sequence with the TE of 144 ms, 512 data-points, and minimum post-processings of water suppression, eddy current correction, and baseline correction can be used for target delineation. CONCLUSION: This study suggests that SVS data can be used to aid target delineation by using a mathematical approach. This can enable a wider use of MR-derived information in radiotherapy. ADVANCES IN KNOWLEDGE: To the best of our knowledge, until now, 2D or 3D MRSI data provided from 3T MRI scanners have been used for MRS-based radiotherapy treatment planning. However, there are a lot of centers that are equipped to 1.5 T MRI scanners and some of them just equipped to SVS. This study introduces a mathematical approach to help these centers to take the benefits of MRS-based treatment planning.


Assuntos
Química Encefálica , Neoplasias Encefálicas/química , Neoplasias Encefálicas/diagnóstico , Espectroscopia de Ressonância Magnética/métodos , Imagens de Fantasmas , Ácido Aspártico/análogos & derivados , Colina , Creatina , Humanos , Reprodutibilidade dos Testes , Software
13.
Ann R Coll Surg Engl ; 101(8): e164-e168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537109

RESUMO

Neuro-Behçet's disease (NBD) is a serious manifestation of Behçet's disease (BD) and can affect either the central or peripheral nervous systems, or both. It occurs in 10-50% of patients with BD. We report on a patient with an unusual intraparenchymal lesion, initially thought to be a brain tumour. Histological examination revealed vasculitis consistent with BD. Clinicians should include NBD as a differential diagnosis when considering an isolated inflammatory intracranial lesion.


Assuntos
Síndrome de Behçet/diagnóstico , Granuloma de Células Plasmáticas/diagnóstico , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/patologia , Biópsia , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/etiologia , Granuloma de Células Plasmáticas/patologia , Humanos , Imagem por Ressonância Magnética , Masculino
14.
BMC Cancer ; 19(1): 793, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399067

RESUMO

BACKGROUND: The treatment strategy for brain metastasis (BM) in patients with epidermal growth factor receptor (EGFR) -mutant lung adenocarcinoma (LAC) remains controversial. In the present study, we compared the efficacy of brain radiotherapy (RT) in combination with tyrosine kinase inhibitors (TKIs) and TKIs alone for advanced LAC patients with EGFR mutations and BM. METHODS: We retrospectively studied 78 patients diagnosed with EGFR-mutant LAC who developed BM. These patients were divided into two groups: 49 patients in the combination treatment group who received brain RT in combination with EGFR-TKIs (including 23 patients with asymptomatic BM before RT); 29 patients in the TKI group who received EGFR-TKI targeted therapy alone (including 22 patients with asymptomatic BM before TKI treatment). RESULTS: The median intracranial progression-free survival (iPFS) of the combination treatment group was longer than that of the TKI alone group (21.5 vs. 15 months; P = 0.036). However, there were no significant differences in median progression-free survival (PFS, 12 vs. 13 months; P = 0.242) and median overall survival (mOS, 36 vs. 23 months; P = 0.363) between the two groups. Further analysis of asymptomatic BM showed that both the median iPFS and the mOS of the combination treatment group were significantly longer than for the TKI alone group (iPFS, 21.5 vs. 14.8 months, P = 0.026; mOS, 36 vs. 23 months, P = 0.041). Cox multivariate regression analysis found no independent adverse predictors of iPFS in all patients. CONCLUSIONS: The synchronous combination of brain RT and TKIs was superior to EGFR-TKIs alone for EGFR-mutant LAC patients with BM. The combination treatment group exhibited longer iPFS, while the PFS and OS were not significantly different between the two groups. In addition, the combination treatment could result in better iPFS and OS in those with asymptomatic BM. Therefore, addition of brain RT was useful for intracranial metastatic lesions.


Assuntos
Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/patologia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidade , Terapia Combinada , Receptores ErbB/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
15.
J Clin Neurosci ; 69: 175-178, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31409547

RESUMO

INTRODUCTION: Vertigo is a common condition occurring in the general population and is usually self-limited. Reports studying vertigo in patients with brain metastasis (BM), are scarce. Therefore, the aim of this study was to analyze if the presence of vertigo in cancer patients is associated with the presence of BM. METHODS: This study was conducted in a cancer referral center, where patients with confirmed systemic cancer sent for a neuro-oncologic consultation from May 2012 to March 2018 were included for review. RESULTS: Of 3220 patients, 723 were diagnosed with BM, and 204 had vertigo. Of these patients, 22.5% of those who had vertigo were diagnosed to have BM and 6% of those with BM had vertigo as an initial symptom (odds ratio [OR] 0.9; p = 0.9). An additional symptom was present in 104 patients with vertigo. Bivariate regression analysis disclosed a higher risk of having BM in patients with vertigo accompanied by headache (OR18.6; p < 0.0001), ataxia (OR12.1; p < 0.0001), seizures (OR10.9; p = 0.04), visual symptoms (OR10.4; p < 0.0001), speech impairment (OR6.3; p = 0.01), altered mental status (OR7.4; p < 0.0001), and focal weakness (OR7.4; p = 0.001), or focal sensitive complaint (OR6.9; p = 0.003). Vertigo with headache or ataxia remained statistically significant after multivariate analysis. CONCLUSION: In this cohort, a higher risk of having BM was associated with the presence of vertigo coexistent with headache, ataxia, seizures, visual symptoms, speech impairment, altered mental status, focal weakness, or focal sensitive complaint. On the basis of these results, these accompanying symptoms must be considered as red flags in patients with systemic cancer.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Vertigem/etiologia , Adulto , Neoplasias Encefálicas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vertigem/diagnóstico
16.
Pan Afr Med J ; 33: 78, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448040

RESUMO

Nearly 75% of patients with metastatic melanoma develop brain metastases. We here report the case of an 83 year-old woman hospitalized for secondarily generalized clonic seizures of the left leg with partial convulsive seizures in the Resuscitation Department. Melanoma resection of the left ankle had been performed 6 months before her admission. Neurological examination showed left ataxic crural monoparesis. Electro-encephalogram showed central and right frontal focus with left-sided dissemination. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain showed multiple supratentorial and subtentorial encephalic lesions with varying size and shape, with T1 hypersignal (A and A'), haemorrhage on T2*-weighted sequences (B and B'), gadolinium-enhancing T1 with perilesional edema on Flair sequences. Positron emission tomography (PET) showed multiple lymph node and bone metastases. Lymph node biopsy was negative for VE1 antibody with no BRAFV600E mutation by immunohistochemistry. An increase in the number of metastatic lesions was observed during control brain CT scan despite 10 brain radiotherapy sessions motivating palliative care. Epileptic seizures were controlled with levetiracetam. In patient with multiple hemorrhagic and spontaneous brain lesions, it is essential to obtain informations on patient's history of melanoma and to perform a thorough dermatologic examination in order to investigate its cause and to establish adequate therapeutic treatment.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Encefálicas/diagnóstico , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Feminino , Humanos , Levetiracetam/administração & dosagem , Metástase Linfática , Imagem por Ressonância Magnética , Melanoma/patologia , Tomografia por Emissão de Pósitrons , Convulsões/tratamento farmacológico , Convulsões/etiologia , Neoplasias Cutâneas/patologia
17.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439570

RESUMO

A constellation of newly diagnosed benign tumours and glioblastoma is an uncommon occurrence in a single individual. We present a case of a patient with a history of skin lipomas who presented with seizures and was found to have a left frontotemporal multifocal enhancing mass on MRI. Work-up for metastatic disease revealed a benign lung carcinoid tumour, a cervical schwannoma, adrenal masses, a growth hormone-secreting pituitary adenoma, and lastly a glioblastoma following brain biopsy.


Assuntos
Neoplasias Encefálicas/diagnóstico , Tumor Carcinoide/diagnóstico , Glioblastoma/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neurilemoma/diagnóstico , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Vértebras Cervicais , Evolução Fatal , Lobo Frontal , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Convulsões/etiologia , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 131: 243-251.e2, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31404694

RESUMO

BACKGROUND: Epithelioid glioblastoma (eGBM) is a very rare histologic variant of glioblastoma that has not been studied in isolation and, therefore, its optimal management has been largely assumed, but not confirmed. The aim of this study was to analyze all reported cases describing the presentation and clinical features to better understand the clinical significance of this histologic diagnosis. METHODS: A comprehensive literature search was conducted from 2005 to April 2019 identifying cases of eGBM that satisfied selection criteria for analysis. Survival was investigated using Kaplan-Meier estimations, and then univariate and multivariate logistic regression analyses for primary end point overall survival (OS) and second end point progression-free survival (PFS). RESULTS: A total cohort of 59 eGBM cases from 28 articles were included for final analysis. Median age of patients at diagnosis was 30 years, with 29 (46%) female patients. When reported, 100% (37/37) cases were IDH1-wild-type and 63% (19/30) were positive for the BRAF V600E mutation by immunohistochemistry. Median OS and PFS were estimated to be 11.0 months (95% confidence interval, 6.5-13.0) and 7.0 months (95% confidence interval, 3.0-10.0), respectively. Surgical extent of resection, radiation therapy, and chemotherapy all predicted superior OS and PFS on multivariate analysis (P < 0.05). No biomarkers prognosticated survival. CONCLUSIONS: These findings indicate that the histologic diagnosis of eGBM does not deviate from the clinical course of the broader glioblastoma diagnosis, despite being a unique histologic identity. These results argue against the temptation to deviate from the traditional management paradigm of surgery, radiation, and chemotherapy for glioblastoma based on this histology alone.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidade , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Glioblastoma/diagnóstico , Glioblastoma/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doenças Raras , Resultado do Tratamento , Adulto Jovem
19.
BMC Neurol ; 19(1): 210, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462223

RESUMO

BACKGROUND: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, which is the most common type of autoimmune encephalitis, is caused by the production of autoantibodies against NMDA receptor. Anti-NMDAR encephalitis patients present with various non-specific symptoms, such as abnormal psychiatric or behaviour, speech dysfunction, cognitive dysfunction, seizures, movement disorders, decreased level of consciousness, and central hypoventilation or autonomic dysfunction. CASE PRESENTATION: A 67-year-old man presented with new-onset focal seizures. The brain magnetic resonance imaging (MRI) plain scan and enhanced scan showed abnormal signal on the proximal midline frontoparietal junction region. Anti-NMDAR antibody was detected in cerebrospinal fluid (CSF) and serum using a commercial kit (Euroimmune, Germany) by indirect immunofluorescence testing (IIFT) according to the manufacturer's instructions for twice. Both of the test results were positive in CSF and serum. The patient was diagnosed as anti-NMDAR encephalitis and then was treated repeatedly with large dose of intravenous corticosteroids and gamma globulin. Accordingly, the refractory nature of seizures in this case may be attributed to NMDAR autoantibodies. When the patient presented at the hospital for the third time, the brain MRI revealed an increase in the size of the frontal parietal lesion and one new lesion in the left basal ganglia. The patient underwent a surgical biopsy and astrocytoma was confirmed by histopathology. CONCLUSIONS: Although the sensitivity and specificity of anti-NMDAR-IgG antibodies in CSF to diagnose anti-NMDAR encephalitis are close to 100%, it is not absolute. Anti-NMDAR antibodies were positive, which might make the diagnosis more complex. The diagnosis of atypical presentation of anti-NMDAR encephalitis requires reasonable exclusion of other disorders.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Idoso , Autoanticorpos/sangue , Erros de Diagnóstico , Alemanha , Humanos , Masculino
20.
Int J Mol Sci ; 20(15)2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31387280

RESUMO

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor featuring rapid cell proliferation, treatment resistance, and tumor relapse. This is largely due to the coexistence of heterogeneous tumor cell populations with different grades of differentiation, and in particular, to a small subset of tumor cells displaying stem cell-like properties. This is the case of glioma stem cells (GSCs), which possess a powerful self-renewal capacity, low differentiation, along with radio- and chemo-resistance. Molecular pathways that contribute to GBM stemness of GSCs include mTOR, Notch, Hedgehog, and Wnt/ß-catenin. Remarkably, among the common biochemical effects that arise from alterations in these pathways, autophagy suppression may be key in promoting GSCs self-renewal, proliferation, and pluripotency maintenance. In fact, besides being a well-known downstream event of mTOR hyper-activation, autophagy downregulation is also bound to the effects of aberrantly activated Notch, Hedgehog, and Wnt/ß-catenin pathways in GBM. As a major orchestrator of protein degradation and turnover, autophagy modulates proliferation and differentiation of normal neuronal stem cells (NSCs) as well as NSCs niche maintenance, while its failure may contribute to GSCs expansion and maintenance. Thus, in the present review we discuss the role of autophagy in GSCs metabolism and phenotype in relationship with dysregulations of a variety of NSCs controlling pathways, which may provide novel insights into GBM neurobiology.


Assuntos
Autofagia , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/metabolismo , Glioblastoma/etiologia , Glioblastoma/metabolismo , Células-Tronco Neoplásicas/metabolismo , Animais , Biomarcadores , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Diferenciação Celular , Transformação Celular Neoplásica/metabolismo , Gerenciamento Clínico , Glioblastoma/diagnóstico , Glioblastoma/terapia , Humanos , Terapia de Alvo Molecular , Células-Tronco Neoplásicas/efeitos dos fármacos , Células-Tronco Neoplásicas/patologia , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismo
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