Relación entre el coeficiente de difusión aparente y la celularidad de gliomas en centro de tercer nivel de Panamá / Relationship between the apparent diffusion coefficient and cellularity of gliomas in tertiary care center of Panamá

Introducción: Los gliomas son tumores malignos altamente celulares del sistema ner­ vioso central. Su grado histológico preoperatorio es de utilidad en el manejo quirúrgico, por lo que la resonancia magnética con secuencias avanzadas intenta brindar mayor información tumoral. Objetivo: Relacionar el coeficiente aparente de difusión (CAD) y celularidad de los gliomas de pacientes entre enero 2015 a diciembre 2017. Metodo­ logía: Retrospectivamente se obtuvieron de archivos clínicos la edad, sexo, tipo, grado histológico y sitio anatómico. Se calculó el CAD en 5mm 2 en los estudios de resonancia magnética preoperatorias y se utilizó las laminillas para conteo de celularidad en 5mm 2 digitalmente. Se utilizó análisis estadísticos descriptivos y coeficiente de correlación entre CDA con celularidad. Se utilizaron valores de p < 0.05 para significancia estadís­ tica. Resultados: 46 casos fueron incluidos, 56.5% fueron hombres. El rango de 41­64 años fueron los más afectados. El glioblastoma fue el tipo histológico más frecuente (47.8%), así como los gliomas de alto grado (73.9%). El 95.7% fueron supratentoriales. La celularidad promedio fue de 3970 ± 2900 vs 2436 ± 948 núcleos/5mm 2 (p = 0.13), con valores promedio de CDA mínimo de 0.813 x 10­3 ± 0.229 mm 2 /s vs 1.052 x 10­3 ± 0.196 mm 2 /s (p = 0.002), para los gliomas de alto y bajo grado respectivamente. La co­ rrelación entre CDA y celularidad fue débil (R = ­ 0.13, p = 0.37). Conclusión: Existe co­ rrelación débil inversamente proporcional entre el CDA y la celularidad con distinción de gliomas de bajo y alto grado con valores de CDA mínimos

Introduction: Gliomas are highly cellular malignant tumors of the central nervous sys­ tem. Its preoperative histological grade is useful in surgical management, so magnetic resonance imaging with advanced sequences tries to provide more tumor information. Objective: Correlate apparent diffusion coefficient (ADC) and cellularity of gliomas of patients between January 2015 to December 2017. Methodology: Data of age, sex, ty­ pe, histologic grade and anatomic site were retrospectively obtained from clinical archi­ ves. The preoperative magnetic resonance ADC was calculated in a 5 mm 2 region of interest and the microscope slides were used for the cellularity digitally count in 5 mm 2 . Descriptive statistical analysis and correlation coefficient between ADC and cellularity were used. Values of p <0.05 were used for statistical significance. Results: 46 cases were included, 56.5% were men. The 41­64 years ranges were the most affected. Glio­ blastoma was the most frequent histological type (47.8%), as well as high grade glio­ mas (73.9%). 95.7% were supratentorial. The average cellularity was 3970 ± 2900 vs 2436 ± 948 nuclei/ 5mm 2 (p = 0.13), with average minimum ADC values of 0.813 x 10­3 ± 0.229 mm 2 /s vs 1052 x 10­3 ± 0.196 mm 2 /s (p = 0.002), for high­ and low­grade glio­ mas, respectively. The correlation between ADC and cellularity was weak (R = ­ 0.13, p = 0.37). Conclusions: There is a weak inversely proportional correlation between ADC and cellularity. With distinction of low­ and high­grade gliomas with minimum ADC values

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).

Epidemiologia dos gliomas no estado do Pará: Parte I (2000-2006) / Epidemiology of gliomas in Pará province, Brazil: Part I (2000-2006)

Objetivo: O presente estudo tem como principal objetivo realizar uma análise epidemiológica inicial acerca dos tumores intracranianos primários no estado do Pará, com foco em gliomas, baseada nos registros hospitalares de um hospital estadual de referência em câncer (Hospital Ophir Loyola ? HOL), durante os anos de 2000 a 2006. Métodos: Análise epidemiológica descritiva, retrospectiva e observacional dos prontuários de 457 pacientes submetidos a tratamento cirúrgico por tumores intracranianos primários (TIP) entre os anos de 2000 e 2006, no Hospital Ophir Loyola (HOL), tendo sido incluídos dados referentes a sexo, etnia, procedência, idade, escolaridade, estado civil, localização do tumor, tipo histológico, realização de quimioterapia e/ou radioterapia e ocorrência de óbito. Resultados: Os resultados mostraram taxa média de 1,22 tumor intracraniano para cada 100 mil habitantes, com predomínio de gliomas (70%) e meningiomas (15%). Ao se analisar o grupo de gliomas por subtipo histológico, encontrou-se predomínio de astrocitomas malignos (graus III e IV, OMS), sendo o glioblastoma o tipo histológico mais encontrado (32% do total e 45% dos gliomas, respectivamente). Conclusão: Os resultados encontrados sugerem discrepâncias relacionadas a dificuldades regionais de acesso ao atendimento especializado e com a notificação e registro dos pacientes com diagnóstico de TIP, fornecendo dados relevantes para caracterizar esse grupo de neoplasias em termos populacionais, permitindo intervenções por parte das autoridades responsáveis.

Objective: The present study has as its main objective to perform an epidemiological analysis about the primary intracranial tumors in the state of Pará, focusing on gliomas, based on hospital records of the state hospital in reference cancer (Ophir Loyola Hospital ? HOL) during the years 2000 to 2006. Methods: Epidemiological study descriptive, retrospective and observational of medical records of 457 patients who underwent surgical treatment for intracranial tumors primary (TIP) between the years 2000 and 2006 in Ophir Loyola Hospital (HOL), it was included data on gender, ethnicity, origin, age, education, marital status, tumor location, histological type, undergo chemotherapy and/or radiotherapy and occurrence of death. Results: The results showed an average rate of 1.22 intracranial tumors per 100,000 population, with a prevalence of gliomas (70%) and meningiomas (15%). When analyzing the group of gliomas by histological subtype, found predominance of malignant astrocytomas (grades III and IV, WHO), and the glioblastoma histological type was the most commonly found (32% of the total and 45% of gliomas, respectively). Conclusion: The results suggest discrepancies related to regional difficulties of access to specialized care and the notification and registration of patients diagnosed with TIP, providing relevant data to characterize this group of neoplasms in population terms and allowing intervention by the authorities.

Frequency of central nervous system tumors in delta region, Egypt.

Introduction and Aim of Work: Central nervous system (CNS) tumors represent a major public health problem, and their epidemiological data in Egypt have been rather incomplete except for some regional reports. There are no available frequency-based data on CNS tumors in our locality. The objective of this study was to estimate the frequency of CNS tumors in east delta region, Egypt. Materials and Methods: The data were collected during the 8-year period from January 1999 to December 2007 from Pathology Department, Mansoura University, and other referred pathology labs. Examination of HandE stained sections from retrieved paraffin blocks were done in all cases for histopathologic categorization of C.N.S. tumors. Immunohistochemical studies were applied to confirm final histopathologic diagnosis in problematic cases. Results: Intracranial tumors represented 86.7% of cases in comparison to only 13.3% for spinal tumors. Gliomas were the CNS tumors of the highest frequency (35.2%), followed by meningioma (25.6%), pituitary adenoma (11.6%) and nerve sheath tumors (6.6%). 10.25% of tumors were of children <15 years. Conclusion: This study provides the largest series of the relative frequency of CNS tumors in Delta region in Egypt till now and may help to give insight into the epidemiology of CNS tumors in our locality.

Tumores primarios del sistema nervioso central en Cartagena, 2001- 2006 / Primary central nervous system tumours reported in Cartagena, 2001-2006

Objetivos Determinar la frecuencia de los tumores primarios del sistema nervioso central, diagnosticados en Cartagena de Indias durante el periodo de 2001-2006 y, determinar las características demográficas, epidemiológicas y clínicas de los pacientes con tumores del sistema nervioso central de una institución de la ciudad, en el mismo periodo. Métodos Se realizó un estudio descriptivo de vigilancia epidemiológica pasiva. Se tomaron los reportes de patología con diagnóstico nuevo de tumor primario del sistema nervioso central de todos laboratorios de Cartagena y se analizaron las historias clínicas disponibles de estos casos. Se estimaron las tasas de incidencia general, por año, género, grupos de edad y tipo histológico con intervalos de confianza al 95 por ciento. Además se calcularon razones estandarizadas de morbilidad. Resultados Durante los años 2001 y 2006 se encontraron 390 casos. La tasa incidencia general fue de 6,91/100 000 personas-año. El tipo histológico más frecuente fue meningioma (3,46/100 000 personas-año). Sólo se determinó la procedencia en el 43,1 por ciento de los casos. Las razones estandarizadas de morbilidad fueron más altas en Cartagena con respecto a las de los Estados Unidos, el Instituto Nacional de Cancerología de Colombia y el Registro Poblacional de Cáncer de Cali. Conclusiones Hubo una frecuencia de tumores primarios del sistema nervioso central más elevada en Cartagena que en el resto del país. Se recomienda mejorar los sistemas de registro y vigilancia para determinar la magnitud real del problema y fomentar investigaciones en busca de factores de riesgo.

Objectives Determining the frequency of primary central nervous system tumours diagnosed in Cartagena; Colombia, from 2001-2006 and determining the demographic, epidemiological and clinical characteristics of patients having central nervous system tumours reported by a single institution in Cartagena between 2001 and 2006. Methods A passive epidemiological surveillance descriptive study was carried out. The pathology reports of new diagnosed central nervous system primary tumours from all laboratories in Cartagena were taken and the available clinical records regarding these cases were analysed. The overall incidence rate and incidence rates by year, gender, age and histological type were estimated, with 95 percent confidence intervals. Standardised morbidity rates were also calculated. Results There were 390 such cases during 2001-2006. The overall incidence rate was 6.91/100,000 people-year. Meningiomas were the most frequently occurring histological types (3.46/100,000 people-year). The provenance could only be determined in 43.1 percent of cases. Standardised morbidity rates were higher in Cartagena regarding those reported in the United States and by the Colombian National Cancer Institute and the Population-based Cali Cancer Registry. Conclusions There was a higher incidence of primary central nervous system tumours in Cartagena than in the rest of the country. Registry and surveillance systems should be improved and research into risk factors encouraged.

Therapy for glioma: Indian perspective.

Central nervous system (CNS) are rare neoplasms with considerable heterogeneity and variation. The most common primary lesions of CNS are gliomas. A majority of the data about the demography and management of gliomas has emerged from the west. However, there may be considerable variation in the presentation, behavior, and response to treatment between patients in the western world and the Asian population. This article discusses gliomas with special reference to data from oncology centers in India.

Gliomas de alto grado en adultos / High grade gliomas in adults

Malignant gliomas represent 80 percent of primary malignant central nervous system tumors. It generally presents with headache, epilepsy, cognitive change, dysphasia, or progressive hemiparesia. Current standard treatment for malignant glioma includes: surgical resection or biopsy, radiation therapy and/or chemotherapy. The prognosis of malignant gliomas is still dismal despite aggressive treatment attempts. Understanding the molecular pathogenesis of glioma may lead to a rational development of new therapies. This review summarizes the diagnosis and management of these tumors in adults.

Malignant glioma: the involvement of loss of allelic heterozygosity and PTEN mutations in a group of Malay patients.

Frequent loss of heterozygosity (LOH) and mutations of the tumor suppressor gene PTEN (phosphatase and tensin homologue deleted from chromosome 10) have been found in sporadic gliomas. The most documented regions of allelic losses include 9p21, 10q23-25 and 17p1 3 whereas PTEN aberrations are preferentially found in glioblastoma multiformes. This research aimed to detect the incidence of allelic losses on chromosomes 10q, 9p, 17p and 13q and mutations on exons 5, 6 and 8 of PTEN in malignant gliomas. Malignant glioma specimens obtained were classified histopathologically according to the WHO criteria. Each tumor was then subjected to polymerase chain reaction (PCR)-LOH analysis using microsatellite markers and single-stranded conformational polymorphism (SSCP) analysis. Twelve of 23 (52%) malignant glioma cases showed allelic losses whereas 7 of 23 (30%) samples showed aberrant band patterns and mutations of PTEN. Four of these cases showed LOH in 10q23 and mutations of PTEN. The data on LOH indicated the involvement of different genes in the genesis of glioma whereas mutations of PTEN indicated the role of PTEN tumor suppressor gene in the progression of glioma in Malay population.

Epileptic seizures in supratentorial gliomas.

Two hundred patients with supratentorial glioma; astrocytoma (pilocytic, fibrillary, gemistocytic) 82, mixed glioma (oligoastrocytoma) 46, oligodendroglioma 8, malignant (anaplastic) astrocytoma 33 and glioblastoma multiforme 31, surgically treated for the tumours and followed up for one to sixteen years, were retrospectively analysed for the incidence of pre and postoperative epileptic seizures. 122 patients (61%) had seizures preoperatively. 62 (50.8%) of them had at least one or more seizures during follow up. Seizures were persistent in 22 patients. Doubtful, or one or two minor seizures occurred in 19 cases. Six patients in this group had seizure only at the time of CT confirmed recurrence, after a seizure free interval of one to nine years. Amongst 78 patients who did not have seizures preoperatively, 24 (30.6%) developed seizures during the postoperative follow up period. Recurrent attacks were reported only by 5 patients while 15 patients had seizure(s) only at the time of recurrence of tumour. Two patients had a few seizures in the early postoperative period and none thereafter, while doubtful seizures were reported by two patients.

Analytical study of 253 cases of central nervous system tumours

This is an analytical study of 253 cases of central nervous system space occupying lesions which were received and diagnosed histologically at the histopathology department at the laboratory section in the specialized surgical hospital at Saddam's Medical City for the period between June 1990 till the end of December 1992. Out of these 253 cases, 231 cases of intracranial and intraspinal tumours were confirmed histologically and 22 cases were miscellaneous. 109 cases were reported among male patients and 122 cases among female. The highest peak incidence was reported in the fifth decade. Of these tumours Glioma constituded the highest incidence [39.4%], and the majority were of high grade malignancy and poor prognosis. This was found to be similar to other previous Iraqi studies and other similar studies reported in literatures

Gliomas do nervo óptico: estudo de 11 casos / Optic nerve gliomas: a study of 11 cases

Os gliomas do nervo óptico podem apresentar-se esporadicamente ou como componentes da neurofibromatose. Sao neoplasias raras, correspondendo a 2 a 5 por cento dos tumores intracranianos e cerca de 6 por cento dos tumores intra-orbitários. No presente estudo, analisamos 11 casos de glioma de nervo óptico diagnosticados em Curitiba num período de 25 anos, sendo 10 pacientes do sexo feminino e 1 do sexo masculino. As idades variaram de 3 a 25 anos; 6 pacientes apresentavam idades inferiores a 15 anos. Dos casos desta série, 27,3 por cento (n=3) apresentavam associaçao com neurofibromatose. Quanto à localizaçao dos tumores, em 5 pacientes a lesao estava restrita ao nervo óptico e no restante havia extensao para o quiasma óptico, regiao supra-selar, lobo frontal ou temporal. Todos os pacientes tinham astrocitoma pilocitico.

Tumores intracraneales en el Hospital Nacional del sur IPSS / Intracraneal tumors in the Hospital Nacional del Sur-IPSS

En el presente trabajo se investigó la incidencia como manejo y evolución de pacientes con tumor intracraneal. El diagnóstico se confirmó con estudio histopatológico y los resultados obtenidos se evaluaron con el Rating de Karnofsky. De 1556 pacientes operados se encontró 54 casos (3.47 por ciento) de tumores intracraneales de los que 33.34 por ciento correspondian a gliomas, 31.48 por ciento a adenomas, 24.08 por ciento a meningiomas, papilomas de plexos coroideos y craneofaringiomas con 3.70 por ciento cada uno, finalmente el neurinoma del acústico y carcinoma de plexos coroideos con 1.85 por ciento. El sexo más afectado fue el masculino 74.07 por ciento y la edad más comprometida fue la quinta década de la vida (20.37 por ciento). Todos los pacientes recibieron tratamiento quirúrgico; 45 con cirugía total, 7 con parcial, 1 con descomprensiva y 1 con cirugía derivativa. En el post operatorio inmediato 50.02 por ciento tuvieron 80 a 90 en el Rating de Karnofsky y 18.50 por ciento estuvieron por debajo de 70. El resultado final arrojó 42.59 por ciento de pacientes aliviados, 38.86 por ciento de sanos y una mortalidad de 18.52 por ciento. Los resultados de este trabajo fueron comparados con otras casuísticas nacionales y extranjeras.

Tumours of hte central nervous system: analysis of 476 cases observed at the University Hospital of the West Indies

A statistical survey of the incidence, age and sx distribution, and preferential sites of occurrence of tumours of the central nervous system observed at the University Hospital of the West Indies during a 15-year period is presented. Four hundred and seventy-six histologically confirmed neoplasms were recorded. Intracranial tumours were 7 times as common as those of the spinal cord. Of 416 intracrianl neoplasms, ther were 40% neuropithelial tumors, 21% meningiomas, 15% pituitary adenomas, 9% metastic lesions, 6% congenital tumours, 5% vasoformative tumours, 3% nerve sheath tumours and 1% unclassified neoplasms. Men and women were equally affected. Meningiomas and pituitary adenomas were more frequent than in otherreported series. Metastases were relatively more frequent in the spinal than in the intracranial group. Of the primary spinal tumours, those of nerve sheath origin were nearly three times as common as the meningiomas