The 2021 World Health Organization classification of gliomas: an imaging approach / Nova classificação das neoplasias gliais segundo a Organização Mundial da Saúde 2021, com enfoque radiológico

Abstract The purpose of this pictorial essay is to describe the recommendations of the 2021 World Health Organization classification for adult-type and pediatric-type gliomas and to discuss the main modifications in relation to the previous (2016) classification, exemplified by imaging, histological, and molecular findings in nine patients followed at our institutions. In recent years, molecular biomarkers have gained importance in the diagnosis and classification of gliomas, mainly because they have been shown to correlate with the biological behavior and prognosis of such tumors. It is important for neuroradiologists to familiarize themselves with this new classification of central nervous system tumors, so that they can use this knowledge in evaluating and reporting the imaging examinations of patients with glioma.

Resumo O propósito deste ensaio iconográfico é descrever e discutir as novas recomendações da Organização Mundial da Saúde de 2021, referente aos gliomas dos tipos adulto e infantil, e suas principais diferenças com a classificação anterior (2016), exemplificadas com imagens de nove casos de pacientes atendidos nas nossas instituições. Recentemente, há uma crescente significância dos marcadores moleculares no diagnóstico e classificação dos gliomas e tumores do sistema nervoso central, principalmente pela correlação com o comportamento biológico e o prognóstico. É importante que os neurorradiologistas estejam familiarizados com a nova classificação dos tumores do sistema nervoso central para a prática clínica, na avaliação e emissão de laudos e opiniões nas imagens dos pacientes com gliomas.

WHO CNS5 2021 incluye mutaciones específicas en gliomas que pueden ser identificadas con biomarcadores cuantitativos de resonancia magnética / WHO CNS5 2021 includes specific mutations in gliomas that can be identified with MRI quantitative biomarkers

Resumen En 2021 se publicó la última versión de la clasificación de tumores del sistema nervioso central de la Organización Mundial de la Salud (WHO CNS5 por sus siglas en inglés), considerada un estándar internacional. Las primeras ediciones se basaron en características histológicas y posteriormente se incorporaron aspectos relacionados con nuevos conocimientos. En la revisión de 2016 se implementaron características moleculares para la clasificación y estadificación de los gliomas, como la presencia de mutaciones en IDH1 y IDH2. Actualmente, las técnicas de resonancia magnética avanzada permiten valorar la presencia de 2-HG (oncometabolito incrementado ante mutaciones en IDH), de forma que indirectamente y sin procedimientos invasivos pueden identificarse las mutaciones en IDH. La resonancia magnética avanzada es un procedimiento aún en desarrollo, de gran utilidad para el diagnóstico y manejo de distintas patologías. En el presente documento se abordan las implicaciones de la WHO CNS5 en la evaluación de gliomas, así como aspectos históricos, las bases de la resonancia magnética convencional y secuencias de resonancia magnética avanzada útiles en la clasificación actual.

Abstract In 2021, the latest version of the World Health Organization classification of central nervous system tumors (WHO CNS5) was published, which is considered an international standard. The first editions of this classification were based on histological characteristics and, subsequently, aspects related to new knowledge were incorporated. In the 2016 revision, molecular characteristics were implemented for the classification and staging of gliomas, such as the presence of mutations in IDH1 or IDH2. Currently, advanced magnetic resonance imaging (MRI) techniques allow assessing for the presence of 2-HG (increased oncometabolite that precedes IDH mutations), whereby IDH mutations can be indirectly identified, without invasive procedures being required. Advanced MRI is a growing field, highly useful for diagnosis and management of different pathologies. This document addresses the implications of WHO CNS5 classification in the evaluation of gliomas, as well as historical aspects, the bases of conventional MRI, and advanced MRI sequences useful in current classification.

As artérias lenticuloestriadas podem interferir na extensão da ressecção tumoral e sobrevida nos gliomas da ínsula? / Can lenticulostriated arteries interfere with the extent of tumor resection and survival in insula gliomas?

Introdução: Os gliomas são tumores encefálicos e da medula espinhal que se originam nas células gliais e cuja progressão invade o tecido cerebral adjacentee e dentre eles um dos mais desafiadores são localizados no lobo cerebral da ínsula. Estas artérias irrigam estruturas nobres e sua lesão pode produzir danos sensitivos, motores e de linguagem. Objetivo: Descrever o impacto da extensão da ressecção, sobrevida global e dos resultados funcionais após a cirurgia dos gliomas insulares, quando estes tumores estejam ou não envolvidos pelas artérias lenticuloestriadas. Métodos: Revisão integrativa nas plataformas virtuais em português e inglês, buscando AND ou OR dados através dos seguintes descritores "Gliomas da ínsula, Mapeamento cerebral, Artérias lenticuloestriadas". A busca inicial foi baseada no título e/ou resumo. Decididos os trabalhos incluíveis foi realizada a leitura na íntegra dos textos. Ao total foram estudados 55 artigos. Resultados: O lobo da ínsula fica "escondido" pela sobreposição dos lobos frontal, parietal e temporal. Para alcançá-lo pode-se realizar as abordagens transsilviana ou transcortical. Ocorre que ao chegar na ínsula visualiza-se significativa ramificação constituída pelas artérias lenticuloestriadas, cuja manipulação pode determinar déficit neurológico e, ao se aprofundar no córtex insular, depara-se com outras estruturas tão importantes quanto a própria ínsula. O conhecimento anatômico das artérias lenticuloestriadas e suas relações é de fundamental importância para a ressecção de glioma insular, pois o comprometimento delas e da artéria cerebral média podem determinar a isquemia dos núcleos da base e da cápsula interna. Conclusão: O tratamento dos gliomas insulares permanece como grande desafio. Devido à sua localização e possibilidade de desenvolvimento de déficits neurológicos na manipulação cirúrgica é necessário não somente conhecer sua localização topográfica, mas também a íntima relação vascular com as artérias lenticuloestriadas. O envolvimento delas pelo tumor possui implicações na sobrevida e na preservação da função neurológica. O conhecimento detalhado da anatomia da região é fundamental para diminuir complicações que afetem grandemente a qualidade de vida dos pacientes.

Introduction: Gliomas are brain and spinal cord tumors that originate in glial cells and whose progression invades the adjacent brain tissue and among them one of the most challenging are located in the cerebral lobe of the insula. These arteries supply noble structures and their damage can cause sensory, motor and language damage. Objective: To describe the impact of the extent of resection, overall survival and functional results after surgery for insular gliomas, when these tumors are or are not involved by lenticulostriate arteries. Methods: Integrative review on virtual platforms in Portuguese and English, searching for AND or OR data using the following descriptors "Insula gliomas, Brain mapping, Lenticulostriate arteries". The initial search was based on the title and/or abstract. Once the included works were decided, the texts were read in full. In total, 55 articles were studied. Results: The insula lobe is "hidden" by the overlap of the frontal, parietal and temporal lobes. To achieve this, transsylvian or transcortical approaches can be performed. It turns out that when arriving at the insula, a significant branch made up of lenticulostriate arteries is seen, the manipulation of which can cause neurological deficits and, when going deeper into the insular cortex, one comes across other structures as important as the insula itself. Anatomical knowledge of the lenticulostriate arteries and their relationships is of fundamental importance for the resection of insular glioma, as their involvement and that of the middle cerebral artery can determine ischemia of the basal ganglia and internal capsule. Conclusion: The treatment of insular gliomas remains a major challenge. Due to its location and the possibility of developing neurological deficits during surgical manipulation, it is necessary not only to know its topographic location, but also the intimate vascular relationship with the lenticulostriate arteries. Their involvement by the tumor has implications for survival and preservation of neurological function. Detailed knowledge of the region's anatomy is essential to reduce complications that greatly affect patients' quality of life.

A review of adult-type diffuse gliomas in the WHO CNS5 classification with special reference to Astrocytoma, IDH-mutant and Oligodendroglioma, IDH-mutant and 1p/19q codeleted

The fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (WHO CNS5) features several changes in the classification, diagnostic criteria, nomenclature, and grading of diffuse gliomas. Adult-type diffuse gliomas are genetically defined and include astrocytoma, isocitrate dehydrogenase (IDH)-mutant, oligodendroglioma, IDH-mutant and 1p/19q codeleted, and glioblastoma, IDH-wildtype. This review briefly discusses two tumor types: astrocytoma, IDH-mutant, and oligodendroglioma, IDH-mutant and 1p/19q codeleted, with emphasis on relevant changes in their classification and defining molecular genetic alterations. A simplified approach to the diagnosis of these tumors is provided.

Efficacy and safety of immunotherapies for the treatment of high-grade gliomas: a systematic review and meta-analysis

Background/Aim: High-grade gliomas are aggressive brain neoplasms usually refractory to treatment. Recently new treatment approaches have emerged, including immunotherapies. Hence, the aim of the present study was to evaluate the efficacy and safety of immunotherapies in adult patients with high-grade gliomas. Methods: Searches were performed in three databases for relevant studies published until December 2020. Title and abstract screening, full-text review, data extraction, and risk of bias assessment were performed independently by two reviewers. Risk of bias assessment was performed according to the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Meta-analyses were performed with Review Manager software (version 5.4.1), using risk ratio and 95% confidence intervals as measure of effect, the Mantel-Haenszel method, and random effects models. The quality of evidence assessment was conducted according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Nineteen studies were included in the systematic review, of which 15 reported comparable data for meta-analyses. The outcomes assessed in the meta-analyses were overall survival (OS) and progression-free survival (PFS), with subgroups at 6, 12, and more than 12 months. No statistical differences were observed between immunotherapy and conventional treatment, except for the OS subgroup over 12 months. The certainty on the evidence was moderate. Conclusion: There was no evidence of an additional benefit of immunotherapy compared to standard treatment in the synthesis of results from clinical trials. Further high-quality clinical trials are needed to improve the quality of evidence concerning immunotherapies for the treatment of high-grade gliomas.

The surgical outcome of adult patients with hypothalamic gliomas / 中国医师进修杂志

Objective:To analyze the clinic-pathological features and surgical outcomes of adult patients with hypothalamic gliomas.Methods:The adult cases pathologically confirmed as hypothalamic gliomas were analyzed from October, 2011 to January, 2022 in Beijing Tiantan Hospital.Results:There were 32 adult cases with hypothalamic gliomas, including 16 males and 16 females. Tumor was located in the hypothalamus in 6 cases, in the hypothalamus plus optic chiasma/nerve in 6 cases, in the hypothalamus plus thalamus in 9 cases, and in the hypothalamus plus the third ventricle in 11 cases. Pre-operative hydrocephalus was found in 20 cases. Five patents underwent stereotactic biopsy, 27 patients underwent craniotomy, and 11 patients underwent shunt surgery for hydrocephalus. Of 27 patients with craniotomy, trans-callosal approach was chosen for 9 patients, trans-cortical for 8 patients, via pterion approach for 4 patients, via lateral sub-frontal approach for 4 patients, via fissurae interhemisphaerica for 1 patient, and trans-sphenoidal approach for 1 patient. Twenty-two patients received gross-total or subtotal resection, 5 patients received partial resection. All the patients were pathologically confirmed, including 9 patients with high-grade and 23 patients with low-grade gliomas. Six patients died within 3 months after craniotomy, 8 patients suffered from endocrine dysfunction, 7 patients suffered from electrolyte disturbance, and 5 patients suffered from hydrocephalus. They were followed for 0.7-110.0 months, with 5-year progression-free survival rate of 63.8% and 5-year overall survival rate of 53.9% for all patients. The 5-year progression-free survival rate was 83.3% and the 5-year overall survival rate was 72.8% for low-grade gliomas.Conclusions:The peri-operative mortality is high for adult patients with hypothalamic gliomas, and protection of the hypothalamic function is important. Patients with low-grade hypothalamic gliomas have good prognoses.

Prognostic value of mutations in isocitrate dehydrogenase 1 (IDH1) and reverse telomerase transcriptase (TERT ) in Argentine patients` gliomas / Valor pronóstico de mutaciones en Isocitrato dehidrogenasa1 (IDH1) y Telomerasa transcriptasa reversa (TERT ) en gliomas de pacientes argentinos

Background and aim: Gliomas are the most common primary brain tumors, classified according to their histopathological and genetic features. Tumorigenesis depends on alterations in different genes. The aim of this study was the identification of mutations in IDH1 and TERT genes in gliomas of Argentine patients and to correlate them with clinical features and prognosis. Methods: DNA was isolated from 19 biopsies with different glioma grades matched with blood samples. IDH1 and TERT mutations were studied by PCR amplifica-tion and sequencing. Results: Six out of seven patients with low-grade glioma (grade II) harbor IDH1 mutations, mainly without tumor growth and overall survival of more than 12 months. Eleven out of twelve patients with high-grade gliomas (grade III/IV) showed wild type IDH1, mainly with tumor growth and shorter survival than low-grade gliomas. Mutated TERT promoter was present in 5 out of 11 high-grade gliomas, showing the prevalence of polymorphic C allele. In 1 out of 5 low-grade gliomas with a predominance of T allele. TERT and IDH1 mutations were mutually exclusive in most gliomas. Conclusions: Our results show that genetic tests provided a more accurate prognosis than histopathological analysis. The evolution of gliomas can be predicted primarily by the mutational status of IDH1 and secondarily by other markers, such as TERT mutational status

Antecedentes y objetivo: los gliomas son los tumores cerebrales primarios más comunes y se clasifican según sus características histopatológicas y genéticas. La tumorigénesis depende de alteraciones en diferentes genes. El objetivo de este estudio fue identificar mutaciones en los genes IDH1 y TERT en gliomas de pacientes argentinos y correlacionarlos con la evolución clínica. Métodos: se obtu-vieron 19 muestras pareadas de ADN de gliomas y de la sangre. Las mutaciones en IDH1 y TERT se analizaron por PCR y secuenciación. Resultados: la IDH1 mutada se encontró en 6 de los 7 gliomas de bajo grado (grado II), mayormente sin crecimiento tumoral y una sobrevida mayor de 12 meses. La IDH1 salvaje estaba presente en 11 de los 12 gliomas de alto grado (grado III y IV) mayormente con crecimiento tumoral y menor sobrevida que los tumores de bajo grado. Las mutaciones en el promotor del gen TERT se observaron en 5 de los 11 gliomas de alto grado, con la prevalencia de alelo polimórfico C, en cambio, en gliomas de bajo grado TERT mutado estaba presente en 1 de los 5 gliomas con predominio del alelo T. Las mutaciones en IDH1 y TERT fueron mutuamente excluyentes en la mayoría de los gliomas. Conclusiones: el análisis genético provee un pronóstico más certero que el análisis histopatológico. Nuestros resulta-dos muestran que la evolución de gliomas puede predecirse primariamente por el estado mutacional de IDH1 y secundariamente por mutaciones en otros marcadores tales como el TERT

Exosome-derived miR-181a promotes angiogenesis of glioma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To explore the effect of exosome-derived miR-181a on angiogenesis and tumor progression in gliomas. Methods: 83 cases of glioma tissues and 13 cases of peritumoral tissues resected in the Second Affiliated Hospital of Hainan Medical University from August 2017 to December 2019, glioma cells U87, A172, U251, LN229, U373 and microglial cell line HM, were selected to detect the expression of miR-181a in tumor tissues and cells by qPCR method. Glioma U373 cells with miR-181a over-expression or knockdown were constructed, and exosomes were isolated and identified. The effects of exsome-derived miR-181a on angiogenesis of HUVEC cells were investigated by tubule formation and chicken chorioallantoic membrane assay in vitro. Nude mice bearing U373 cell transplanted xenograft was constructed to observe the effect of exsome-derived miR-181a on angiogenesis and tumor growth in vivo. Results: The expression of miR-181a in glioma tissues and cells was significantly higher than that in normal tissues and normal glial HM cells (all P<0.01). The exsome-derived miR-181a could significantly promote the tubule formation of HUVEC cells (P<0.01) and the angiogenesis of chicken chorioallantoic membrane (all P<0.01). In vivo experiments showed that the growth of xenografts was promoted (P<0.05) and the amount of angiogenesis in the tumor tissues was increased in the nude mice after being transfused with exsome-derived miR-181a (P<0.01). Conclusion: miR-181a plays an important role in promoting angiogenesis of gliomas and may be a potential target for diagnosis and treatment of gliomas.

The application of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language functional area during postoperative IMRT of cerebral gliomas / 中华放射医学与防护杂志

Objective:To investigate the clinical application value of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language function in patients with unilateral frontal and temporal lobes glioma receiving postoperative intensity modulation radiation therapy (IMRT).Methods:A total of 27 patients with unilateral frontal and temporal lobe gliomas were treated with postoperative radiotherapy. The planning CT and BOLD-fMRI were performed before radiotherapy, and the language functional areas were delineated based on the fused images of 3D T1 and CT. IMRT technology was used to develop radiotherapy plans with and without language function area protection, naming conventional and protective radiotherapy plans respectively. The maximum radiation dose ( Dmax), average radiation dose ( Dmean), target conformal (CI) and dose uniformity (HI) of PTV of the two plans were compared and analyzed to ensure that the protective radiotherapy plan could meet the radiotherapy standard. Then, the Dmax and Dmean of the language function area were compared and analyzed to evaluate whether the Dmax and Dmean of the language function area were decreased in the protective radiotherapy plan. Results:There were no significant differences in CI, HI, Dmax and Dmean of PTV between the conventional radiotherapy plan and protective radiotherapy plan ( P>0.05). There were statistically significant differences in Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) between the conventional radiotherapy plan and protective radiotherapy plan ( t=3.073-12.707, P<0.05). Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) were decreased in the protective radiotherapy plan compared with the conventional radiotherapy plan, and the decrease was significant in the healthy side. Conclusions:BOLD-fMRI combined with IMRT can not only guarantee the target dose of patients with glioma receiving postoperative radiotherapy, but also reduces the radiation dose to the language function area. Chinese reading task and paragraph comprehension task are the stimulation mode of language function in patients after brain tumor surgery. These tasks are simple and the effect is accurate.

Genomic and transcriptomic characterization of the human glioblastoma cell line AHOL1

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

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

Apparent Diffusion Coefficient Histogram Analysis:Differentiation of Genetic Subtypes of Diffuse Lower-grade Gliomas / 中国医学科学院学报

To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH group),19 patients with IDH-mutant 1p19q intact gliomas(IDH 1p19q group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH 1p19q group).The whole-lesion ADC values derived from histogram analysis(including ADC,ADC,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADC,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's test or Mann-Whitney test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Compared with IDH group,the ADC75%(=0.021),ADC90%(=0.015),ADC95%(=0.014),ADC (=0.035),range(=0.009),standard deviation(=0.001)and inhomogeneity(=0.001)were significantly lower in IDH group;in contrast,the ADC (=0.031)and kurtosis(=0.020)of IDH group were significantly higher than those in IDH group.The ADC(=0.010),ADC5%(=0.016),ADC10%(=0.012),ADC25%(=0.007),ADC50%(=0.005),ADC75%(=0.015),and mode(=0.002)were significantly higher in IDH 1p19q group than in IDH 1p19q group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH gliomas and IDH gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH 1p19q gliomas and IDH 1p19q gliomas,with a cutoff value was 1448.75×10 mm /s;the sensitivity and specificity were 57.9% and 90.9%. ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.

Uso de nimotuzumab en paciente con astrocitoma anaplásico / Nimotuzumab in the treatment of a patient with anaplastic astrocytoma

Introducción: Nimotuzumab es una inmunoglobina de isotipo IgG1, obtenido por tecnología de ADN recombinante. La expectativa de vida de niños con tumores cerebrales recurrentes, refractarios a tratamientos a la cirugía, la radioterapia y la quimioterapia es de un mes aproximadamente. Con este tratamiento la supervivencia alcanza 44,5 meses. Objetivos: Presentar el caso clínico de un paciente con diagnóstico de Astrocitoma anaplásico que recibió tratamiento oncoespecífico concurrente con Nimotuzumab. Presentación de caso: Se realizó la descripción del diagnóstico, tratamiento y evolución de un paciente de 31 años de edad que fue diagnosticado con una neoplasia del sistema nervioso central. (Astrocitoma anaplásico). Recibió la combinación terapéutica de cirugía, radioterapia y anticuerpos monoclonales, lográndose una sobrevida de 39 meses. Conclusiones: La adición del anticuerpo monoclonal al tratamiento estándar de los tumores cerebrales aumentó la sobrevida del paciente, convirtiéndose en una alternativa terapéutica segura, ventajosa y factible como parte del tratamiento convencional en las condiciones asistenciales(AU)

Introduction: Nimotuzumab is an IgG1 isotype immunoglobin, obtained by recombinant DNA technology. Life expectancy is approximately one month in children with recurrent brain tumors, refractory to treatments to surgery, radiotherapy and chemotherapy. Survival reaches 44.5 months when using Nimotuzumab. Objectives: To report the clinical case of a patient diagnosed with anaplastic astrocytoma who received concurrent oncospecific treatment with Nimotuzumab. Case report: This paper describes the diagnosis, treatment and evolution of a 31-year-old male patient with neoplasm of the central nervous system (Anaplastic astrocytoma). He received the therapeutic combination of surgery, radiotherapy and monoclonal antibodies, achieving a survival of 39 months. Conclusions: The adding the monoclonal antibody to the standard treatment of brain tumors increased patient survival, making it a safe, advantageous and feasible therapeutic alternative as part of conventional treatment in healthcare conditions(AU)

Neurofibromatosis tipos 1 y 2 / Neurofibromatosis type 1 and 2

La neurofibromatosis (NF) comprende un grupo de enfermedades genéticas de herencia autosómica dominante, que se clasifican de la siguiente manera: neurofibromatosis tipo 1 (NF1), neurofibromatosis tipo 2 (NF2) y schwannomatosis (también conocida como neurofibromatosis tipo 3). Esta última es una enfermedad muy infrecuente, con una prevalencia aproximada de 1/126 000 personas, por lo que solo profundizaremos las dos primeras. La NF1, también conocida como la enfermedad de Von Recklinghausen, es la más frecuente de las tres y afecta principalmente la piel y el sistema nervioso periférico. Se caracteriza por la presencia de máculas "café con leche", pecas axilares o inguinales, nódulos de Lisch (hamartomas en el iris) y neurofibromas (tumores de la vaina de nervios periféricos). Otras manifestaciones menos frecuentes, aunque de mayor gravedad, incluyen gliomas del nervio óptico, meningiomas, neurofibromas malignos, escoliosis y displasia de la tibia. Su diagnóstico se suele realizar al nacimiento o durante los primeros años de vida, y se estima que un 50% de quienes la padecen presenta dificultades cognitivas. No hay datos concluyentes sobre la mortalidad en los pacientes con NF1, aunque se sabe que la expectativa de vida es menor que en la población general. La NF2 tiene una prevalencia considerablemente menor que la NF1 y su inicio es más tardío, afectando principalmente a adultos jóvenes. La presentación clínica típica se caracteriza por acúfenos, hipoacusia y ataxia en contexto de la presencia de schwannomas vestibulares bilaterales. Otros hallazgos menos frecuentes incluyen schwannomas de nervios periféricos, meningiomas, ependimomas o astrocitomas. La esperanza de vida es de unos 36 años, con una supervivencia media desde el momento del diagnóstico de 15 años. (AU)

Neurofibromatosis (NF) includes a group of genetic diseases with an autosomal-dominant inheritance pattern, and they are classified as follows: Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and Schwannomatosis (also known as neurofibromatosis type 3). This last one is a very rare disease, with an approximate prevalence of 1/126000, so we will only deepen in the first two. NF1, also known as von Recklinghausen disease, is the most frequent, and mainly affects the skin and peripheral nervous system. Its typical manifestations are the presence of café-au-lait macules, axillary or inguinal freckles, Lisch nodules (hamartomas in the iris) and neurofibromas (peripheral nerve sheath tumors). Less frequent manifestations, although more serious, include optic nerve gliomas, meningiomas, malignant neurofibromas, scoliosis and tibial dysplasia. The diagnosis is usually made at birth or during the first years of life, and approximately 50% of patients present cognitive difficulties. There is no conclusive data on mortality in patients with NF1, although it is known that life expectancy is lower than in general population. NF2 has a considerably lower prevalence than NF1, and its onset is later in life, mainly affecting young adults. Its typical clinical presentation is characterized by tinnitus, hearing loss and ataxia in the context in the presence of bilateral vestibular schwannomas. Less frequent findings include peripheral nerve schwannomas, meningiomas, ependymomas or astrocytomas. Life expectancy is about 36 years old, with a median survival from the moment of diagnosis of 15 years. (AU)

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).

MRI imaging of diffuse midline gliomas with H3K27M mutation / 中华放射学杂志

Objective To explore the MRI findings of diffuse midline gliomas with H3K27M mutation, and help us understand this new entity and improve the accuracy of diagnosis. Methods The clinical and imaging data of 17 diffuse midline gliomas with H3K27M mutation confirmed by pathology were retrospectively collected from July 2016 to April 2018 in Guangdong Sanjiu Brain Hospital. All patients were performed with pre?contrast and post?contrast MRI examination. All images were analyzed according to the location, shape, boundary, solid or cystic, signal feature, enhancement feature, and degree of edema. Results (1) Location:Six cases located in thalamus,4 cases located in brainstem,1 located in hypothalamus, 6 cases had multiple lesions in the midline and/or involving one or more brain. (2) Morphology and boundary:Seven cases had regular shape and clear boundary, 10 cases had irregular shapes and unclear boundaries. (3) Necrosis, cystic degeneration, hemorrhage: Twelve cases had necrosis or cystic degeneration in varying degree, 4 cases had hemorrhage. (4) Signal and enhancement features: The solid component showed slightly?low or low signal on T1WI, and slightly?high or high signal on T2WI; the cystic component showed obvious low signal on T1WI and obvious high signal on T2WI. T1WI enhancement:Eight cases showed uneven light?moderate enhancements, and all cases were adults; Six cases showed significant enhancements with large or small rings; Three cases showed uneven obvious enhancement. (5) Peritumoral edema: Fourteen cases had mild peritumoral edema,1 case had moderate peritumoral edema,2 cases had obvious peritumoral edema. Conclusion The MRI findings of diffuse midline gliomas with H3K27M mutation had certain characteristics,which can help to improve the level of diagnosis and differential diagnosis.

Investigation and analysis of the demand for health education in various postoperative stages of patients with low grade gliomas / 中国实用护理杂志

Objective To explore the characteristics of demand of reexamination of patients with low grade gliomas in various stages postoperative, so as to satisfy the demand and increase efficiency for health education of discharged patients with low grade gliomas as well as provide basis for personalized health education and continuous nursing. Methods The convenient sampling was conducted during the outpatients in Neurosurgical department of Beijing Tiantan Hospital Affiliated to Capital Medical University from April to March in 2017. The 170 outpatients were surveyed with the author designed questionnaire. Results The total rate of demand in 170 patients was 100% . Patients had the highest demand for the knowledge of recurrence, which rate was 91.8% . The longer the postoperative time, the lower the overall demand. The lowest rate was more than 12 months after operation, which scored 24 (17, 39). The higher the demand for the knowledge of recurrence. The highest rate was more than 12 months after operation, which scored 16 (11, 16). Professional consultation was a normal and expected way for patients to solve health problems (respectively 95.3% and 95.9% ). Conclusions The demand of postoperative patients with low grade gliomas are not high, but relatively have more demand on the knowledge of recurrence. They have different demand in different postoperative stages, genders, age groups, marital status, current employment status, glioma grades. Professional consultation was a method of health education which patients most willing to take.

Non-enhancing gliomas: does intraoperative ultrasonography improve resections?

PURPOSE: Non-enhancing diffuse gliomas are a challenging surgical proposition. Delineation of tumor extent on preoperative imaging and intraoperative visualization are often difficult. METHODS: We retrospectively analyzed all cases of non-enhancing gliomas that were operated on using navigated 3-dimensional ultrasonography (US). tumor delineation (good, moderate, or poor) on preoperative magnetic resonance imaging (MRI) and intraoperative US was compared. Post-resection US findings with respect to residual tumor status were compared to the postoperative imaging findings. The extent of resection was calculated and recorded. RESULTS: There were 55 gliomas (43 high-grade, 12 low-grade). Forty were close to eloquent areas. The pre-resection concordance of MRI with US was 56%, with US defining more tumors as well-delineated (n=26) than MRI (n=13). US was used for resection control in 50 cases. Gross tumor resection was achieved in 24 cases (51%). US correctly predicted the residual tumor status in 78% of cases. The use of US led to radical resections even in some tumors preoperatively deemed to be unresectable. However, eloquent location was the only independent predictor of the extent of resection. CONCLUSION: Intraoperative US is a useful tool for guiding resection of non-enhancing gliomas. It may be better than MRI for delineating these tumors, and may thereby facilitate improved resection of these otherwise poorly delineated tumors. However, functional boundaries remain the main limiting factor for achieving complete resection of non-enhancing gliomas.

Investigation and analysis of the demand for health education in various postoperative stages of patients with low grade gliomas / 中国实用护理杂志

Objective@#To explore the characteristics of demand of reexamination of patients with low grade gliomas in various stages postoperative, so as to satisfy the demand and increase efficiency for health education of discharged patients with low grade gliomas as well as provide basis for personalized health education and continuous nursing.@*Methods@#The convenient sampling was conducted during the outpatients in Neurosurgical department of Beijing Tiantan Hospital Affiliated to Capital Medical University from April to March in 2017. The 170 outpatients were surveyed with the author designed questionnaire.@*Results@#The total rate of demand in 170 patients was 100%. Patients had the highest demand for the knowledge of recurrence, which rate was 91.8%. The longer the postoperative time, the lower the overall demand. The lowest rate was more than 12 months after operation, which scored 24 (17, 39). The higher the demand for the knowledge of recurrence. The highest rate was more than 12 months after operation, which scored 16 (11, 16). Professional consultation was a normal and expected way for patients to solve health problems (respectively 95.3% and 95.9%).@*Conclusions@#The demand of postoperative patients with low grade gliomas are not high, but relatively have more demand on the knowledge of recurrence. They have different demand in different postoperative stages, genders, age groups, marital status, current employment status, glioma grades. Professional consultation was a method of health education which patients most willing to take.

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade III Cerebral Gliomas in Adults: Version 2019.01

BACKGROUND: There was no practical guideline for the management of patients with central nervous system tumor in Korea in the past. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, developed the guideline for glioblastoma successfully and published it in Brain Tumor Research and Treatment, the official journal of KSNO, in April 2019. Recently, the KSNO guideline for World Health Organization (WHO) grade III cerebral glioma in adults has been established. METHODS: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searches in PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords. Scope of the disease was confined to cerebral anaplastic astrocytoma and oligodendroglioma in adults. RESULTS: Whenever radiological feature suggests high grade glioma, maximal safe resection if feasible is globally recommended. After molecular and histological examinations, patients with anaplastic astrocytoma, isocitrate dehydrogenase (IDH)-mutant should be primary treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy whereas those with anaplastic astrocytoma, NOS, and anaplastic astrocytoma, IDH-wildtype should be treated following the protocol for glioblastomas. In terms of anaplastic oligodendroglioma, IDH-mutant and 1p19q-codeletion, and anaplastic oligodendroglioma, NOS should be primary treated by standard brain radiotherapy and neoadjuvant or adjuvant PCV (procarbazine, lomustine, and vincristine) combination chemotherapy. CONCLUSION: The KSNO's guideline recommends that WHO grade III cerebral glioma of adults should be treated by maximal safe resection if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors.