Genetic alterations of IDH1 and Vegf in brain tumors.

BACKGROUND: This study evaluates the presence of R132H mutation in isocitrate dehydrogenase (IDH1) gene and the vascular endothelial growth factor (VEGF) +936 C/T polymorphism in brain tumors. The impact of these genetic alterations on overall survival (OS) and progression free survival (PFS) was evaluated. METHODS: A cohort of 80 patients surgically treated at Hospital Clínico San Carlos, Madrid, between March 2004 and November 2012, was analyzed. Tumors were distributed in 73 primary brain tumors (gliomas, meningiomas, hemangiopericytomas and hemangioblastomas) and seven secondary tumors evolved from a low grade glioma, thus providing a mixed sample. RESULTS: IDH1R132H gene mutation was found in 12 patients (15%) and appears more frequently in secondary tumors (5 (71.4%) whereas in 7 (9.7%) primary tumors (p < .001)). The mutation is related to WHO grade II in primary tumors and a supratentorial location in secondary tumors. The OS analysis for IDH1 showed a tendency towards a better prognosis of the tumors containing the mutation (p = .059).The IDH1R132H mutation confers a better PFS (p = .025) on primary tumors. The T allele of VEFG +936 C/T polymorphism was found in 16 patients (20%). No relation was found between this polymorphism and primary or secondary tumor, neither with OS or PFS. CONCLUSIONS: IDH1R132H gene mutation is exclusive in supratentorial tumors and more frequent in secondary ones, with a greater survival trend and better PFS in patients who carry it. The T allele of VEGF +936 C/T polymorphism is more common in primary tumors, although there is no statistical relation with survival.

Pseudomeningocele after traumatic nerve root avulsion. A novel technique to close the fistula.

Traumatic brachial plexus complete avulsions and the subsequent formation of pseudomeningoceles are a well-known entity that usually remains asymptomatic. Pseudomeningocele is due to the dural sleeve encasing the damaged roots and the spinal liquid that may accumulate locally or in the supraclavicular soft tissues. The pseudomeningocele, added to the associated lesion of the plexus and usually the surrounding vessels, may become difficult to manage. We describe the novel management of a traumatic pseudomeningocele using an endovascular technique.

Pérdidas en el cromosoma 1p36 y la sobreexpresión de COX-2 predicen el intervalo libre de recurrencia en meningiomas completamente extirpados grados I y II / Chromosome 1p36 loss and COX-2 overexpression predict recurrence-free survival in completely removed meningioma grade I and II

Diversos estudios con un largo periodo de seguimiento muestran que la tasa de recidiva para los meningiomas grado I (benignos) y II (atípicos) se sitúa entre el 15-25% y el 30-35% respectivamente, a pesar de una cirugía agresiva. Hemos investigado 135 meningiomas completamente resecados para identificar y comparar marcadores pronósticos de recurrencia tumoral. Hemos determinado la expresión inmunohistoquímica de 30 biomarcadores, la muerte celular por apoptosis mediante un ensayo de hibridación in situ (ApopDETEKTM) y las perdidas en el cromosoma 1p36 mediante FISH. El análisis estadístico univariante mostró que el grado tumoral de la OMS, la alta celularidad, la atipia nuclear, las pérdidas en el cromosoma 1p36 (determinadas en 20 de los 107 casos válidos) y la expresión de COX-2 (9 casos positivos y 126 negativos), Ciclina A, Topoisomerasa II y MIB1/Ki67 se asociaron con el periodo libre de recurrencia. El análisis multivariante de estas variables pronósticas reveló que solamente las pérdidas en el cromosoma 1p36 y la expresión de COX-2 y MIB1 eran factores independientes para la predicción de recidiva tumoral. El análisis estadístico para la covariación de COX-2 y las perdidas en 1p36 mostraron un efecto antagonista para ambos marcadores. Los meningiomas con pérdidas en 1p36 mostraron un incremento significativo de la necrosis, la atipia nuclear y la expresión de Ciclina E, PAKT, PDGF y p21. La sobreexpresión de COX-2 se asocia a su vez con un aumento de la expresión de VEGF, PDGF, HER2 y MDM2. Los inhibidores selectivos de COX-2 podrían ser usados como un tratamiento quimiopreventivo putativo para evitar la recurrencia en aquellos meningiomas con sobreexpresión de COX-2(AU)

Long follow-up studies show that the 10-year regrowth rate for grade I (benign) and II (atypical) meningiomas rises up to 15---25% and 30---35%, respectively, despite aggressive surgery. We investigated completely removed meningiomas grade I and II (n = 135) to identify and compare prognostic markers for tumour recurrence. We determined the immunohistochemical expression of 30 biomarkers, cell death assay by in situ hybridisation (ApopDETEKTM) and loss of chromosome 1p36 by FISH. The univariate statistical analysis showed that WHO grade, high cellularity, nuclear atypia, loss of 1p36 (determined in 20 out of 107 valid cases), expression of COX-2 (9 positive cases and 126 negative cases), Cyclin A, Topoisomerase II and MIB1/ki67 were associated with recurrence-free survival. The multivariate linkage analysis for the prognostic variables revealed that only 1p36 loss, expression of COX-2 and MIB1 were independent factors for predicting meningioma recurrence. The statistical analysis of COX-2 and 1p36 loss co-variation showed an antagonistic effect for both prognostic markers. Meningiomas with 1p36 loss showed significant increase of necrosis, nuclear atypia and increased expression of Cyclin E, PAKT, PDGF and p21. COX-2 overexpression was associated with increased VEGF, PDGF, HER2 and MDM2 expression. COX-2 inhibitors may be used as a putative chemopreventive treatment for meningioma recurrence in tumours with COX-2 over-expression(AU)

Recurrent meningeal inflammatory myofibroblastic tumor: a case report and literature review.

An inflammatory myofibroblastic tumor (IMT) is a rare lesion with an uncertain prognosis and a disorder difficult to classify. IMTs are a heterogeneous group of lesions, sometimes indistinguishable from meningiomas and other expanding or inflammatory lesions of the central nervous system. This report presents a patient with IMT, who presented with recurrent retroocular pain radiating to the occipital region and no neurologic deficits. He had early recurrence in spite of total resection of the lesion. The clinical profile of 18 patients with either progression or recurrence has been reviewed.

Clinicopathological variables, immunophenotype, chromosome 1p36 loss and tumour recurrence of 247 meningiomas grade I and II.

The WHO grading scheme distinguishes benign (grade I), atypical (grade II) and anaplastic (grade III) meningiomas. Both atypical and anaplastic meningiomas exhibited an overall increased rate of recurrence, but between 15-20% benign meningiomas will also exhibit an unfavourable clinical course with recurrence before 10 years despite aggressive surgery. We investigated 247 cases of meningiomas grade I and II. The immunohistochemical expression of 30 different molecular biomarkers of cell adhesion molecules, cell-cycle and apoptosis regulators and checkpoints was analyzed. We also determined apoptosis by in-situ hybridization (APOPDETEKTM) and loss of chromosome 1p36 by FISH. The study revealed a statistically significant co-variation (p<0.05) between meningiomas grade II associated with several clinicopathological features (Simpson grade of clinical resection, necrosis, nuclear atypia, macronucleoli, transition to small cell, sheet-like growth, high cellularity), increased expression of several biomarkers of tumour proliferation (Cyclin A, Cyclin E, MIB-1 or MDM2), proteases (Cathepsin D) or cell-adhesion (CD44) and lower expression of progesterone receptors than meningiomas grade I. The presence of Psammoma bodies or the location at convexity were protective prognostic factors for tumour recurrence while high cellularity and early age of onset (<57 year-old) were indicators of increased recurrence risk. The expression of COX-2, gamma-catenin, Topoisomerase IIa, VEGF and MIB-1 was significantly higher in the cohort of recurrent meningiomas. Meningiomas with chromosome 1p36 loss showed a higher recurrence rate (33.3%) than meningiomas with normal chromosome 1p36 (18%). Increased COX-2 expression in recurrent meningioma may also suggest a putative role of COX-2 inhibitors as a chemopreventive treatment for recurrence.