Myxopapillary ependymomas; proximity to the conus and its effect on presentation and outcomes

Background: Myxopapillary ependymomas (MPE) are intradural spinal tumors with a predilection to the filum terminale. Damage to conus medullaris during surgery can result in sphincteric and sexual dysfunction. The purpose of this study is to determine how myxopapillary ependymoma proximity to the conus impacts patient presentation, extent of resection, and clinical outcomes. Methods: Fifty-one patients who underwent surgical resection of pathologically confirmed myxopapillary ependymoma with at least 1 year of follow-up were included in the study. We collected initial presenting symptoms, distance of the tumor from the conus, extent of resection, and postoperative clinical outcomes including bladder dysfunction. Results: Average age was 38 years (range 7–75 years) with a male to female ratio of 1.43:1. Patients most commonly presented with pain symptoms (88%), and 12 patients (23.5%) had urologic symptoms on presentation. The mean tumor distance from the tip of the conus was 1.60 cm (10 cm above to 21 cm below the tip of the conus). Patients with tumors in contact with the conus had a significantly higher rate of preoperative urinary symptoms and were more likely (32% vs. 14%) to suffer postoperative urinary sphincteric disturbances. Tumors with direct invasion of the conus medullaris were more likely to require intralesional resection and fail to achieve a gross total resection (GTR). Conclusion: Patients with MPE in close proximity to the conus were more likely to suffer from long-term morbidity related to urologic issues following surgical resection. Adjuvant radiotherapy may be a viable option for patients who fail to achieve GTR.

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Clinical Outcomes of Surgical Management of Primary Brachial Plexus Tumors

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1731252 ◽

2021 ◽

Vol 54 (02) ◽

pp. 124-129

Author(s):

Sunil Gaba ◽

Subair Mohsina ◽

Jerry R. John ◽

Satyaswarup Tripathy ◽

Ramesh Kumar Sharma

Keyword(s):

Brachial Plexus ◽

Clinical Outcomes ◽

Surgical Resection ◽

Total Resection ◽

Dumbbell Tumor ◽

Female Ratio ◽

Grade 5 ◽

Benign Pathology ◽

A Prospective Study ◽

Intraoperative Electrical Stimulation

Abstract Introduction This study evaluates the clinical presentation, tumor characteristics, and clinical outcomes of surgically treated benign and malignant brachial plexus tumors (BPTs). Methods A prospective study of patients with BPTs from June 2015 to August 2020 was conducted. All patients underwent surgical resection with microneurolysis and intraoperative electrical stimulation to preserve the functioning nerve fascicles. Results Fourteen patients with 15 BPTs underwent surgical resection. Mean age was 37.8 ± 12.3 years; with male to female ratio 4:10. The clinical presentations were swelling (100%), pain (84.6%), and paresthesia (76.9%). The lesions involved roots (5/15), trunk (5/15), division (1/15), and cords (4/15). Thirteen patients had benign pathology (8 schwannomas, 3 neurofibromas, 2 lipomas) and two had malignant neurofibrosarcoma. Gross total resection was achieved in all cases except a dumbbell tumor. The mean follow-up period was 24 ± 5 months. Postoperatively, all patients reported improvement in pain and paresthesia with no new sensory deficit. All patients had developed initial motor weakness (Grades 2–4); however, full power (Grade 5) was recovered by 3 to 5 months. Conclusion Total resection can be achieved by appropriate microneural dissection and electrophysiologic monitoring and is potentially curative with preserving function.

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Filum terminale paraganglioma with associated cyst: a case report

Romanian Neurosurgery ◽

10.2478/romneu-2018-0028 ◽

2018 ◽

Vol 32 (2) ◽

pp. 217-223 ◽

Cited By ~ 1

Author(s):

Danil Adam ◽

Cristiana Moisescu ◽

Dragos Iftimie ◽

Gina Burdusa

Keyword(s):

Histopathological Examination ◽

Conus Medullaris ◽

Neurological Deficits ◽

Spinal Tumors ◽

Filum Terminale ◽

Neurosurgical Department ◽

Total Resection ◽

Presenting Symptoms ◽

Normal Ranges ◽

Contrast Enhanced Ct

Abstract Background and importance: Paragangliomas are neuroendocrine tumors that occur most often within the adrenal glands. The most frequent extra-adrenal locations include the carotid body and the jugular bulb. Filum terminale paragangliomas are extremely rare, with just 33 cases reported to date. Imagistic appearance is similar with other types of intradural extramedullary tumors such as ependymomas and schwannomas. Histopathological examination is the only method of establishing a definitive diagnosis. They are classified as grade I WHO tumors with favorable prognosis in the case of total resection. Clinical presentation: A 46-year-old woman without any relevant medical history was admitted to our Neurosurgical Department, complaining of low back pain with bilateral sciatica. She presented no neurological deficits and routine blood tests, as well as heart rate and blood pressure, were within normal ranges. Lumbar spine MRI with gadolinium enhancement revealed an intradural tumor with irregular, well defined margins and intense homogeneous enhancement, located at the level of the L3 vertebra. It presented an unenhancing intradural cystic lesion that extended cranially up to the level of the L1 vertebra. The tumor and associated cyst were completely resected through L2-L4 laminectomy. The tumor-cyst complex was attached, yet nonadherent to the conus medullaris and nerve roots, which allowed safe total removal. Histopathological examination was suggestive for paraganglioma, a diagnosis confirmed by immunohistochemistry that classified it as moderately differentiated, non-secreting type. Serum metanephrines subsequently determined were within normal ranges. Also, additional imagistic tests consisting of cervical and abdominal ultrasound and contrast enhanced CT scans did not detect any additional tumors. Postoperatively, the patient was neurologically intact, with complete remission of presenting symptoms at 3 months follow-up. Conclusion: Filum terminale paraganglioma is a rare diagnosis which is frequently overlooked. However, gross total resection, a common goal for all spinal tumors, can be curative in these particular cases.

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Clinical Outcomes of Metastatic Colorectal Cancer Following Surgical Resection of the Primary tumor at Hiwa Cancer Hospital, Sulaimani, Iraq

Disease and Diagnosis ◽

10.34172/ddj.2021.02 ◽

2021 ◽

Vol 10 (1) ◽

pp. 7-12

Author(s):

Kadhim Faruq Namiq ◽

Kosar Mohammad Ali ◽

Mohammed Ibrahim Mohialdeen Gubari

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Clinical Outcomes ◽

Surgical Resection ◽

Primary Tumor ◽

Smoking Habit ◽

Primary Tumors ◽

Female Ratio ◽

Cancer Hospital ◽

One Year

Background: Colorectal cancer (CRC) is one of the main causes of cancer-related mortality. The surgical resection of primary CRC tumors is a critical line of treatment. The present study investigated the clinical outcomes of the surgical resection of the primary tumor in metastatic CRC patients. Materials and Methods: In this prospective and retrospective study, 81 metastatic CRC patients were recruited at Hiwa Cancer Hospital in Sulaimani, Iraq from January 2016 to December 2019. Forty-one patients underwent surgical resection of their primary tumor while the remaining 40 patients did not undergo resection. Data regarding patients’ clinical outcomes were obtained from the clinical portal system of the hospital and were analyzed using SPSS (version 23.0). Results: The patients’ mean (± SD) age was 53.5 (± 17.02) years and the male-to-female ratio was 1.3:1. Patients undergoing the surgical resection of their primary tumors had a significantly better one-year survival compared to those who did not undergo resection (P = 0.04). Based on the results, patients in the surgical resection group continued to have a better overall survival although it was not statistically significant (P = 0.1). Significantly more patients with colon cancer underwent surgical resection compared to rectal cancer (P = 0.03), and smoking habit negatively affected the chance to undergo surgical resection (P = 0.009). Conclusion: In general, the surgical resection of the primary tumor has a significant favorable impact on one-year survival, but possibly not on overall survival. The primary site of the tumor and smoking habits significantly influence the chance to undergo surgical resection whereas the grade of the tumor or the type of systemic therapy has no significant impact in this regard.

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LINC-28. EPIDEMIOLOGICAL CHARACTERISTICS AND SURVIVAL OUTCOMES OF CHILDREN WITH MEDULLOBLASTOMA TREATED AT THE NATIONAL CANCER INSTITUTE (INCA) IN RIO DE JANEIRO, BRAZIL

Neuro-Oncology ◽

10.1093/neuonc/noaa222.462 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii383-iii384

Author(s):

Gabriela Oigman ◽

Diana Osorio ◽

Joseph Stanek ◽

Jonathan Finlay ◽

Denizar Vianna ◽

...

Keyword(s):

High Risk ◽

Maternal Education ◽

Survival Outcomes ◽

Middle Income ◽

Female Ratio ◽

High Risk Patients ◽

Presenting Symptoms ◽

Risk Patients ◽

Epidemiological Characteristics ◽

Standard Risk

Abstract BACKGROUND Medulloblastoma (MB), the most malignant brain tumor of childhood has survival outcomes exceeding 80% for standard risk and 60% for high risk patients in high-income countries (HIC). These results have not been replicated in low-to-middle income countries (LMIC), where 80% of children with cancer live. Brazil is an upper-middle income country according to World Bank, with features of LMIC and HIC. METHODS We conducted a retrospective review of 126 children (0–18 years) diagnosed with MB from 1997 to 2016 at INCA. Data on patients, disease characteristics and treatment information were retrieved from the charts and summarized descriptively; overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier Method. RESULTS The male/female ratio was 1.42 and the median age at diagnosis was 7.9 years. Headache (79%) and nausea/vomiting (75%) were the most common presenting symptoms. The median time from onset of symptoms to surgery was 50 days. The OS for standard-risk patients was 69% and 53% for high-risk patients. Patients initiating radiation therapy within 42 days after surgery (70.6% versus 59.6% p=0.016) experienced better OS. Forty-five patients (35%) had metastatic disease at admission. Lower maternal education correlated with lower OS (71.3% versus 49% p=0.025). Patients who lived >40km from INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20% of families lived below the Brazilian minimum wage. CONCLUSIONS These findings suggest that socioeconomic factors, education, early diagnosis and continuous data collection, besides oncological treatment must be adressed to improve the survival of children with MB.

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Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

Case Reports in Oncology ◽

10.1159/000512061 ◽

2021 ◽

pp. 739-745

Author(s):

Zane Blank ◽

Richard Sleightholm ◽

Beth Neilsen ◽

Michael Baine ◽

Chi Lin

Keyword(s):

Radiation Therapy ◽

Disease Progression ◽

Surgical Resection ◽

Local Control ◽

Benign Neoplasm ◽

Good Prognosis ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Adjuvant Radiation ◽

Nasopharyngeal Angiofibroma ◽

Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

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Presenting symptoms of COVID ‐19 and clinical outcomes in hospitalised older adults

Internal Medicine Journal ◽

10.1111/imj.15286 ◽

2021 ◽

Author(s):

Kate Gregorevic ◽

Andrea Maier ◽

Roeisa Miranda ◽

Paula Loveland ◽

Katherine Miller ◽

...

Keyword(s):

Older Adults ◽

Clinical Outcomes ◽

Presenting Symptoms

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Concomitant Intramedullary Pilocytic Astrocytoma and Conus Medullaris Myxopapillary Ependymoma: A Case Report

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1313594 ◽

2012 ◽

Vol 74 (02) ◽

pp. 113-115

Author(s):

B. Elmostarchid ◽

A. Akhaddar ◽

E. Ennouali ◽

Y. Zoubir ◽

A. Belhachmi ◽

...

Keyword(s):

Case Report ◽

Pilocytic Astrocytoma ◽

Conus Medullaris ◽

Myxopapillary Ependymoma

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POS0294 PROFILE OF SPINAL TUMORS IN RHEUMATOLOGY DEPARTMENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3905 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 372.2-372

Author(s):

B. A. Hiba ◽

H. Sahli ◽

S. Boussaid ◽

S. Nouicer ◽

S. Jemmali ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Signal Intensity ◽

Spinal Tumor ◽

Sensory Function ◽

Spinal Tumors ◽

Vertebral Compression Fractures ◽

Myxopapillary Ependymoma ◽

Resonance Imaging ◽

Weighted Sequences

Background:Spine tumors remain a hot topic because of their associated morbidity by affecting motor and sensory function. Contrary to metastatic spine disease (MSD), extremely prevalent, rise within or surrounding the spinal cord and/or vertebral column, primary spinal tumors are rare, 5% of all primary skeletal tumors and frequently benign (20%). The diagnostic delay of these tumors, even when benign, is associated with a poor prognosis. Establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation.Objectives:to provide an overview of the epidemiology, radiological and histopathological of spinal tumors diagnosed in a rheumatology department.Methods:A retrospective study consisting of clinical characteristics analysis, laboratory and x-ray examinations, was performed on 40 patients who were hospitalised for a spinal tumor, in a rheumatology department, over 5-year period from 2015 to 2020.Results:A total of 40 patients with a mean age of 66 ± 13.5 years [18-93] and a sex-ratio of 1.1, were included. The most common initial complaints were inflammatory back pain (67.5%) and fatigue (52.5%), with a median duration of 5 months. Physical examination abnormalities included lumbar stiffness (32.5%), radicular signs (18.7%), hepatomegaly (12.5%), and lymphadenopathy (17.5%). Neurological deficit was found in only 3 patients (7.5%). Hypercalcemia (corrected serum calcium > 105 mg/l), and anemia (hemoglobin (Hb) < 100 g/l in female, Hb <110g/l in male) were present initially in respectively 47.5% and 46.3% patients, while biological inflammatory syndrome was present in 89.7% patients (median C-reactive protein of 44.7). Tumor markers were performed in 12 patients and they were positive in 9 of them.Plain radiographs findings were vertebral compression fractures (43.6%), osteolytic lesions (30.8%) and osteoblastic lesions (12.5%). Lumbar spine was the most affected (57.5%), followed by the dorsal spine (45%). Magnetic resonance imaging (MRI) was performed in 55%, and the most common lesion was low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences (68.1%).In our study, only one patient was diagnosed for a myxopapillary ependymoma, a benign primary spinal tumor characterised by a metastatic dissemination risk. For the rest (39 patients), the diagnosis of bone metastasis, multiple myeloma (57.7%), and of solid tumor cancers (40%), were established. Primary cancers were mainly prostate cancer (37.5%), lung cancer (18.7%) and kidney cancer (18.7%). By a median follow-up time of 25 months, overall survival rate was 30%.Conclusion:Extradural lesions are the most common, and are typically metastatic. Special attention should be pain to the patient’s medical history and laboratory abnormalities. In fact, an early diagnosis requires a high index of clinical suspicion.Disclosure of Interests:None declared

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PATH-16. EVALUATION OF SEX-BASED DIFFERENCES IN CLINICAL OUTCOMES AND TUMOR GENOMICS IN PATIENTS WITH NEWLY DIAGNOSED IDH-WILDTYPE GLIOBLASTOMA RECEIVING CHEMORADIATION

Neuro-Oncology ◽

10.1093/neuonc/noab196.468 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi118-vi118

Author(s):

Diana Shi ◽

Mary Jane Lim-Fat ◽

Amin Nassar ◽

Jared Woods ◽

Gilbert Youssef ◽

...

Keyword(s):

Clinical Outcomes ◽

Karnofsky Performance Status ◽

Performance Status ◽

Methylation Status ◽

Multivariable Analysis ◽

Extent Of Resection ◽

Hazard Ratio ◽

Newly Diagnosed ◽

Loss Of Function ◽

Female Sex

Abstract BACKGROUND We evaluated sex-based differences in clinical outcomes and tumor genomics in patients with newly-diagnosed GBM. METHODS We reviewed 665 IDH-wild type GBM patients with Karnofsky Performance Status (KPS) ≥60 treated at our institution from 2010-2019 including; 585 patients with targeted exome sequencing of 447 cancer associated genes (OncoPanel). Deleterious mutations were defined as homozygous deletions or loss of function mutations of known tumor suppressors (as reported in TCGA, ≥ 3 times in the COSMIC database, or predicted as “damaging” in SIFT and/or “probably damaging” in Polyphen 2) or known oncogenic mutations in proto-oncogenes (reported in TCGA or ≥ 3 times in COSMIC). RESULTS There were 384 (57.7%) males and 281 (42.3%) females. Median OS was 22.5 months for females and 19.3 months for males (hazard ratio [HR] 0.81, 95% CI 1.03-1.48, p = 0.02). On multivariable analysis adjusted for age, KPS ≥90, extent of resection, and MGMT methylation status, female sex (adjusted hazard ratio 0.78, 95% CI [0.64-0.95], p = 0.015) was associated with improved OS. Superior OS in females was observed in MGMT-unmethylated patients (HR 0.69, 95% CI [0.54-0.90], p = 0.005) but not MGMT-methylated patients. Thirteen genes were deleteriously altered in ≥5% of our cohort: CDK4 (12.1% male vs. 7.8% female), CDKN2A (46.5% vs. 45.7%), CDKN2B (41.8% vs. 43.3%), EGFR (34.7% vs. 40.0%, MTAP (18.2% vs. 18.8%), NF1 (11.5% vs. 9.4%), PTEN (28.2% vs. 29.8%), TP53 (28.2% vs. 30.2%), RB1 (5.6% vs. 6.5%), MDM4 (6.2% vs. 5.7%), ATM (5.9% vs. 3.7%), MDM2 (7.4% vs. 4.1%), PIK3R1 (6.2% vs. 4.1%). There were no differences in frequency of mutations in these individual genes between males and females (χ 2 [1, N=585] = 0.05-2.86, p = 0.09-0.86). CONCLUSIONS Female sex is associated with improved survival. We did not identify sex-based differences in deleterious genomic alterations amongst commonly altered genes in GBM.

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PC3 - 152 Impact of Extent of Resection Upon Outcome in Newly Diagnosed Glioblastoma: A Study in the Molecular Era

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.380 ◽

2016 ◽

Vol 43 (S4) ◽

pp. S17-S18

Author(s):

W.M.H. Sayeed ◽

E. Batuyong ◽

J.C. Easaw ◽

M. Pitz ◽

J.J.P. Kelly

Keyword(s):

Multivariable Analysis ◽

Extent Of Resection ◽

Postal Code ◽

Newly Diagnosed ◽

Presenting Symptoms ◽

Tumour Location ◽

Newly Diagnosed Glioblastoma ◽

Molecular Marker Analysis

For decades, debate has persisted regarding the role of surgical resection in newly diagnosed glioblastoma. There is increasing evidence that extent of resection (EoR) is an independent prognostic factor. Previous work has proposed the inclusion of EoR in a risk stratification algorithm but does not incorporate account recent advances in the molecular characterization of tumours. We set out to investigate the effect of EoR on overall survival (OS), and to develop a stratification algorithm incorporating both EoR and modern molecular markers for prognostication. HYPOTHESIS: Greater EoR is independently associated with improved OS. METHODS: We examined 190 consecutive cases of histopathologically confirmed newly-diagnosed glioblastoma who were operated upon between January 1, 2012 and December 31, 2014. Variables including age, sex, postal code, KPS, tumour location, presenting symptoms, treatment history, date of progression, date of reoperation, as well as MGMT, IDH, 1p/19q codeletion, and ATRX status were recorded. Preoperative and postoperative MRIs were reviewed and volumetric tumour burden will be analyzed and EoR will be calculated. RESULTS: Preliminary EoR calculations (n=18) show a positive correlation between EoR and OS. CONCLUSION: A correlation exists between EoR and OS, although multivariable analysis is planned to exclude potential confounders. MRI review, chart review including molecular marker analysis and EoR calculations are ongoing.

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