scholarly journals Therapeutic strategy for pineal parenchymal tumor of intermediate differentiation (PPTID): case report of PPTID with malignant transformation to pineocytoma with leptomeningeal dissemination 6 years after surgery

2019 ◽  
Vol 130 (6) ◽  
pp. 2009-2015 ◽  
Author(s):  
Toshiaki Bando ◽  
Yasushi Ueno ◽  
Narihide Shinoda ◽  
Yukihiro Imai ◽  
Kazuhito Ichikawa ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Gamma Knife Radiosurgery ◽  
Craniospinal Irradiation ◽  
Histopathological Study ◽  
Leptomeningeal Dissemination ◽  
Who Grade ◽  
Lower Extremity Weakness ◽  
Long Term Follow Up ◽  
Grade Ii

Pineal parenchymal tumor of intermediate differentiation (PPTID) is rare. The WHO first classified PPTID in 2000 as a pineal parenchymal tumor (PPT) with an intermediate prognosis between pineocytoma (PC) and pineoblastoma (PB). It is considered an intermediate-grade tumor and divided into WHO grade II or III.The number of available reports about PPTID is presently limited, and the appropriate management for this tumor has not yet been determined.The authors report a rare case of PC in a 63-year-old woman who presented with lower-extremity weakness and gait disturbance. A pineal mass lesion was detected on MRI. A diagnosis of PC was established after microsurgical gross-total tumor resection, and the patient received no adjuvant therapy after surgery. Two years after surgery, a partial recurrence was recognized and Gamma Knife radiosurgery was performed. Fours years later, the patient developed diffuse leptomeningeal dissemination. She was successfully treated with craniospinal irradiation. Leptomeningeal dissemination may develop 6 years after the initial diagnosis of PC. A histopathological study of the recurrent tumor revealed a malignant change from PC to PPTID.The present case shows the importance of long-term follow-up of patients with PPTs following resection and the efficacy of craniospinal irradiation in the treatment of leptomeningeal dissemination.

Oligodendroglioma arising in the glial component of ovarian teratomas: a series of six cases and review of literature

2012 ◽  
Vol 65 (7) ◽  
pp. 631-634 ◽  
Author(s):  
Nasir Ud Din ◽  
Aisha Memon ◽  
Kanwal Aftab ◽  
Zubair Ahmad ◽  
Rashida Ahmed ◽  
...  
Keyword(s):  
Review Of Literature ◽  
Ki 67 ◽  
Who Grade ◽  
Long Term Follow Up ◽  
Grade Ii ◽  
The Right ◽  
Rule Out ◽  
Ovarian Teratomas

AimsTo report the exceedingly rare occurrence of oligodendroglioma in the glial component of ovarian teratomas.MethodsSix cases of oligodendrogliomas arising in the glial component of ovarian teratomas were studied and the literature was reviewed. Immunohistochemistry was performed by the Flex technique.ResultsThe ages of the patients ranged from 12 to 28 years (mean 21 years). Four tumours were located in the right and one in the left ovary. The size of the ovarian cysts ranged from 7 cm to 29 cm (mean 19.6 cm). Four cases arose in immature and two cases in mature teratomas. In all cases, oligodendroglioma was WHO grade II. On immunohistochemistry, glial fibrillary acidic protein stain was positive in all cases. The Mib 1 (Ki 67) proliferative index was low and the tumour cells were negative for synaptophysin. Follow-up was available in five patients and ranged from 1 to 42 months. Two patients died of disease after 1 and 36 months of diagnosis, respectively. In both these cases oligodendroglioma arose in an immature teratoma. The remaining three patients are alive with a follow-up of 4–42 months.ConclusionsOligodendroglioma arising in the glial component of ovarian teratomas is exceedingly rare. Ovarian teratomas should be extensively sampled and carefully evaluated to rule out the possibility of a glial tumour. This is the single and largest series of oligodendrogliomas arising in ovarian teratomas. The prognosis is good for oligodendrogliomas arising in mature teratomas compared with those arising in immature teratomas, although long-term follow-up is needed to determine the exact behaviour.

PETROCLIVAL MENINGIOMAS

Neurosurgery ◽  
2007 ◽  
Vol 60 (6) ◽  
pp. 965-981 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Laligam N. Sekhar ◽  
David Schessel ◽  
Akio Morita
Keyword(s):  
Survival Rate ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Gamma Knife Radiosurgery ◽  
Free Survival ◽  
Petroclival Meningiomas ◽  
Long Term Follow Up

Abstract OBJECTIVE To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclivaTl meningiomas. METHODS During a 13-year period (1991–2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images. RESULTS At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15–180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 ± 11 preoperatively, 76 ± 11 at 1 year postoperatively, and 84 ± 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms. CONCLUSION This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.

Cordotomy for patients with thoracic malignant astrocytoma

2010 ◽  
Vol 13 (4) ◽  
pp. 418-423 ◽  
Author(s):  
Masaya Nakamura ◽  
Osahiko Tsuji ◽  
Kanehiro Fujiyoshi ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Radical Resection ◽  
Subtotal Resection ◽  
Optimal Management ◽  
Malignant Astrocytoma ◽  
Initial Operation ◽  
Who Grade ◽  
Kaplan Meier ◽  
Malignant Astrocytomas ◽  
Grade Ii

Object The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

scholarly journals Positive outcome in a high-grade myxofibrosarcoma: a case report

2018 ◽  
Vol 1 (1) ◽  
pp. 27-30
Author(s):  
Mihaela Olaru ◽  
Cornelia Nitipir
Keyword(s):  
Case Report ◽  
Fibrous Histiocytoma ◽  
Tumor Resection ◽  
Pulmonary Nodules ◽  
Positive Outcome ◽  
Pet Ct ◽  
Longus Muscle ◽  
Long Term Follow Up

AbstractMyxofibrosarcoma or myxoid malignant fibrous histiocytoma is one of the most common sarcomas of the limb. It is usually treated multimodally. Most frequent sites of metastasis are the bone, lung and lymph nodes. The present paper is a case report of a 65-year-old male with myxofibrosarcoma of the fibularis longus muscle, for which he first underwent surgery - tumor resection with appropriate margins. The tumor was staged pT2b cN0 cM0. Postoperative PET-CT revealed metabolically inactive pulmonary nodules. Two months after surgery, he underwent adjuvant radiotherapy, a total dose of 60 Gy and 6 courses of chemotherapy (doxorubicin and ifosfamide). Pulmonary nodules have been stationary on all subsequent imagistic studies. He is free of recurrence on long-term follow-up.

scholarly journals Treating Vestibular Schwannomas with Gamma-Knife Radiosurgery Versus Microsurgery: Long-Term Follow-up of 702 Cases

2019 ◽  
Vol 87 (June) ◽  
pp. 2599-2610
Author(s):  
AHMED R. RIZK, M.D. GUIHERME LEPSLI, M.D. ◽  
GERHARD A. HORSTMANN, M.D. MARCOS TATABIBA, M.D.
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Vestibular Schwannomas ◽  
Long Term Follow Up

scholarly journals Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

2021 ◽  
Vol 18 (3) ◽  
pp. 77-85
Author(s):  
I. A. Eliseenko ◽  
S. G. Struts ◽  
V. V. Stupak
Keyword(s):  
Laser Radiation ◽  
Tumor Resection ◽  
Relative Number ◽  
Neodymium Laser ◽  
Long Term Results ◽  
Primary Tumors ◽  
Classical Technique ◽  
Long Term Follow Up ◽  
Microsurgical Techniques

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

Optic Nerve Pilocytic Astrocytoma With Leptomeningeal Dissemination – Case Report

2021 ◽  
Vol 14 (63) (1) ◽  
pp. 37-42
Author(s):  
Claudia Raluca Mărginean ◽  
Patricia Maria Luminița Simu ◽  
Robert Aurelian Tiucă ◽  
Alexandru Mariean-Șchiopu ◽  
Iunius Paul Simu
Keyword(s):  
Optic Nerve ◽  
Pilocytic Astrocytoma ◽  
Tumor Location ◽  
Good Prognosis ◽  
Incomplete Resection ◽  
Leptomeningeal Dissemination ◽  
Term Survival ◽  
Long Term Follow Up ◽  
The Right

"Pilocytic astrocytoma is the most frequent type of brain tumor diagnosed during childhood. It originates from midline structures and is associated with good prognosis, with an estimated survival rate higher than 95%. We presented the case of a male patient diagnosed at the age of 6 with pilocytic astrocytoma located in the right optic nerve with associated chiasm infiltration. Incomplete resection of the tumoral process was performed, without any additional therapy, as association of chemotherapy or radiotherapy is still controversial among specialists. The patient had an unpredictable severe evolution of the disease, with associated leptomeningeal dissemination and extreme worsening of neurological and endocrinologic status. Six years after diagnosis, despite complex medical efforts the patient died. This article raises awareness of leptomeningeal dissemination risk, a rare evolution in cases of pilocytic astrocytoma. Early diagnosis, complete tumoral resection, tumor location and careful long-term follow up are key factors for long-term survival. "

Gamma-Knife Radiosurgery for Cranial Base Meningiomas: Experience of Tumor Control, Clinical Course, and Morbidity in a Follow-Up of More than 8 Years

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Iris Zachenhofer ◽  
Stefan Wolfsberger ◽  
Martin Aichholzer ◽  
Alexander Bertalanffy ◽  
Karl Roessler ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Open Surgery ◽  
Clinical Course ◽  
Gamma Knife Radiosurgery ◽  
Cranial Base ◽  
Long Term Results ◽  
Tumor Control ◽  
Long Term Follow Up

Abstract OBJECTIVE: Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial neural structures. Within the last 2 decades Gamma Knife radiosurgery (GKRS) has gained increasing importance as an adjunct treatment after incomplete resection and as an alternative treatment to open surgery. However, reports of long-term results are still sparse. We therefore performed this study to analyze the long-term results of GKRS treatment of cranial base meningiomas, following our previously published early follow-up experience. METHODS: A retrospective analysis of the medical files for Gamma Knife and surgical treatments, clinicoradiological findings, and outcome was carried out focusing on tumor control, clinical course, and morbidity. RESULTS: Between 1992 and 1995, we treated 36 patients with cranial base meningiomas using GKRS (male:female ratio, 1:5; mean age, 59 yr; range, 44–89 yr). Twenty-five patients were treated with GKRS after open surgery, and 11 patients received GKRS alone. Tumor control, neurological outcomes, and adverse effects were analyzed after a long-term follow-up period (mean, 103 mo; range, 70–133 mo) and compared with our previous results after an early follow-up period (mean, 48 mo; range, 36–76 mo). Control of tumor growth was achieved in 94% of patients. Compared with the early follow-up period, the late neuroradiological effects of GKRS on cranial base meningiomas were continuing tumor shrinkage in 11 patients (33%), stable tumor size in 20 patients (64%) and tumor progression in two meningiomas (6%). The neurological status improved in 16 patients (44%), remained stable in 19 patients (52%), and deteriorated in one patient (4%). Adverse side effects of GKRS were found only during the early follow-up period. CONCLUSION: Our data confirm that GKRS is not only a safe and effective treatment modality for cranial base meningiomas in short-term observation, but also in a mean long-term follow-up period of more than 8 years. Tumor shrinkage and clinical improvement also continued during the longer follow-up period.

scholarly journals Pineocytoma with diffuse dissemination to the leptomeninges

Rare Tumors ◽  
2011 ◽  
Vol 3 (4) ◽  
pp. 163-165 ◽  
Author(s):  
Caitlin Gomez ◽  
Jeffrey Wu ◽  
Whitney Pope ◽  
Harry Vinters ◽  
Antonio DeSalles ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiotherapy ◽  
Leptomeningeal Dissemination ◽  
Resonance Imaging ◽  
Pineal Parenchymal Tumors ◽  
Craniospinal Radiation ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Pineal parenchymal tumors are rare. Of the three types of pineal parenchymal tumors, pineocytomas are the least aggressive and are not known to diffusely disseminate. In this paper, we report the successful treatment of a case of pineocytoma with diffuse leptomeningeal relapse following initial stereotactic radiotherapy. A 39-year-old female presented with headaches, balance impairment, urinary incontinence, and blunted affect. A pineal mass was discovered on magnetic resonance imaging (MRI). A diagnosis of pineocytoma was established with an endoscopic pineal gland biopsy, and the patient received stereotactic radiotherapy. Ten years later, she developed diffuse leptomeningeal dissemination. The patient was then successfully treated with craniospinal radiation therapy. Leptomeningeal spread may develop as late as 10 years after initial presentation of pineocytoma. Our case demonstrates the importance of long-term follow-up of patients with pineal parenchymal tumors following radiation therapy, and the efficacy of craniospinal radiation in the treatment of leptomeningeal dissemination.

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