The Ki-67 labeling index as a prognostic factor in Grade II oligoastrocytomas

2005 ◽  
Vol 102 (6) ◽  
pp. 1033-1039 ◽  
Author(s):  
Mark E. Shaffrey ◽  
Elana Farace ◽  
David Schiff ◽  
James M. Larner ◽  
Melike Mut ◽  
...  
Keyword(s):  
Labeling Index ◽  
World Health ◽  
Ki 67 ◽  
Content Type ◽  
Prognostic Utility ◽  
Grade Ii ◽  
Health Organization ◽  
The University ◽  
Grade Iii ◽  
Fine Print

Object. This study was conducted to determine whether proliferative tumor activity, as assessed using the Ki-67 immunohistochemical labeling index (LI), has prognostic utility for patients with Grade II oligoastrocytomas. Methods. The study period spans the years 1988 to 2000. In a retrospective analysis, the authors selected cases with biopsy-proven diagnoses of Grade II oligoastrocytomas on initial presentation. The authors added new patients to this group and followed all patients prospectively at the University of Virginia Neuro-Oncology Center. Twenty-three adult patients were followed for at least 1 year (median 40.3 months). Eleven patients with Grade II tumors and initial Ki-67 LIs less than 10% had a significantly longer median time to tumor progression (TTP, 51.8 months compared with 9.9 months) and a longer median survival (93.1 months compared with 16.1 months) than 12 patients with initial Ki-67 LIs of 10% or greater. Twelve patients with Grade III oligoastrocytomas had a mean TTP that was similar to the TTP of patients with Grade II tumors and high Ki-67 LIs (mean 4 months compared with 9.9 months) and duration of survival (13.3 months compared with 16.1 months). Conclusions. Patients with a Grade II oligoastrocytoma and a Ki-67 LI of 10% or greater have a much shorter TTP and potentially a poorer disease prognosis than expected—more similar to patients with a Grade III oligoastrocytoma. These results indicate that in the future a measure of proliferative activity should be taken into consideration along with the World Health Organization grading criteria for oligoastrocytomas.

scholarly journals Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts

2016 ◽  
Vol 140 (5) ◽  
pp. 437-448 ◽  
Author(s):  
Joo Young Kim ◽  
Seung-Mo Hong
Keyword(s):  
World Health Organization ◽  
Neuroendocrine Tumors ◽  
Classification Scheme ◽  
Neuroendocrine Cells ◽  
Labeling Index ◽  
World Health ◽  
World Health Organization Classification ◽  
Clinicopathologic Characteristics ◽  
Ki 67 ◽  
Health Organization

Context.—Gastrointestinal (GI) and pancreatobiliary tracts contain a variety of neuroendocrine cells that constitute a diffuse endocrine system. Neuroendocrine tumors (NETs) from these organs are heterogeneous tumors with diverse clinical behaviors. Recent improvements in the understanding of NETs from the GI and pancreatobiliary tracts have led to more-refined definitions of the clinicopathologic characteristics of these tumors. Under the 2010 World Health Organization classification scheme, NETs are classified as grade (G) 1 NETs, G2 NETs, neuroendocrine carcinomas, and mixed adenoneuroendocrine carcinomas. Histologic grades are dependent on mitotic counts and the Ki-67 labeling index. Several new issues arose after implementation of the 2010 World Health Organization classification scheme, such as issues with well-differentiated NETs with G3 Ki-67 labeling index and the evaluation of mitotic counts and Ki-67 labeling. Hereditary syndromes, including multiple endocrine neoplasia type 1 syndrome, von Hippel-Lindau syndrome, neurofibromatosis 1, and tuberous sclerosis, are related to NETs of the GI and pancreatobiliary tracts. Several prognostic markers of GI and pancreatobiliary tract NETs have been introduced, but many of them require further validation. Objective.—To understand clinicopathologic characteristics of NETs from the GI and pancreatobiliary tracts. Data Sources.—PubMed (US National Library of Medicine) reports were reviewed. Conclusions.—In this review, we briefly summarize recent developments and issues related to NETs of the GI and pancreatobiliary tracts.

Stereotactic radiation treatment for recurrent nonbenign meningiomas

2007 ◽  
Vol 106 (5) ◽  
pp. 846-854 ◽  
Author(s):  
Carlos A. Mattozo ◽  
Antonio A. F. De Salles ◽  
Ivan A. Klement ◽  
Alessandra Gorgulho ◽  
David McArthur ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Progression Free Survival ◽  
Malignant Progression ◽  
World Health ◽  
Who Grade ◽  
Stereotactic Radiation ◽  
Grade Ii ◽  
Health Organization ◽  
Grade Iii

Object The authors analyzed the results of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for the treatment of recurrent meningiomas that were described at initial resection as showing aggressive, atypical, or malignant features (nonbenign). Methods Twenty-five patients who underwent SRS and/or SRT for nonbenign meningiomas between December 1992 and August 2004 were included. Thirteen of these patients underwent treatment for multiple primary or recurrent lesions. In all, 52 tumors were treated. All histological sections were reviewed and reclassified according to World Health Organization (WHO) 2000 guidelines as benign (Grade I), atypical (Grade II), or anaplastic (Grade III) meningiomas. The median follow-up period was 42 months. Seventeen (68%) of the cases were reclassified as follows: WHO Grade I (five cases), Grade II (11 cases), and Grade III (one case). Malignant progression occurred in eight cases (32%) during the follow-up period; these cases were considered as a separate group. The 3-year progression-free survival (PFS) rates for the Grades I, II, and III, and malignant progression groups were 100, 83, 0, and 11%, respectively (p < 0.001). In the Grade II group, the 3-year PFS rates for patients treated with SRS and SRT were 100 and 33%, respectively (p = 0.1). After initial treatment, 22 new tumors required treatment using SRS or SRT; 17 (77%) of them occurred inside the original resection cavity. Symptomatic edema developed in one patient (4%). Conclusions Stereotactic radiation treatment provided effective local control of “aggressive” Grade I and Grade II meningiomas, whereas Grade III lesions were associated with poor outcome. The outcome of cases in the malignant progression group was intermediate between that of the Grade II and Grade III groups, with the lesions showing a tendency toward malignancy.

Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens

2005 ◽  
Vol 3 (5) ◽  
pp. 379-385 ◽  
Author(s):  
Stefan A. König ◽  
Axel Goldammer ◽  
Hans-Ekkehart Vitzthum
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Craniocervical Junction ◽  
Degenerative Changes ◽  
Content Type ◽  
Articular Surfaces ◽  
Anatomical Data ◽  
Grade Ii ◽  
Grade Iii ◽  
Fine Print

>Object. The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo. Methods. The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in > 50% of the articular surface). The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found. Conclusions. Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.

Nutritional intake of university employees’

2018 ◽  
Vol 120 (2) ◽  
pp. 483-489
Author(s):  
João Pedro Marques Lima ◽  
Sofia A. Costa ◽  
Ada Rocha
Keyword(s):  
Fatty Acids ◽  
Sodium Intake ◽  
Monounsaturated Fatty Acids ◽  
Nutritional Intake ◽  
World Health ◽  
Content Type ◽  
Total Fat ◽  
Health Organization ◽  
The University

Purpose Excessive high caloric and nutritional intake has been associated with weight gain which is linked to an increased prevalence of cardiovascular disease, type 2 diabetes and several types of cancers. The purpose of this paper is to characterize the nutritional intake pattern of the population in terms of energy, macro and micronutrients. Design/methodology/approach There were assessed 513 workers of the University of Porto (UP) randomly selected. The Food Processor Plus was used to convert foods into nutrients and, to assess nutritional intake adequacy. Data were compared to Dietary Reference Intakes and with recommended ranges by the World Health Organization. Findings The intake of most individuals was above recommendations for protein, carbohydrates and sodium. The average of energy intake observed in UP employees was lower than data available for Portuguese general population. The protein, carbohydrates, total fat and water intake, cholesterol, saturated, monounsaturated, polyunsaturated fatty acids and sodium intake were found to be significantly higher for men. Significant differences were found for vitamin D and calcium between age ranges; Carbohydrates, sugar, monounsaturated fatty acids, cholesterol, water and vitamin K was significantly different between teachers and non-teachers. Originality/value According to nutritional intake analysis, food consumption of this population was unbalanced, attending to high protein, carbohydrates and sodium intake.

Thoracic pedicle screws: postoperative computerized tomography scanning assessment

2004 ◽  
Vol 100 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Robert F. Heary ◽  
Christopher M. Bono ◽  
Margaret Black
Keyword(s):  
Computerized Tomography ◽  
Pedicle Screws ◽  
Ct Scanning ◽  
Screw Placement ◽  
Grading System ◽  
Content Type ◽  
Thoracic Pedicle Screws ◽  
Grade Ii ◽  
Grade Iii ◽  
Fine Print

Object. The authors evaluated the accuracy of placement of thoracic pedicle screws by performing postoperative computerized tomography (CT) scanning. A grading system is presented by which screw placement is classified in relation to neurological, bone, and intrathoracic landmarks. Methods. One hundred eighty-five thoracic pedicle screws were implanted in 27 patients with the assistance of computer image guidance or fluoroscopy. Postoperative CT scanning was conducted to determine a grade for each screw: Grade I, entirely contained within pedicle; Grade II, violates lateral pedicle but screw tip entirely contained within the vertebral body (VB); Grade III, tip penetrates anterior or lateral VB; Grade IV, breaches medial or inferior pedicle; and Grade V, violates pedicle or VB and endangers spinal cord, nerve root, or great vessels and requires immediate revision. Based on anatomical morphometry, the spine was subdivided into upper (T1–2), middle (T3–6), and lower (T7–12) regions. Statistical analyses were performed to compare regions. The mean follow-up period was 37.6 months. The following postoperative CT scanning—documented grades were determined: Grade I, 160 screws (86.5%); Grade II, 15 (8.1%); Grade III, six (3.2%); Grade IV, three (1.6%); and Grade V, one (0.5%). Among cases involving screw misplacements, Grade II placement was most common, and this occurred most frequently in the middle thoracic region. Conclusions. The authors' grading system has advantages over those previously described; however, further study to determine its reliability, reproducibility, and predictive value of clinical sequelae is warranted. Postoperative CT scanning should be considered the gold standard for evaluating thoracic pedicle screw placement.

Morphological redifferentiation in a malignant astrocytic tumor after gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 627-630 ◽  
Author(s):  
György T. Szeifert ◽  
Nicolas Massager ◽  
Jacques Brotchi ◽  
Marc Levivier
Keyword(s):  
Gamma Knife Radiosurgery ◽  
Emission Tomography ◽  
Proliferative Capacity ◽  
Astrocytic Tumor ◽  
Ki 67 ◽  
Content Type ◽  
Positron Emission ◽  
Resected Tumor ◽  
Grade Ii ◽  
Fine Print

Object. The purpose of this study was to demonstrate positron emission tomography (PET), histological, and immunohistochemical data supporting the notion of morphological redifferentiation in a malignant astrocytic tumor after gamma knife radiosurgery (GKS). Methods. The 11C- methionine-PET activity, Ki-67 labeling index (LI), and p53 protein expression were examined using immunohistochemical methods to assess tumor proliferative capacity. Tissue samples were obtained before and after radiosurgery in a patient with a malignant (Grade III) cerebellar astrocytoma. Positron emission tomography scans obtained 5.5 months following radiosurgery were suggestive of decreased tumor proliferative capacity and radionecrosis. Histological examination of tumor tissue removed 42 months before GKS was characteristic of a diffuse Grade III astrocytoma in every part of the resected tumor. Similar material removed 6 months after GKS was consistent with a Grade II astrocytoma in the great majority of the resected tumor. Conclusions. Histopathological examination showed positive phenotypic modification (redifferentiation) consistent with a Grade II astrocytoma in the majority of tumor specimens after radiosurgery. After GKS both the Ki-67 LI and p53 reaction decreased considerably as did 11C methionine uptake. Because p53 is one of the essential genes involved in the radiation response, mutations induced by the ionizing effect of gamma rays might promote partial repair of this gene's tumor suppressor function.

Surgery for cerebral arteriovenous malformation: risks related to lenticulostriate arterial supply

1997 ◽  
Vol 86 (5) ◽  
pp. 801-805 ◽  
Author(s):  
Michael K. Morgan ◽  
Katharine J. Drummond ◽  
Verity Grinnell ◽  
William Sorby
Keyword(s):  
Cerebral Arteriovenous Malformation ◽  
Arterial Supply ◽  
Content Type ◽  
Increased Risk ◽  
Complications Of Surgery ◽  
Grade Ii ◽  
Martin Grade ◽  
Grade Iii ◽  
Fine Print

✓ The aim of this study was to compare complications of surgery in arteriovenous malformations (AVMs) supplied by the middle cerebral artery (MCA) with and without a lenticulostriate arterial contribution. Ninety-two consecutive surgical resections of AVMs with an angiographically demonstrated MCA supply were performed between January 1989 and July 1996. Ten of these cases had a significant lenticulostriate arterial contribution. The cases were graded according to the Spetzler—Martin classification. There were no deaths and 4.3% of cases developed new major neurological deficit by the 3-month follow-up examination. All cases had angiographically confirmed obliteration of the AVM. There were no complications in 16 patients with Spetzler—Martin Grade I AVMs, one case of complications in 40 patients with Grade II AVMs, eight cases of complications in 26 patients with Grade III AVMs, and seven cases of complications in 10 patients with Grade IV and V AVMs. The supply of blood from lenticulostriate branches was associated with complications in eight of the 10 cases. The effect of the presence of a lenticulostriate arterial supply was most apparent in cases of Grade III AVMs: complications were experienced in three of 20 patients whose AVMs were not supplied by the arteries and in five of six patients whose AVMs were fed by the lenticulostriate arteries. This difference is significant (p < 0.0001). The conclusions drawn from this study are that for Grade III AVMs, the presence of a lenticulostriate arterial supply can be considered a factor predictive of an increased risk of surgical complications.

Discrimination between low-grade oligodendrogliomas and diffuse astrocytoma with the aid of 11C-methionine positron emission tomography

2011 ◽  
Vol 114 (6) ◽  
pp. 1640-1647 ◽  
Author(s):  
Natsuki Shinozaki ◽  
Yoshio Uchino ◽  
Kyosan Yoshikawa ◽  
Tomoo Matsutani ◽  
Azusa Hasegawa ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Histological Type ◽  
Labeling Index ◽  
Low Grade ◽  
Astrocytic Tumors ◽  
Ki 67 ◽  
Oligodendroglial Tumors ◽  
Grade Ii ◽  
The Mean ◽  
Grade Iii

Object The diagnostic usefulness of 11C-methionine PET scans in gliomas is still controversial. The authors investigated the clinical significance of 11C-methionine PET findings in preoperative diagnosis of histological type and grade. Methods The tissue uptake of 11C-methionine was assessed using PET in 70 patients with histologically confirmed intracerebral gliomas. The ratio of maximum standard uptake values in tumor areas to the mean standard uptake values in the contralateral normal brain tissue (tumor/normal tissue [T/N] ratio) was calculated and correlated with tumor type, histological grade, contrast enhancement on MR imaging, Ki 67 labeling index, and 1p/19q status. Results The T/N ratio was significantly increased as tumor grade advanced in astrocytic tumors (WHO Grade II vs Grade III, p = 0.0011; Grade III vs Grade IV, p = 0.0007). Among Grade II gliomas, the mean T/N ratio was significantly higher in oligodendroglial tumors than in diffuse astrocytomas (DAs) (p < 0.0001). All T/N ratios for oligodendroglial tumors were ≥ 1.46, and those for DA were consistently < 1.46, with the exception of 2 cases of gemistocytic astrocytoma. The Ki 67 labeling index significantly correlated with T/N ratio in astrocytic tumors, but not in oligodendrogliomas. Oligodendroglial tumors without 1p/19q deletion had a significantly higher T/N ratio than those with the codeletion. In combination with Gd-enhanced MR imaging, 67% of nonenhanced tumors with a T/N ratio of ≥ 1.46 were proved to be Grade II oligodendrogliomas. Conclusions These results clearly show that 11C-methionine PET T/N ratios in Grade II oligodendrogliomas were higher than those in DAs independently of their proliferative activity. This information contributes to preoperative differential diagnoses of histological type, especially in suspected low-grade gliomas.

5-Aminolevulinic Acid Fluorescence-Guided Resection of Intramedullary Ependymoma: Report of 9 Cases

2012 ◽  
Vol 72 (2) ◽  
pp. ons159-ons168 ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Kenichi Nagamatsu ◽  
Mika Watanabe ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Labeling Index ◽  
World Health ◽  
Histopathological Diagnosis ◽  
Glioma Surgery ◽  
Ki 67 ◽  
Grade Ii

Abstract BACKGROUND: Resection guided by 5-aminolevulinic acid (5-ALA) fluorescence has proved to be useful in intracranial glioma surgery. However, the effects of 5-ALA on spinal cord tumors remain unknown. OBJECTIVE: To evaluate the usefulness of 5-ALA fluorescence-guided resection of intramedullary ependymoma for achieving maximum tumor resection. METHODS: This study included 10 patients who underwent surgical resection of an intramedullary ependymoma. Nine patients were orally administered 5-ALA (20 mg/kg) 2 hours before the induction of anesthesia. 5-ALA fluorescence was visualized with an operating microscope. Tumors were removed in a standardized manner with electro-physiological monitoring. The extent of resection was evaluated on the basis of intra-operative findings and postoperative magnetic resonance imaging. Histopathological diagnosis was established according to World Health Organization 2007 criteria. Cell proliferation was assessed by Ki-67 labeling index. RESULTS: 5-ALA fluorescence was positive in 7 patients (6 grade II and 1 grade III) and negative in 2 patients (grade II). Intraoperative findings were dichotomized: Tumors covered by the cyst were easily separated from the normal parenchyma, whereas tumors without the cyst appeared to be continuous to the spinal cord. In these cases, 5-ALA fluorescence was especially valuable in delineating the ventral and cranial and caudal margins. Ki-67 labeling index was significantly higher in 5-ALA-positive cases compared with 5-ALA-negative cases. All patients improved neurologically or stabilized after surgery. CONCLUSION: 5-ALA fluorescence was useful for detecting tumor margins during surgery for intramedullary ependymoma. When combined with electrophysiological monitoring, fluorescence-guided resection could help to achieve maximum tumor resection safely.

Pathology of Spinal Ependymomas

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 247-255 ◽  
Author(s):  
Phiroz E. Tarapore ◽  
Peter Modera ◽  
Agne Naujokas ◽  
Michael C. Oh ◽  
Beejal Amin ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Histological Grade ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
World Health ◽  
Subtotal Resection ◽  
Who Grade ◽  
Grade Ii ◽  
Health Organization ◽  
Grade Iii

AbstractBACKGROUND:Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS).OBJECTIVE:This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy.METHODS:We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging.RESULTS:There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P &lt; .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P &lt; .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P &lt; .36).CONCLUSION:Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

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