scholarly journals Laporan Kasus Butterfly gliobasltoma pada Laki-Laki Usia 24 Tahun

2021 ◽  
Vol 8 (3) ◽  
pp. 395-411
Author(s):  
Dewa Kartika ◽  
Baskoro Nurdopo
Keyword(s):  
White Matter ◽  
Corpus Callosum ◽  
Ct Scan ◽  
Pilocytic Astrocytoma ◽  
High Grade ◽  
Who Grade ◽  
High Grade Astrocytoma ◽  
Perifocal Edema

Pendahuluan Butterfly Glioma adalah high grade astrocytoma, biasanya glioblastoma (WHO grade IV), yang melintasi garis tengah melalui corpus callosum. Komissura white matter lainnya kadang juga terlibat. Istilah kupu-kupu mengacu pada ekstensi yang melewati garis tengah seperti sayap. Butterfly Glioma paling sering terjadi di lobus frontal, melintasi garis tengah melalui genu corpus callosum, namun butterfly glioma posterior kadang juga ditemui. Laporan kasus Seorang pasien laki-laki usia 24 tahun dengan keluhan utama 9 bulan, yang lalu. Penglihatan kabur, konsentrasi menurun. Kejang(-). Kemudian 3 bulan yang lalu mata tidak bisa melihat. Dan 1 bulan yang lalu tubuh lemas susah digerakkan Pemeriksaan patologi anatomi menunjukkan Pylocytic Astrocytoma. Pemeriksaan CT scan kepala menunjukkan  Massa solid inhomogen intraxial ( ukuran ± AP 7,6 x 8,9 x CC 6,2 cm ) disertai kalsifikasi di dalamnya pada corpus callosum yang tampak cross mid line ( sisi kiri lebih dominan ) membentuk gambaran butterfly sign dengan perifocal edema à curiga gambaran glioblastoma multiformis.   Pembahasan Hasil pemeriksaan anamnesis dan pemeriksaan fisik pasien ini menunjukkan kecurigaan adanya SOL. Pemeriksaan CT scan kepala menunjukkan  Massa solid inhomogen intraxial disertai kalsifikasi di dalamnya pada corpus callosum yang tampak cross mid line ( sisi kiri lebih dominan ) membentuk gambaran butterfly sign dengan perifocal edema à curiga gambaran glioblastoma multiformis. Dari PA didapatkan hasil Pilocytic astrocytoma. Sedangkan gambaran radiologi Pilocytic astrocytoma berupa lesi kistik dengan nodul mural yang enhanced. Kasus ini secara radiologis lebih mengarah ke Butterfly Glioblastoma dengan adanya lesi yang melewati garis tengah, serta ada komponen nekrotik dan perdarahan.. Modalitas imejing pilihan yang dapat dilakukan pada kasus Butterfly Glioblastoma adalah CT scan dan MRI. Kesimpulan Kasus ini secara radiologis lebih mengarah ke Butterfly Glioblastoma dengan adanya lesi yang melewati garis tengah, serta ada komponen nekrotik dan perdarahan. Dan pemeriksaan radiologis yang dapat digunakan pada Butterfly Glioblastoma adalah CT scan dan MRI.

BMX-HGG: Phase II trial of newly diagnosed high-grade glioma treated with concurrent radiation therapy, temozolomide, and BMX-001.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS2577-TPS2577
Author(s):  
Katherine B. Peters ◽  
Adam Louis Cohen ◽  
Nicholas A. Butowski ◽  
John L. Villano ◽  
Pierre Giglio ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
White Matter ◽  
Cancer Therapy ◽  
Phase Ii ◽  
Functional Assessment ◽  
Phase Ii Study ◽  
High Grade Glioma ◽  
High Grade ◽  
Newly Diagnosed ◽  
Who Grade

TPS2577 Background: Patients diagnosed with malignant high-grade gliomas (WHO grade III-IV) experience significant morbidity and mortality associated with these cancers. While the mainstay of therapy for patients with newly diagnosed high-grade glioma is surgery followed by concurrent chemotherapy and radiation therapy (RT), the outcomes remain very poor. BMX-001 (MnTnBuOE-2-PyP5+) is a metalloporphyrin with differential action in response to radiation therapy and chemotherapy-induced oxidative stress. Early preclinical studies demonstrated BMX-001’s ability to act as a radioprotectant to healthy tissue such as a central nervous white matter and as a radiosensitizer to cancer cells, in particular, human glioblastoma xenografts. We evaluated the safety of BMX-001 in combination with concurrent RT and temozolomide (TMZ) in a phase I study of newly diagnosed high-grade glioma patients, and we found that BMX-001 is safe and well-tolerated in this population. The maximum tolerated dose of BMX-001 during concurrent RT and TMZ was determined to be 28 mg delivered subcutaneously (SC) followed by 16 biweekly SC doses at 14 mg (Peters et al., Neuro-Oncology 2018). Methods: For this multi-site, open-label, phase II study (NCT02655601), we will randomize approximately 160 patients 1:1 to concurrent RT and TMZ with BMX-001 versus concurrent RT and TMZ alone. Key eligibility criteria include newly diagnosed histologically confirmed high-grade glioma (WHO III-IV), 18 ≥ years, and Karnofsky performance status ≥ 70%. The primary endpoint is overall survival. Secondary endpoints include cognitive performance as assessed by standardized cognitive testing, bone marrow protection, safety and tolerability, progression-free survival, overall tumor response rate, and plasma pharmacokinetics. Exploratory endpoints are health-related quality of life (as assessed by Functional Assessment of Cancer Therapy–Brain, Functional Assessment of Cancer Therapy-Cognition, and Functional Assessment of Chronic Illness Therapy-Fatigue), qualitative hair loss, and white matter integrity (as measured by MRI diffusion tensor/susceptibility imaging). Since November 2018, this phase II study has enrolled 64 of 160 high-grade glioma patients at six sites with future sites planned to be implemented. Clinical trial information: NCT02655601 .

Interobserver Agreement of White Matter Tract Involvement in Gliomas with Diffusion Tensor Tractography

2019 ◽  
Vol 81 (03) ◽  
pp. 233-237 ◽  
Author(s):  
Ahmed Abdel Khalek Abdel Razek ◽  
Lamiaa El-Serougy ◽  
Amani Ezzat ◽  
Hany Eldawoody ◽  
Ahmad El-Morsy
Keyword(s):  
White Matter ◽  
Corpus Callosum ◽  
Interobserver Agreement ◽  
Diffusion Tensor ◽  
Diffusion Tensor Tractography ◽  
High Grade ◽  
White Matter Tract ◽  
Optic Radiation ◽  
Tract Involvement ◽  
High Grade Gliomas

Abstract Aim To assess with diffusion tensor tractography (DTT) the interobserver agreement of white matter tract involvement in patients with gliomas. Patient and Methods A prospective study was conducted on 35 patients (21 male, 14 female; age: 2–71 years) with gliomas that underwent DTT. Two independent readers assessed the patterns of involvement of the corticospinal tract, corpus callosum, optic radiation, and fasciculi as normal, edematous, displaced, infiltrated, or disrupted. Results Overall interobserver agreement of involvement of the white matter tracts was excellent (κ = 0.93; 95% confidence interval [CI], 0.91–0.95; p = 0.001). Interobserver agreement was excellent for involvement of corticospinal tracts (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), corpus callosum (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001), optic radiation (κ = 0.77; 95% CI, 0.53–0.98; p = 0.001), and fasciculi (κ = 0.912; 95% CI, 0.81–0.99; p = 0.001. The interobserver agreement was excellent for tract edema (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), tract displacement (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001), tract disruption (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), and good for tract infiltration (κ = 0.77; 95% CI, 0.53–0.98; p = 0.001). The interobserver agreement was excellent for white matter tract involvement in patients with low-grade gliomas (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001) and high-grade gliomas (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001). Conclusion DTT is a reliable and reproducible method for assessment of white matter tract involvement in patients with low- and high-grade gliomas.

scholarly journals Astrocytoma Mimickings Stroke pada Pasien Pria Dewasa Muda

2018 ◽  
Vol 7 (01) ◽  
Author(s):  
Rima Zakiyah ◽  
Shinta Kusumawati
Keyword(s):  
Ct Scan ◽  
Cerebrovascular Accident ◽  
High Grade ◽  
High Grade Astrocytoma

 AbstrakAstrocytoma adalah tumor otak terbanyak, lebih dari separuh keganasan pada sistem saraf pusat. Pasien dengan astrocytoma hemisferik sering datang dengan klinis kejang dan berbagai gejala sehingga diagnosa menjadi sukar.Astrocytoma menginfiltrasi jaringan otak,namun efeknya pada fungsi otak hanya sedikit sekali pada awal penyakit. Dilaporkan, laki laki usia 19 tahun, oleh bagian neurologi awalnya pasien diduga mengalami Cerebro Vascular Accident(CVA) trombosis, karena terjadi disartria akut (saat pasien istirahat),didahului kesulitan bicara dan riwayat kelemahan badan sebelah kiri, serta riwayat kejang fokal selama kurang dari 1 menit setahun sebelumnya. Pemeriksaan Neurologis didapatkan parese N. VII sinistra UMN, penurunan motoris ekstremitas sebelah kiri (4), peningkatan refleks fisiologis sinistra, serta peningkatan tonus. Hasil pemeriksaan Radiologi (CT scan kepala) adalah tumor supratentorial pada lobus frontoparietal dextra suspect high grade astrocytoma yang menyebabkan edema perifokal dan herniasi subfalsin ke sinistra dengan Leptomeningeal carcinomatosis.Ketidaksesuaian diagnosa awal dengan hasil CT, karena tumor bisa memberikan manifestasi klinis yang sangat luas dan kadang menyerupai suatu CVA karena efek penekanan massa terhadap vaskular atau gangguan vaskular akibat infiltrasi massa/ sel metastase.Kata kunci: Astrocytoma, Cerebrovascular Accident, CT scan 

Corpus callosum involvement as a prognostic factor for patients with high-grade astrocytoma

1997 ◽  
Vol 38 (1) ◽  
pp. 27-30 ◽  
Author(s):  
Keith J. Stelzer ◽  
Kristen I. Sauvé ◽  
Alexander M. Spence ◽  
Thomas W. Griffin ◽  
Mitchel S. Berger
Keyword(s):  
Prognostic Factor ◽  
Corpus Callosum ◽  
High Grade ◽  
High Grade Astrocytoma

scholarly journals PATH-05. A CASE OF PILOCYTIC ASTROCYTOMA HARBORING THE FGFR1 GENE MUTATION WITH A PREDOMINANT OLIGODENDROGLIOMA-LIKE COMPONENT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii425-iii425
Author(s):  
Nobuyoshi Sasaki ◽  
Tomohiro Chiba ◽  
Kuniaki Saito ◽  
Keiichi Kobayashi ◽  
Yoshiaki Shiokawa ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Parietal Lobe ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Histopathological Diagnosis ◽  
Diagnostic Challenge ◽  
Ki 67 ◽  
Who Grade ◽  
Idh1 R132h ◽  
Perifocal Edema

Abstract Pilocytic astrocytomas rarely present with oligodendroglioma-like morphological features, which gives rise to a diagnostic challenge. In this report we present a case of pilocytic astrocytoma harboring the FGFR1 mutation, accompanied with a predominant oligodendroglioma-like component, thus initially diagnosed as oligodendroglioma. A 14-year-old female presented with syncope and simple partial seizure involving her right upper limb. Contrast-enhanced MRI revealed an enhancing lesion with substantial cystic portion and perifocal edema in the left parietal lobe. Open surgery was performed and a gross total resection of the tumor was achieved. On initial histopathological diagnosis, tumor cells with monotonous round nuclei and perinuclear halo predominated with branching capillaries, which were strongly suggestive for oligodendroglioma. Immunohistochemically, IDH1 R132H was negative, and Ki-67 index was around 5%. The patient was thus initially diagnosed as oligodendroglioma, WHO grade II, based on the 2007 WHO classification criteria. However, histopathological re-review revealed a minor astrocytic component with Rosenthal fibers and rare eosinophilic granular bodies, thus the diagnosis was changed as pilocytic astrocytoma. FGFR1 K654E mutation was confirmed by Sanger sequencing. Although she postoperatively developed mild sensory disturbance in her right hands, finger agnosia, and left-right disorientation, her symptoms had gradually improved, and she was discharged on day 17 with a Karnofsky performance status (KPS) of 90 and no cognitive decline. Without any adjuvant therapies, she has remained recurrence-free for 85 months. While the diagnosis of pilocytic astrocytoma with predominant oligodendroglioma-like component can be challenging, analysis of IDH1 and FGFR1 mutations can be beneficial in certain cases.

scholarly journals P04.04 Different stages of astrocytoma in young adult patient

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii29-iii29
Author(s):  
E Susanti ◽  
R Kamarlis ◽  
N Suci Rahayu
Keyword(s):  
Ct Scan ◽  
Pilocytic Astrocytoma ◽  
Large Mass ◽  
Pleomorphic Xanthoastrocytoma ◽  
Low Grade ◽  
Favorable Result ◽  
Who Grade ◽  
Head Ct ◽  
Grade Ii ◽  
The Brain

Abstract BACKGROUND astrocytoma is a type of cancer that involve brain parenchym or spinal cord. It arises from glial cells, called astrocytes-star shaped cells which function as supportive tissue of the brain. About 50% of primary brain tumors are astrocytomas. It’s more common in men than women and most often occur at the age of after 45. There are several types of astrocytoma and some of them grow faster than other. We found a rare case where different stages of astrocytoma occur in different areas of the brain and where the latter seemed to show up just within 8 months after the first. MATERIAL AND METHODS a 43 year old male patient admitted to neurology ward after a convulsion and hemiparesis on the left extremities. Patient was known to have suffered from astrocytoma in the frontal lobe in October 2017, and had undergone craniectomy evacuation and subsequent radiotherapy which was completed in March 2018. A few months while during recovery at home, patient complained about headache which increased in intensity over a period of 3 months before admission. The first and only convulsion occurred just 12 hours before admission, while left side weakness occurred 7 days prior. Patient underwent a series of radiologic examination after the radiotherapy and also while admitted into hospital. We found a new and large mass in the right temporoparietal lobe from the latest head ct scan. This large mass was not found from the last MRI and head ct scan which was done 8 months prior. pathology anatomy examination was done to the first and second mass found. RESULTS Pathology anatomy examination depicted different stages from the two masses, the first one was pleomorphic xanthoastrocytoma (WHO grade II) and the second one was pilocytic astrocytoma (WHO grade I) CONCLUSION pleomorphic xanthoastrocytoma (WHO grade II) and pilocytic astrocytoma (WHO grade I) both are considered low grade glioma. neverthless treatment for this devastating disease still far from favorable result or outcome

Proliferation-dominant high-grade astrocytoma: survival benefit associated with extensive resection of FLAIR abnormality region

2020 ◽  
Vol 132 (4) ◽  
pp. 998-1005 ◽  
Author(s):  
Haihui Jiang ◽  
Yong Cui ◽  
Xiang Liu ◽  
Xiaohui Ren ◽  
Mingxiao Li ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Characteristic Curve ◽  
Extent Of Resection ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
High Grade ◽  
Extensive Resection ◽  
High Grade Astrocytoma

OBJECTIVEThe aim of this study was to investigate the relationship between extent of resection (EOR) and survival in terms of clinical, molecular, and radiological factors in high-grade astrocytoma (HGA).METHODSClinical and radiological data from 585 cases of molecularly defined HGA were reviewed. In each case, the EOR was evaluated twice: once according to contrast-enhanced T1-weighted images (CE-T1WI) and once according to fluid attenuated inversion recovery (FLAIR) images. The ratio of the volume of the region of abnormality in CE-T1WI to that in FLAIR images (VFLAIR/VCE-T1WI) was calculated and a receiver operating characteristic curve was used to determine the optimal cutoff value for that ratio. Univariate and multivariate analyses were performed to identify the prognostic value of each factor.RESULTSBoth the EOR evaluated from CE-T1WI and the EOR evaluated from FLAIR could divide the whole cohort into 4 subgroups with different survival outcomes (p < 0.001). Cases were stratified into 2 subtypes based on VFLAIR/VCE-T1WIwith a cutoff of 10: a proliferation-dominant subtype and a diffusion-dominant subtype. Kaplan-Meier analysis showed a significant survival advantage for the proliferation-dominant subtype (p < 0.0001). The prognostic implication has been further confirmed in the Cox proportional hazards model (HR 1.105, 95% CI 1.078–1.134, p < 0.0001). The survival of patients with proliferation-dominant HGA was significantly prolonged in association with extensive resection of the FLAIR abnormality region beyond contrast-enhancing tumor (p = 0.03), while no survival benefit was observed in association with the extensive resection in the diffusion-dominant subtype (p=0.86).CONCLUSIONSVFLAIR/VCE-T1WIis an important classifier that could divide the HGA into 2 subtypes with distinct invasive features. Patients with proliferation-dominant HGA can benefit from extensive resection of the FLAIR abnormality region, which provides the theoretical basis for a personalized resection strategy.

Assessment of White Matter Lesions in Parkinson's Disease: Voxel-based Analysis and Tract-based Spatial Statistics Analysis of Parkinson's Disease with Mild Cognitive Impairment

2020 ◽  
Vol 17 (4) ◽  
pp. 480-486
Author(s):  
Wei Pu ◽  
Xudong Shen ◽  
Mingming Huang ◽  
Zhiqian Li ◽  
Xianchun Zeng ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
White Matter ◽  
Corpus Callosum ◽  
Fractional Anisotropy ◽  
Spatial Statistics ◽  
Diffusion Tensor ◽  
Tract Based Spatial Statistics

Objective: Application of diffusion tensor imaging (DTI) to explore the changes of FA value in patients with Parkinson's disease (PD) with mild cognitive impairment. Methods: 27 patients with PD were divided into PD with mild cognitive impairment (PD-MCI) group (n = 7) and PD group (n = 20). The original images were processed using voxel-based analysis (VBA) and tract-based spatial statistics (TBSS). Results: The average age of pd-mci group was longer than that of PD group, and the course of disease was longer than that of PD group. Compared with PD group, the voxel based analysis-fractional anisotropy (VBA-FA) values of PD-MCI group decreased in the following areas: bilateral frontal lobe, bilateral temporal lobe, bilateral parietal lobe, bilateral subthalamic nucleus, corpus callosum, and gyrus cingula. Tract-based spatial statistics-fractional anisotropy (TBSS-FA) values in PD-MCI group decreased in bilateral corticospinal tract, anterior cingulum, posterior cingulum, fornix tract, bilateral superior thalamic radiation, corpus callosum(genu, body and splenium), bilateral uncinate fasciculus, bilateral inferior longitudinal fasciculus, bilateral superior longitudinal fasciculus, bilateral superior fronto-occipital fasciculus, bilateral inferior fronto-occipital fasciculus, and bilateral parietal-occipital tracts. The mean age of onset in the PD-MCI group was greater than that in the PD group, and the disease course was longer than that in the PD group. Conclusion: DTI-based VBA and TBSS post-processing methods can detect abnormalities in multiple brain areas and white matter fiber tracts in PD-MCI patients. Impairment of multiple cerebral cortex and white matter fiber pathways may be an important causes of cognitive dysfunction in PD-MCI.

scholarly journals Topographic patterns of white matter hyperintensities are associated with multimodal neuroimaging biomarkers of Alzheimer’s disease

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Malo Gaubert ◽  
Catharina Lange ◽  
Antoine Garnier-Crussard ◽  
Theresa Köbe ◽  
Salma Bougacha ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
White Matter ◽  
Glucose Metabolism ◽  
Corpus Callosum ◽  
Gray Matter ◽  
Fdg Pet ◽  
White Matter Hyperintensities ◽  
Gray Matter Volume ◽  
Matter Volume

Abstract Background White matter hyperintensities (WMH) are frequently found in Alzheimer’s disease (AD). Commonly considered as a marker of cerebrovascular disease, regional WMH may be related to pathological hallmarks of AD, including beta-amyloid (Aβ) plaques and neurodegeneration. The aim of this study was to examine the regional distribution of WMH associated with Aβ burden, glucose hypometabolism, and gray matter volume reduction. Methods In a total of 155 participants (IMAP+ cohort) across the cognitive continuum from normal cognition to AD dementia, FLAIR MRI, AV45-PET, FDG-PET, and T1 MRI were acquired. WMH were automatically segmented from FLAIR images. Mean levels of neocortical Aβ deposition (AV45-PET), temporo-parietal glucose metabolism (FDG-PET), and medial-temporal gray matter volume (GMV) were extracted from processed images using established AD meta-signature templates. Associations between AD brain biomarkers and WMH, as assessed in region-of-interest and voxel-wise, were examined, adjusting for age, sex, education, and systolic blood pressure. Results There were no significant associations between global Aβ burden and region-specific WMH. Voxel-wise WMH in the splenium of the corpus callosum correlated with greater Aβ deposition at a more liberal threshold. Region- and voxel-based WMH in the posterior corpus callosum, along with parietal, occipital, and frontal areas, were associated with lower temporo-parietal glucose metabolism. Similarly, lower medial-temporal GMV correlated with WMH in the posterior corpus callosum in addition to parietal, occipital, and fontal areas. Conclusions This study demonstrates that local white matter damage is correlated with multimodal brain biomarkers of AD. Our results highlight modality-specific topographic patterns of WMH, which converged in the posterior white matter. Overall, these cross-sectional findings corroborate associations of regional WMH with AD-typical Aß deposition and neurodegeneration.

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