scholarly journals Central nervous system tumors: Radiologic pathologic correlation and diagnostic approach

2015 ◽  
Vol 6 (02) ◽  
pp. 191-197 ◽  
Author(s):  
Ishita Pant ◽  
Sujata Chaturvedi ◽  
Deepak Kumar Jha ◽  
Rima Kumari ◽  
Samta Parteki
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Metastatic Tumor ◽  
Rural Setting ◽  
Complete Agreement ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Metastatic Tumors ◽  
Diagnostic Algorithms

ABSTRACT Objectives: This study was conducted to formulate location-wise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis so as to evaluate their utility in a rural setting where only basic facilities are available. Materials and Methods: A retrospective analysis to assess the concordance of radiology (primarily MRI) with final histopathology report was done. Based on the most common incidence of tumor location and basic radiology findings, diagnostic algorithms were prepared. Results: For supratentorial intraaxial parenchymal location concordance was seen in all high-grade astrocytomas, low- and high-grade oligodendrogliomas, metastatic tumors, primitive neuroectodermal tumors, high-grade ependymomas, neuronal and mixed neuro-glial tumors and tumors of hematopoietic system. Lowest concordance was seen in low-grade astrocytomas. In the supratentorial intraaxial ventricular location, agreement was observed in choroid plexus tumors, ependymomas, low-grade astrocytomas and meningiomas; in the supratentorial extraaxial location, except for the lack of concordance in the only case of metastatic tumor, concordance was observed in meningeal tumors, tumors of the sellar region, tumors of cranial and paraspinal nerves; the infratentorial intraaxial parenchymal location showed agreement in low- as well as high-grade astrocytomas, metastatic tumors, high-grade ependymoma, embryonal tumors and hematopoietic tumors; in the infratentorial intraaxial ventricular location, except for the lack of concordance in one case of low-grade astrocytoma and two cases of medulloblastomas, agreement was observed in low- and high-grade ependymoma; infratentorial extraaxial tumors showed complete agreement in all tumors of cranial and paraspinal nerves, meningiomas, and hematopoietic tumors. Conclusion: A location-based approach to central nervous system (CNS) tumors is helpful in establishing an appropriate differential diagnosis.

Accuracy of Intraoperative Examination in Central Nervous System Lesions: A Study of 133 Cases

2019 ◽  
Vol 63 (3) ◽  
pp. 224-232
Author(s):  
Ludmila Barbosa de Souza Balsimelli ◽  
Jamille Costa de Oliveira ◽  
Flora Ávila Adorno ◽  
Clarissa Almeida Brites ◽  
Giuliano Stefanello Bublitz ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Frozen Section ◽  
Final Diagnosis ◽  
World Health ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Predictive Values ◽  
Health Organization ◽  
Cns Lesions

Objective: Intraoperative examination is a highly valuable tool for the evaluation of central nervous system (CNS) lesions, helping the neurosurgeon to determine the best surgical management. This study aimed to evaluate the accuracy and to analyze the diagnostic disagreements and pitfalls of the intraoperative examinations through correlation with the final histopathological diagnosis in CNS lesions. Study Design: Retrospective analysis of intraoperative examination of CNS lesions and their final diagnosis obtained during 16 consecutive years. All diagnoses were reviewed and classified according to World Health Organization (WHO) grading for CNS tumors. Squash was performed in 119 cases, while frozen section and both methods were done in 7 cases each. Results: Among the 133 intraoperative examinations considered, 114 (85.7%) presented concordance and 19 (14.3%) diagnostic disagreement when compared with subsequent histopathological examinations. The sensitivity and specificity for the detection of neoplasia in intraoperative examination was 98 and 94%, respectively. The positive and negative predictive values were 99 and 88%, respectively. The accuracy for neoplastic and nonneoplastic disease was 85.7%. Disagreements were more frequent among low-grade (WHO grades I and II) neoplasms and nonmalignant cases. Conclusions: Our results showed good accuracy of the intraoperative assessments for diagnosis of CNS lesions, particularly in high-grade (grades III and IV) lesions and metastatic neoplasms.

scholarly journals Immunohistochemical expression of glial fibrillary acidic protein and CAM5.2 in glial tumors and their role in differentiating glial tumors from metastatic tumors of central nervous system

2015 ◽  
Vol 06 (04) ◽  
pp. 499-503 ◽  
Author(s):  
Rama Goyal ◽  
Satyavir Kumar Mathur ◽  
Sumiti Gupta ◽  
Rahul Goyal ◽  
Sanjay Kumar ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Glial Fibrillary Acidic Protein ◽  
Metastatic Carcinoma ◽  
Acidic Protein ◽  
Histopathological Diagnosis ◽  
Immune Markers ◽  
Metastatic Tumors ◽  
Glial Tumors ◽  
Hematoxylin And Eosin

ABSTRACT Background and Objectives: Immunohistochemistry (IHC) has become an important tool in the diagnosis of metastatic brain tumors. The judicious use of a panel of selected immunostains is unquestionably helpful in diagnostically challenging cases. In our study, the best combination of immune markers useful in differentiating metastatic carcinoma from high-grade gliomas in central nervous system (CNS) are glial fibrillary acidic protein (GFAP) and cytokeratin (CK) (CAM5.2). Materials and Methods: The study was conducted on 80 cases of glial tumors including metastatic tumors to the CNS. Histopathological diagnosis was established on routine hematoxylin and eosin staining of the sections. Special IHC markers, GFAP, and CAM5.2 were used to differentiate glial from metastatic tumors. Result: Of total 80 cases, 40 cases of astrocytic tumors, 2 cases of ependymoma, 2 cases of mixed glial tumors, and 16 cases of glioblastoma multiforme were positive for GFAP. Twelve cases of oligodendroglioma were negative for GFAP. The sensitivity of GFAP in glial tumors was statistically significant as 81.1% and specificity 100%, whereas sensitivity and specificity of CAM5.2 in metastatic tumors were 100%. Conclusion: IHC plays an important role in diagnosing tumors of CNS and markers such as GFAP and CK (CAM5.2) are quite effective in differentiating glial tumors from metastatic tumors of CNS.

A rare type primary central nervous system lymphoma with primarily psychiatric diagnosis- a case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S489-S490
Author(s):  
U. Cikrikcili ◽  
B. Saydam ◽  
M. Aktan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Neuropsychiatric Symptoms ◽  
Clinical Manifestations ◽  
Central Nervous System Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Histopathological Diagnosis ◽  
High Grade

Primary central nervous system lymphoma (PCNSL) is a high-grade malignant B-cell non-Hodgkin neoplasm that is an infrequent variant of all intracranial neoplasms (1%) and all lymphomas (< 1%)PCNSL is documented mainly in immunocompromised patient groups, although it may also be diagnosed in immunocompetent patients. It affects mainly the eyes, supratentorial areas, or the spinal cord. The lesions are typically localized in frontal lobes, corpus callosum and basal ganglia. Additionally, lesions might rarely be detected at infratentorial areas and in medulla spinalis. Even though a wide spectrum of treatment options are available, such as chemotherapy, radiotherapy, or surgery; response rates are low and prognosis is poor in spite of appropriate treatment.The case we reported here is 57-year-old male presented with symptoms of aggresivity, impulsivity, depressive mood and personality changes. Histopathological diagnosis was CD5 positive diffuse large B cell lymphoma, which is very rare in high-grade lymphomas. There were no neurological signs related to CNS tumor and the clinical manifestations responded very well to chemotherapy consisting of high dose methotrexate, vincristine and procarbazine. The significance of such neuropsychiatric symptoms in the course of treatment for PCNSL has been previously documented as well. These behavioral and emotional symptoms might manifest themselves based on where the neoplasm is localized. Therefore, psychiatrists should be more aware of the uncommon manifestation of the disorder as reported in this case. Consultation for differential diagnosis might also be necessary in such cases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Oncology is changing: the challenge of effectively assessing response within clinical trials in low-grade gliomas

2011 ◽  
pp. 75-76
Author(s):  
Ilaria Imarisio ◽  
Chiara Fumagalli
Keyword(s):  
Central Nervous System ◽  
Clinical Trials ◽  
Nervous System ◽  
Who Classification ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
Microvascular Proliferation ◽  
Grade Iii

The current WHO classification of primary central nervous system (CNS) tumors recognizes four separate tumor grades (I–IV), which can be grouped into low-grade (I and II) or high-grade (III and IV), depending on the absence or presence of high-grade histopathological features, such as microvascular proliferation and necrosis...

Oncology is changing: the challenge of effectively assessing response within clinical trials in low-grade gliomas

2011 ◽  
Vol 5 (2) ◽  
pp. 75
Author(s):  
Ilaria Imarisio ◽  
Chiara Fumagalli
Keyword(s):  
Central Nervous System ◽  
Clinical Trials ◽  
Nervous System ◽  
Who Classification ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
Microvascular Proliferation ◽  
Grade Iii

The current WHO classification of primary central nervous system (CNS) tumors recognizes four separate tumor grades (I–IV), which can be grouped into low-grade (I and II) or high-grade (III and IV), depending on the absence or presence of high-grade histopathological features, such as microvascular proliferation and necrosis...

scholarly journals RONC-22. SECOND TUMORS IN PEDIATRIC PATIENTS TREATED WITH PROTON THERAPY TO THE CENTRAL NERVOUS SYSTEM

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii459-iii459
Author(s):  
Daniel J Indelicato ◽  
James Bates ◽  
Raymond Mailhot-Vega ◽  
Christopher Morris ◽  
Eric Sandler ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Proton Therapy ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Photon Radiation ◽  
Low Grade ◽  
High Grade ◽  
Second Tumors

Abstract BACKGROUND Previous institutional data suggests the 10-year cumulative incidence of second tumors is 3% in children treated with photon radiation for central nervous system (CNS) malignancy, with 90% of these tumors occurring in areas receiving ≤36 Gy. Comparative figures for children treated with proton therapy (PT) does not exist. METHODS 1056 consecutive pediatric patients with a median follow-up of 5.0 years were treated between 2006–2019 with double-scattered PT to a site within the craniospinal axis. 230 patients were ≤3 years old and 14 had neurofibromatosis. A second tumor was defined as any solid neoplasm with histologic features different from the original tumor that had arisen within the irradiated volume. RESULTS Five patients developed second tumors resulting in a 5- and 10-year cumulative incidence of 0.2% (95% CI: 0–1.2%) and 1.6% (95% CI: 0.6%-3.9%), respectively. Of those who developed second tumors, median age at radiation was 4.3 years old (range, 2.1 to 5.1 years old) and diagnoses consisted of medulloblastoma (n=2), ependymoma (n=2), and craniopharyngioma (n=1). The second tumors included high grade gliomas (n=3) and high grade sarcoma (n=1) that occurred in regions receiving at least 54 Gy. One patient with neurofibromatosis developed both a low-grade glioma and choroidal melanoma in craniospinal irradiation regions receiving 36 Gy. Four of five patients with second tumors are alive. CONCLUSION The reduction in moderate-to-low dose radiation exposure from proton therapy may be associated with a decreased incidence of second tumors in children treated for CNS neoplasms. More follow-up is needed to confirm these findings.

Disseminated ependymomas of the central nervous system

1996 ◽  
Vol 85 (4) ◽  
pp. 618-624 ◽  
Author(s):  
Ali R. Rezai ◽  
Henry H. Woo ◽  
Mark Lee ◽  
Henry Cohen ◽  
David Zagzag ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Proliferation Index ◽  
Significant Variable ◽  
Low Grade ◽  
High Grade ◽  
Primary Tumor Site ◽  
Tumor Dissemination ◽  
Proliferative Indices ◽  
Disseminated Disease

✓ Ependymomas are rare central nervous system (CNS) neoplasms that occasionally disseminate along the neuraxis or to extraneural sites. Definitive criteria predictive of dissemination have yet to be determined. One hundred forty patients with CNS ependymoma (88 primary spinal and 52 primary intracranial tumors) were surgically treated by the senior author (F.J.E.) between 1986 and 1994. Sixteen patients (11.4%) demonstrated tumor dissemination. The disseminated group consisted of 11 (12.5%) of 88 primary spinal and five (9.6%) of 52 primary intracranial ependymomas. The authors retrospectively reviewed the patients with CNS ependymoma and have identified several characteristics associated with dissemination from the primary tumor site. The mean time from diagnosis to dissemination was 6.8 years. The patients with disseminated disease were younger (16.8 vs. 28.3 years old, p = 0.02), had fewer gross-total resections (29% vs. 68%, p = 0.015), and had tumors with higher proliferative indices (MIB-1 staining, 13.14% vs. 2.06%, p = 0.02). High-grade tumors had a mean proliferation index of 21%, versus 2.4% and 1.6% for myxopapillary and low-grade tumors, respectively (p = 0.0003). In contrast to previous studies, tumor histology was the most significant variable for time to dissemination as determined by multivariate analysis (p = 0.008). Myxopapillary and high-grade tumors were 3.6 and 5.6 times more likely to have a shorter time to dissemination than low-grade tumors. In addition, dissemination is associated with a worse prognosis. At follow-up review, 31% of patients with disseminated disease had died compared to 7% of patients without dissemination (p = 0.04). It is concluded that younger patients with subtotal resections, myxopapillary or high-grade histology, and tumors with high proliferative indices are at substantial risk for the development of disseminated disease during their clinical course.

Hemangiopericytoma in the central nervous system: treatment, pathological features, and long-term follow up in 38 patients

2003 ◽  
Vol 98 (6) ◽  
pp. 1182-1187 ◽  
Author(s):  
Robert D. Ecker ◽  
W. Richard Marsh ◽  
Bruce E. Pollock ◽  
Özlem Kurtkaya-Yapicier ◽  
Robyn McClelland ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Survival Rate ◽  
Mayo Clinic ◽  
Recurrent Disease ◽  
External Beam Radiation ◽  
Low Grade ◽  
High Grade ◽  
Content Type ◽  
Fine Print

Object. The authors reviewed the Mayo Clinic experience with the treatment of hemangiopericytoma in the primary central nervous system (CNS). Methods. A retrospective study of all patients at the Mayo Clinic revealed 38 who had been treated for hemangiopericytoma in the CNS. Twenty of these patients were diagnosed in the decade between 1990 and 2000; 18 were initially diagnosed and underwent surgery before 1990. In the patients treated since 1990, the 5-year Kaplan—Meier survival rate was 93%. The 5-year disease-free survival rate was 89%. Sixty percent of patients treated with the aid of stereotactic radiosurgery for recurrent disease were alive 4.4 years after their initial treatment. Salvage chemotherapy was not effective. No survival benefit was detected in patients who had received initial adjuvant external-beam radiation therapy. High-grade tumors recurred 6.7 years earlier than did low-grade lesions (p = 0.004). Conclusions. The 5-year survival rate in patients with hemangiopericytoma of the CNS has improved at the authors' institution during the last 10 years. Although the reason for this is not entirely clear, the authors suspect that the improved treatment of patients with cancer, a 0% intraoperative mortality rate, and the use of radiosurgery in the treatment of recurrent disease all likely contribute. High-grade tumors recurred statistically significantly earlier than low-grade lesions. Current chemotherapies are ineffective in the treatment of hemangiopericytoma of the CNS.

scholarly journals A Study of the correlation between radiological and histopathological findings in intracranial lesions

2021 ◽  
Vol 8 (3) ◽  
pp. 34-38
Author(s):  
Monika Singh Parihar ◽  
Ranu Tiwari Mishra ◽  
Vijay SIngh Parihar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Malignant Tumors ◽  
Standard Procedure ◽  
Rural Setting ◽  
Diagnostic Tools ◽  
Benign Tumors ◽  
Histopathological Diagnosis ◽  
Common Location ◽  
Neoplastic Lesions

Objective: This study was conducted to formulate locationwise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis of intracranial mass lesions to evaluate their utility in a rural setting where only basic facilities are available. Material and Method: In present study seventy two cases were analyzed.Histopathological evaluation was done from biopsy sample sent in formalin, tissue processing was done by standard procedure, tissue sections were routinely stained by H&E, immunohistochemical examination was performed in case of histopathological discrepancies. Radiological findings were correlated with histopathological diagnosis and concordances were calculated. Statistical Analysis: Frequencies and crosstabs were used for calculation. Result: This was a study of seventy-two patients with age ranging from 9months to 65 years. In these entire 72 cases, male patients were 42(58%), female patients were 30(42%). M: F was 1.38:1. Most of patient presented with headache, and frontal lobe was the most common location. In all these lesions, 88.8% cases were neoplastic lesions. Among all neoplastic lesions, 52.7% were malignant tumors and 34.7% were benign tumors. Among all malignant tumors, Astrocytoma was the most common malignant tumor.Meningioma was the second most commonly encountered lesion. In the present study radiological and histopathological correlation was present in84.7% of cases. IHC was performed wherever needed, to support diagnosis. Conclusion: Radiological investigations are reliable diagnostic tools for space occupying central nervous system lesions, but histopathology is still the gold standard. So multidisciplinary approach is the ideal approach for space occupying lesions of central nervous system.

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