multiple lesions
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H-INDEX

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2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi27-vi27
Author(s):  
Nobuhide Hayashi ◽  
Hiroki Enomoto ◽  
Kenji Kubo ◽  
Yuta Nakanishi ◽  
Kenji Ishii ◽  
...  

Abstract Introduction: In 2016, the World Health Organization (WHO) defined diffuse midline glioma, H3K27M mutant (WHO Grade 4) as a tumor with K27M mutation in histone H3.3 (H3F3A) or H3.1 (HIST1H3B/C) that develops mainly in the midline regions of the central nervous system. Here, we report a rare case of the abovementioned disease with remote multiple lesions in addition to the midline regions that was diagnosed on the initial visit. Case: The 52-year-old man, suffered from dysarthria, dysphagia, gait disturbance, and headache that gradually worsened over several months. Non-contrast-enhanced lesions were noted in the pons(swelling and involvement of the basilar artery trunk), cerebellum, thalamus, fornix, periventricular area, hippocampus, medial aspect of bilateral frontal lobes, and distally in the right frontal cortex and apical region of the left temporal lobe. The open biopsy was performed for left cerebellar surface lesion, and the pathological and genetic diagnosis was diffuse midline glioma, H3K27M mutant. Extended focal radiation at 50Gy/25fr and corpus callosal/cerebellar boost at 10Gy/5fr were performed. The lesions were markedly reduced, and neurological symptoms were also alleviated. However, 20 months after the initial visit, neurological symptoms had worsened and cerebrospinal fluid dissemination occurred, after that died at 29 months. An autopsy revealed tumor invasion mainly in the midline regions of the cerebrum and in the cerebellum, brain stem, pituitary gland, entire spinal cord, and cauda equina. Immunostaining of the distally cerebral cortex lesions showed that with a negative result for H3G34V. Discussion/Conclusion: It was suggested that caution is required for primary differential diagnosis may be presented at multiple lesions such as remote cerebral cortex of diffuse midline glioma, H3K27M-mutant.


2021 ◽  
Author(s):  
Bongkot Jia-Mahasap ◽  
Chakri Madla ◽  
Patumrat Sri ◽  
Imjai Chitapanarux ◽  
Ekkasit Tharavichitkul ◽  
...  

Abstract Background: Specific radiation delivered to the tumor by stereotactic radiosurgery (SRS) has become widely used in the treatment of brain metastasis. This study aimed to compare radiation dosimetry and its parameters from SRS using three different modalities: Helical Tomotherapy (HT), Volumetric Modulated Arc Therapy (VMAT), and Cone-based Linac Radiosurgery (Cone-based). Methods: Patients who had experienced oligo-brain metastasis received SRS in our treatment center. Each contouring dataset was re-planned to create radiation dosimetry in all three treatment systems (HT, VMAT, and Cone-based). The parameters of conformity index (CI), homogeneity index (HI), CI50, and gradient index (CGI) were analyzed to compare the effects of the three techniques. Results: A total of 21 patients with 39 lesions were included in this study. For single lesion, Cone-based and VMAT revealed statistically identical CI, CI50, and CGI values, while exhibiting the poorest HI value. For multiple lesions, Cone-based provided the best CI50 and CGI values. VMAT displayed better CI50 and CGI values than HT. Moreover, VMAT exhibited the lowest BrainV5Gy value and displayed the shortest beam on time (BoT) calculation. Lastly, Decision Score analysis demonstrated better performance in VMAT when compared to the Cone-based approach. Conclusions: Our data indicated the dosimetric comparison between three radiation techniques for single and multiple lesions. The Cone-based technique revealed the poorest HI value. On the other hand, VMAT provided the best estimated BoT value. Moreover, we have reported on the feasibility of SRS using HT, which has been associated with well-tolerability and an acceptable level of radiation output.Trial registration: Thai Clinical Trials Registry (TCTR) ID No. TCTR20200803006Date of registration: 24 July 2020 (Retrospectively registered)URL: http://www.thaiclinicaltrials.org/show/TCTR20200803006


2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi158-vi158
Author(s):  
Andres Ramos-Fresnedo ◽  
Ricardo Domingo ◽  
Jesus Sanchez-Garavito ◽  
Carlos Perez-Vega ◽  
Oluwaseun Akinduro ◽  
...  

Abstract INTRODUCTION Multiple meningiomas (MM) occurs in up to 18% of meningioma patients and progression data are scarce. The objective of this study is to explore the influence of number of lesions and clinical characteristics on progression-free survival (PFS) and time to a second intervention (TTSI) in patients with WHO grade 1 meningiomas. METHODS We retrospectively reviewed records of all adults diagnosed with a meningioma at our three main sites from January 2009 to May 2020. Progression was considered as time from diagnosis until radiographic progression of the originally resected meningioma. A secondary analysis was carried to evaluate the time from diagnosis to time of a second intervention. Univariable and multivariable analyses were conducted to assess whether number of lesions or any associated variables (age, sex, race, radiation, location, and extent of resection) had a significant impact on PFS and TTSI. RESULTS 838 patients were included. Log-rank test evaluating PFS and TTSI between single and multiple lesions showed significantly shorter progression for MM (p< 0.001 and p< 0.001, respectively). Multivariable Cox regression showed significantly inferior PFS on MM vs. single lesion (HR 2.262 [CI 95%, 1.392-3.677], p=0.001) and a significantly inferior TTSI for patients with MM vs. single meningioma (HR 2.377 [CI 95%, 1.617 – 3.494], p=0.001). When input as a continuous variable, PFS was significantly inferior for each additional meningioma (HR 1.350 [CI 95% 1.074-1.698], p=0.010) and TTSI is significantly inferior as well (HR 1.428 [CI 95% 1.189 – 1.716], p< 0.001). African-Americans had an inferior PFS when compared to Non-Hispanic White patients (HR 3.472 [CI 95% 1.083-11.129], p=0.036). CONCLUSION The PFS of meningiomas is influenced by the number of lesions present. Patients with MM are more prone to undergo a second intervention for progressive disease. Hence, a closer follow-up may be warranted in patients who present with multiple lesions.


2021 ◽  
Vol 108 (5) ◽  
Author(s):  
Diem-Phuong Dao

2021 ◽  
pp. 1-9
Author(s):  
Andres Ramos-Fresnedo ◽  
Ricardo A. Domingo ◽  
Jesus E. Sanchez-Garavito ◽  
Carlos Perez-Vega ◽  
Oluwaseun O. Akinduro ◽  
...  

OBJECTIVE Multiple meningiomas (MMs) occur in as many as 18% of patients with meningioma, and data on progression-free survival (PFS) are scarce. The objective of this study was to explore the influence of the number of lesions and clinical characteristics on PFS in patients with WHO grade I meningiomas. METHODS The authors retrospectively reviewed the records of all adults diagnosed with a meningioma at their three main sites from January 2009 to May 2020. Progression was considered the time from diagnosis until radiographic growth of the originally resected meningioma. A secondary analysis was performed to evaluate the time of diagnosis until the time to second intervention (TTSI). Univariable and multivariable analyses were conducted to assess whether the number of lesions or any associated variables (age, sex, race, radiation treatment, tumor location, and extent of resection) had a significant impact on PFS and TTSI. RESULTS Eight hundred thirty-eight patients were included. Use of a log-rank test to evaluate PFS and TTSI between a single and multiple lesions showed a significantly shorter progression for MM (p < 0.001 and p < 0.001, respectively). Multivariable Cox regression analysis showed significantly inferior PFS on MM compared to a single lesion (hazard ratio [HR] 2.262, 95% confidence interval [CI] 1.392–3.677, p = 0.001) and a significantly inferior TTSI for patients with MM when compared to patients with a single meningioma (HR 2.377, 95% CI 1.617–3.494, p = 0.001). By testing the number of meningiomas as a continuous variable, PFS was significantly inferior for each additional meningioma (HR 1.350, 95% CI 1.074–1.698, p = 0.010) and TTSI was significantly inferior as well (HR 1.428, 95% CI 1.189–1.716, p < 0.001). African American patients had an inferior PFS when compared to non-Hispanic White patients (HR 3.472, 95% CI 1.083–11.129, p = 0.036). CONCLUSIONS The PFS of meningiomas appears to be influenced by the number of lesions present. Patients with MM also appear to be more prone to undergoing a second intervention for progressive disease. Hence, a closer follow-up may be warranted in patients who present with multiple lesions. These results show a decreased PFS for each additional lesion present, as well as a shorter PFS for MM compared to a single lesion. When assessing associated risk factors, African American patients showed an inferior PFS, whereas older age and adjuvant therapy with radiation showed an improved PFS.


2021 ◽  
Author(s):  
Jiamin Gong ◽  
Liufei Guo ◽  
Jiewei Jiang ◽  
Chengchao Wu ◽  
Mengjie Pei ◽  
...  

2021 ◽  
pp. 196-202
Author(s):  
Abigail Funari ◽  
Murray Echt ◽  
Vijay Agarwal
Keyword(s):  

Author(s):  
Luciana Faria ◽  
Catarina Patronillo ◽  
Sónia Fernandes ◽  
Cristina Gonçalves

Diffuse large B cell lymphoma (DLBCL) it’s the most frequent of all non-Hodgkin lymphomas. We describe a case of a man with multiple lesions on both legs being treated as venous ulcer for two months until a biopsy of them result on the diagnose of DLBCL.


Pituitary ◽  
2021 ◽  
Author(s):  
Christian Hagel ◽  
Ulrich Schüller ◽  
Jörg Flitsch ◽  
Ulrich J. Knappe ◽  
Udo Kellner ◽  
...  

Abstract Purpose Pituitary adenoma (PA) constitutes the third most common intracranial neoplasm. The mostly benign endocrine lesions express no hormone (null cell PA) or the pituitary hormone(s) of the cell lineage of origin. In 0.5–1.5% of surgical specimens and in up to 10% of autopsy cases, two or three seemingly separate PA may coincide. These multiple adenomas may express different hormones, but whether or not expression of lineage-restricted transcription factors and molecular features are distinct within multiple lesions remains unknown. Methods Searching the data bank of the German Pituitary Tumor Registry 12 double pituitary adenomas with diverse lineage were identified among 3654 adenomas and 6 hypophyseal carcinomas diagnosed between 2012 and 2020. The double adenomas were investigated immunohistochemically for expression of hormones and lineage markers. In addition, chromosomal gains and losses as well as global DNA methylation profiles were assessed, whenever sufficient material was available (n = 8 PA). Results In accordance with the literature, combinations of GH/prolactin/TSH–FSH/LH adenoma (4/12), GH/prolactin/TSH–ACTH adenoma (3/12), and ACTH–FSH/LH adenoma (3/12) were observed. Further, two out of 12 cases showed a combination of a GH/prolactin/TSH adenoma with a null-cell adenoma. Different expression pattern of hormones were confirmed by different expression of transcription factors in 11/12 patients. Finally, multiple lesions that were molecularly analysed in 4 patients displayed distinct copy number changes and global methylation pattern. Conclusion Our data confirm and extend the knowledge on multiple PA and suggest that such lesions may origin from distinct cell types.


2021 ◽  
Vol 8 (13) ◽  
pp. 1-36
Author(s):  
Narayan Karunanithy ◽  
Emily J Robinson ◽  
Francis Calder ◽  
Anthony Dorling ◽  
Janet L Peacock ◽  
...  

Background Reliable vascular access is essential for patients receiving haemodialysis. An arteriovenous fistula is the preferred option; however, these are prone to developing stenotic segments. These lesions are treated with angioplasty, but there is a high rate of recurrence. When the PAVE (Paclitaxel-assisted balloon Angioplasty of Venous stenosis in haEmodialysis access) trial was conceived, a number of small studies suggested that restenosis may be reduced by paclitaxel-coated balloons. Objective To test the efficacy of paclitaxel-coated balloons in arteriovenous fistulas. Design A randomised controlled trial. Setting Twenty UK centres. Participants Patients (aged ≥ 18 years) referred with a clinical indication for angioplasty of an arteriovenous fistula (212 patients in total, 106 per group). Interventions High-pressure plain balloon fistuloplasty was performed in all patients. In the intervention arm, the second component was insertion of a paclitaxel-coated balloon. In the control arm, an identical procedure was followed, but using a standard balloon. Main outcome measures The primary end point was time (days) to loss of target lesion primary patency. Secondary patency end points were time to loss of access circuit primary patency and time to loss of access circuit cumulative patency. Other secondary end points included angiographically determined late lumen loss, rate of binary angiographic restenosis, procedural success, number of thrombosis events, fistula interventions, adverse events during follow-up and patient quality of life. Results Primary analysis showed no evidence for a difference in time to end of target lesion primary patency between groups (hazard ratio 1.18, 95% confidence interval 0.78 to 1.79; p = 0.440). An adjusted secondary analysis with prespecified clinical covariates gave similar results (hazard ratio 1.11, 95% confidence interval 0.69 to 1.78; p = 0.664). Prespecified secondary outcomes included the time to intervention anywhere in the access circuit or the time until the fistula was abandoned. There were no differences in these patency-related secondary outcomes or in any other secondary outcomes, such as adverse events. Limitations The PAVE trial was not a fully blinded trial. It was impossible to ensure that treating radiologists were blinded to treatment allocation because of the appearance of the paclitaxel-coated balloon. The extent to which our findings can be generalised to patients with multiple lesions could be questioned, given the proportion randomised. However, if paclitaxel-coated balloons had been effective at a single lesion segment, then there is no plausible reason why they could not be effective in patients with multiple lesions. Conclusions There were no differences in primary or secondary outcomes. Following a plain balloon angioplasty, additional treatment with a paclitaxel-coated balloon does not provide benefit. Future work The reasons for differences between the results of the PAVE trial and of other studies deserve further analysis and consideration. Other interventions to prevent restenosis following a fistuloplasty are needed. Trial registration Current Controlled Trials ISRCTN14284759. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 13. See the NIHR Journals Library website for further project information.


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