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Is adult medulloblastoma merely the counterpart of pediatric medulloblastoma? 成人髓母细胞瘤仅仅是儿童髓母细胞癌的对应物吗?
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_24_20
G. Wong, K. Li, M. Poon, H. Ng
Medulloblastoma is one of the most common pediatric malignant brain tumors. Its understanding and treatment have advanced rapidly over the decade, with the identification of four distinct molecular groups. In contrast, adult medulloblastoma is a rare entity that accounts for <1% of adult central nervous system tumors, and is understudied in both its genetic landscape and clinical management. Adult medulloblastomas demonstrate many differences from pediatric medulloblastomas that are relevant to clinicians and biologists. Unlike its pediatric counterpart, adult medulloblastomas are typically located laterally in the cerebellum, are seldom metastatic, and commonly relapse beyond 5 years. The distribution and survival outcomes of molecular groups in adult medulloblastoma differ from those in pediatric medulloblastoma, with the sonic hedgehog-activated group being the predominant and most well-studied group in adults. Adult medulloblastomas also exhibit cytogenetic and mutational characteristics unique to this age group, such as the high frequency of telomerase reverse transcriptase promoter mutations and the paucity of MYC and MYCN amplifications. Clinical trials for adult medulloblastoma need to take into account the clinical and biological differences between adult and pediatric medulloblastomas, for example through the use of smoothened inhibitors in adult SHH medulloblastomas to lower the toxicities resulting from direct adoption of pediatric chemotherapeutic regimens. This review summarizes the clinical characteristics, molecular groups, genetic features, and treatment of adult medulloblastoma, with a focus on its differences from pediatric medulloblastoma.
髓母细胞瘤是儿童最常见的恶性脑肿瘤之一。在过去的十年中,随着四种不同的分子群的确定,对其的理解和治疗取得了迅速的进展。相比之下,成人髓母细胞瘤是一种罕见的实体,占成人中枢神经系统肿瘤的不到1%,在其遗传景观和临床管理方面都未得到充分研究。成人成神经管细胞瘤与儿科成神经管细胞瘤有许多不同之处,这与临床医生和生物学家有关。与儿童不同,成人髓母细胞瘤通常位于小脑外侧,很少转移,通常在5年以上复发。成人成神经管细胞瘤分子群的分布和生存结果与儿童成神经管细胞瘤不同,其中声刺猬激活组是成人中主要的和研究最多的组。成人髓母细胞瘤也表现出该年龄组特有的细胞遗传学和突变特征,例如端粒酶逆转录酶启动子突变的高频率以及MYC和MYCN扩增的缺乏。成人成神经管母细胞瘤的临床试验需要考虑成人和儿童成神经管母细胞瘤的临床和生物学差异,例如,通过在成人SHH成神经管母细胞瘤中使用平滑抑制剂来降低直接采用儿科化疗方案所产生的毒性。本文综述了成人成神经管细胞瘤的临床特点、分子类群、遗传特征和治疗方法,并重点介绍了成人成神经管细胞瘤与儿童成神经管细胞瘤的区别。
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引用次数: 0
Comprehensive RNAseq analysis reveals PIK3CD promotes glioblastoma tumorigenesis by mediating PI3K-Akt signaling pathway 综合RNAseq分析发现,PIK3CD通过介导PI3K-Akt信号通路促进胶质母细胞瘤的发生
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_23_20
Zulfikar Azam, W. Shao, H. Ng, Jing Wang, Zhongping Chen, S. To
Background and Aim: Glioblastoma (GBM) is the most common and aggressive form of primary malignant brain tumors. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta (PIK3CD), which is overexpressed in GBM, is involved in GBM pathogenesis and drug resistance. However, the molecular mechanism by which PIK3CD drives its transcriptional program toward GBM favors remains elusive. Materials and Methods: Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and CRISPR-associated 9 technology was used to knock-out (KO) PIK3CD gene, and comprehensive RNAseq analysis was performed to investigate the underlying role of PIK3CD in GBM. Results: To minimize the off-target effects, two KO cell clones were used, and our data showed that PIK3CD KO altered the expression 306 genes in both KO cell clones compared with the parent U87 cell line. Gene set enrichment analysis revealed that genes involved in epithelial-mesenchymal (MES) transition-related biological processes were highly depressed in both KO cell clones in a similar fashion, suggesting PIK3CD's involvement in MES transformation/transition in GBM. Comprehensive pathway analysis by three different platforms confirmed that PIK3CD exerted its oncogenic function in GBM through phosphatidylinositol 3-kinase (PI3K)-Akt signaling pathway. In addition, other signaling pathways (integrin, cadherin, Wnt, and inflammation mediated by chemokine and cytokine signaling pathways) were found decreased in the KO cell clones. Further, The Cancer Genomic Atlas (TCGA) analysis of our PI3K-Akt pathway-related genes showed a similar pattern of expression. Conclusion: PIK3CD is involved in GBM pathogenesis, and this action probably mediated through the PI3K-Akt signaling pathway.
背景与目的:胶质母细胞瘤(GBM)是最常见、侵袭性最强的原发性恶性脑肿瘤。磷脂酰肌醇-4,5-二磷酸3激酶催化亚基δ (PIK3CD)在GBM中过表达,参与GBM的发病和耐药。然而,PIK3CD驱动其转录程序向GBM倾斜的分子机制仍然难以捉摸。材料和方法:利用CRISPR和CRISPR-associated 9技术敲除(KO) PIK3CD基因,并进行综合RNAseq分析,探讨PIK3CD在GBM中的潜在作用。结果:为了尽量减少脱靶效应,我们使用了两个KO细胞克隆,我们的数据显示,与亲本U87细胞系相比,PIK3CD KO改变了两个KO细胞克隆中306个基因的表达。基因集富集分析显示,参与上皮-间充质(MES)转化相关生物学过程的基因在两个KO细胞克隆中以相似的方式被高度抑制,这表明PIK3CD参与了GBM中MES的转化/转化。三个不同平台的综合通路分析证实PIK3CD通过磷脂酰肌醇3-激酶(PI3K)-Akt信号通路在GBM中发挥其致癌作用。此外,其他信号通路(整合素、钙粘蛋白、Wnt以及由趋化因子和细胞因子信号通路介导的炎症)在KO细胞克隆中均下降。此外,我们的PI3K-Akt通路相关基因的癌症基因组图谱(TCGA)分析显示了类似的表达模式。结论:PIK3CD可能通过PI3K-Akt信号通路参与GBM的发病过程。
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引用次数: 1
Strategy of awake surgical resection for glioma based on intraoperative functional mapping and monitoring: A case report 基于术中功能定位和监测的神经胶质瘤清醒手术切除策略:1例报告
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_15_20
Ying-wu Shi, S. Ge, P. Ji, Jing-hui Liu, Yuan Wang, Shao-chun Guo, Y. Zhai, Min Chao, G. Gao, Y. Qu, Liang Wang
We reported a case of awake surgery for the left frontal low-grade glioma and reviewed the literature on the strategy of awake surgical resection for glioma. The eloquent cerebral areas that are involved in motor, language, memory, and visuospatial functions, which have to be preserved during surgery, is identified through intraoperative use of brain mapping techniques. This technique of combining intraoperative ultrasound and neuronavigation enabled extension of the surgical indications and improved the extent of resection, while minimizing postoperative morbidity and safeguarding the patient's quality of life. This work was approved by the Institutional Review Board of Tangdu Hospital, Fourth Military Medical University, China.
我们报告了一例左额叶低级别胶质瘤的清醒手术,并回顾了清醒手术切除胶质瘤的策略。涉及运动、语言、记忆和视觉空间功能的雄辩脑区在手术中必须保留,通过术中使用脑映射技术来识别。术中超声与神经导航相结合的技术扩大了手术指征,提高了切除范围,同时降低了术后发病率,保障了患者的生活质量。本工作经中国第四军医大学唐都医院机构审查委员会批准。
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引用次数: 0
Advancement of clinical therapeutic research on glioma: A narrative review 胶质瘤临床治疗研究进展综述
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_18_20
Fengping Li, Chao Ma, Cheng-shi Xu, Zhi-yong Pan, Zhiqiang Li
As theories evolve, the mechanism of glioma origination remains poorly understood. Understanding this mechanism promotes the clinical research on glioma therapeutic strategy and then improves the prognosis of patients with glioma. However, the overall survival of these patients is unsatisfactory. In the recent decade, a few novel therapies, such as tumor-treating fields and immunotherapy, have been introduced in clinic. Before they can be widely used, many key factors, including efficacy, safety, and benefit ratio, should be fully evaluated. Therefore, more clinical trials are required to corroborate the results and conclusions of basic research and improve the current treatment strategies. In this article, we searched relevant literature published in the past 5 years in PubMed and China National Knowledge Infrastructure and reviewed the advancements of clinical therapeutic research on glioma.
随着理论的发展,神经胶质瘤起源的机制仍知之甚少。了解这一机制有助于神经胶质瘤治疗策略的临床研究,进而改善神经胶质瘤患者的预后。然而,这些患者的总体生存率并不令人满意。近十年来,一些新的治疗方法,如肿瘤治疗领域和免疫疗法,已被引入临床。在它们被广泛使用之前,应该充分评估许多关键因素,包括疗效、安全性和获益率。因此,需要更多的临床试验来证实基础研究的结果和结论,并改进当前的治疗策略。在这篇文章中,我们检索了PubMed和China National Knowledge Infrastructure在过去5年中发表的相关文献,并回顾了神经胶质瘤临床治疗研究的进展。
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引用次数: 1
Maximal safe resection of diffuse low-grade gliomas within/near motor areas using awake craniotomy with intraoperative cortical/subcortical mapping via direct electrical stimulation: A narrative review 通过直接电刺激进行清醒开颅术术中皮质/皮质下定位,最大限度地安全切除运动区内/附近的弥漫性低级别胶质瘤:一篇叙述性综述
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_14_20
Ruixin Yang, Hongmin Bai
Diffuse low-grade gliomas are a diverse category of neuroepithelial neoplasms, which are characterized by a low proliferation index and an indolent course with a long-term survival in comparison with high-grade gliomas. It is convinced that maximal safe resection can significantly increase survival. Multiple intraoperative techniques help neurosurgeons to maximize the resection with a safe range; however, the tumors involving motor areas are still intractable for many surgeons who believe that these tumors are unresectable. We searched on PubMed database and summarized studies and reviews about diffuse low-grade gliomas within/near motor areas. Moreover, studies about anatomy about motor area were also reviewed. In this article, we discussed the anatomy of the central lobe and supplementary motor area, including the cortex, subcortical fibers, and relevant vessels, as well as the technical details of awake craniotomy and direct electrical stimulation. At last, combined with some cases, we try to demonstrate that tumors within/near motor areas are resectable, which may cause only mild neurological deficits using awake craniotomy with intraoperative monitoring by cortical/subcortical mapping, and, furthermore, it provides a longer and better survival for those young patients.
弥漫性低级别胶质瘤是一种不同类型的神经上皮肿瘤,与高级别胶质瘤相比,其特点是增殖指数低,病程缓慢,长期生存。认为最大限度的安全切除可显著提高生存率。多种术中技术帮助神经外科医生在安全范围内最大限度地切除;然而,对于许多外科医生来说,涉及运动区域的肿瘤仍然是难以治疗的,他们认为这些肿瘤是不可切除的。我们检索了PubMed数据库,总结了关于运动区域内/附近弥漫性低级别胶质瘤的研究和综述。此外,还对运动区的解剖学研究进行了综述。在本文中,我们讨论了中央叶和辅助运动区域的解剖,包括皮层、皮层下纤维和相关血管,以及清醒开颅和直接电刺激的技术细节。最后,结合一些病例,我们试图证明运动区域内/附近的肿瘤是可切除的,在术中通过皮质/皮质下定位监测的清醒开颅术中可能只会导致轻微的神经功能障碍,并且为这些年轻患者提供了更长和更好的生存期。
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引用次数: 1
Mechanisms of telomere maintenance in pediatric brain tumors: Promising targets for therapy – A narrative review 儿童脑肿瘤的端粒维持机制:有希望的治疗靶点
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_20_20
S. Minasi, F. Gianno, Hiba Alzoubi, M. Antonelli, F. Giangaspero, F. Buttarelli
Recent advances in genetic and molecular characterization of telomere maintenance mechanisms (TMMs) highlighted their strong relationship with cancer pathogenesis; neoplastic cells rely on two mechanisms to maintain telomere length and escape from replicative senescence: (a) reactivation of telomerase expression and (b) activation of alternative lengthening of telomere (ALT). Our aims are to describe the role of telomere maintenance in the context of recently published literature regarding pediatric brain cancers and to discuss the emerging therapeutic strategies to target telomerase-positive and ALT-positive tumors. In this review, we illustrate the incidence of TMM via telomerase or ALT and discuss the importance of analyzing telomere length and ALT-associated genetic alterations in certain histological/molecular subtypes of pediatric brain tumors, as potential therapeutic biomarkers. Telomerase-dependent TMM is a common mechanism in SHH-medulloblastomas and ependymomas, which could potentially benefit from antitelomerase therapies, while ALT-dependent TMM is more frequently activated in α-thalassemia/mental retardation syndrome X-linked/H3.3-mutated pediatric high-grade gliomas, metastatic medulloblastomas, and choroid plexus tumors, which could potentially be treated with ALT-targeted drugs. Conversely, pediatric low-grade gliomas lack both mechanisms of telomere maintenance, and anti-TMM therapies do not appear to be a promising strategy for these tumors.
端粒维持机制(TMMs)的遗传和分子表征的最新进展强调了它们与癌症发病机制的密切关系;肿瘤细胞依靠两种机制来维持端粒长度和避免复制性衰老:(a)端粒酶表达的再激活和(b)端粒选择性延长(ALT)的激活。我们的目的是在最近发表的关于儿童脑癌的文献中描述端粒维持的作用,并讨论针对端粒酶阳性和alt阳性肿瘤的新兴治疗策略。在这篇综述中,我们阐述了端粒酶或ALT引起TMM的发生率,并讨论了分析端粒长度和ALT相关遗传改变在儿童脑肿瘤的某些组织学/分子亚型中的重要性,作为潜在的治疗生物标志物。端粒酶依赖性TMM是shh -髓母细胞瘤和室管膜瘤的常见机制,可能从抗端粒酶治疗中获益,而alt依赖性TMM在α-地中海贫血/智力低下综合征x连锁/ h3.3突变的儿童高级别胶质瘤、转移性髓母细胞瘤和脉膜丛肿瘤中更频繁激活,可能用alt靶向药物治疗。相反,小儿低级别胶质瘤缺乏端粒维持的两种机制,抗tmm治疗似乎不是治疗这些肿瘤的有希望的策略。
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引用次数: 1
To do genomics or not do? This is the question 做基因组学还是不做?这就是问题所在
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_22_20
H. Ng, A. Chan, Nim-Chi Amanda Kan, Dennis Ku, D. Chan, K. Li
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引用次数: 1
Carbonic anhydrase IX as a marker of hypoxia in gliomas: A narrative review 碳酸酐酶IX作为胶质瘤缺氧标志物的研究进展
Pub Date : 2020-07-01 DOI: 10.4103/glioma.glioma_19_20
R. McLendon
Hypoxia is a powerful driver of the malignant phenotype in solid tumors including gliomas. A major, though not sole, driver of this effect is the hypoxia-inducible factors (HIF) which promote the expression of hundreds of downstream genes through binding with hypoxia-responsive elements in the promoter regions of targeted genes. HIF-2α drives the cancer stem cell phenotype that has been shown to promote chemo- and radioresistance. HIF-1α drives the transcription of a number of genes, the most prolific and important of which appears to be that of CAIX, but also drives the transcription of VEGF and a number of glycolytic enzymes, thus participating in driving the Warburg effect. This brief review introduces how the localization of CAIX by immunohistochemistry has, though still in its early phases, allowed the identification of gliomas with worse prognosis, an application of significant importance in diagnostic neuropathology. The future of hypoxia research will manipulate these downstream pathways to provide further biomarkers through which the presence of hypoxia and its effects can be established, analyzed, and exploited.
缺氧是包括胶质瘤在内的实体瘤恶性表型的强大驱动因素。这种作用的一个主要但不是唯一的驱动因素是缺氧诱导因子(HIF),它通过与靶基因启动子区的缺氧反应元件结合来促进数百个下游基因的表达。HIF-1α驱动癌症干细胞表型,该表型已被证明可促进化疗和放射性耐药性。HIF-1α驱动许多基因的转录,其中最多产和最重要的似乎是CAIX,但也驱动VEGF和许多糖酵解酶的转录,从而参与驱动Warburg效应。这篇简短的综述介绍了免疫组织化学对CAIX的定位,尽管仍处于早期阶段,如何能够识别预后较差的胶质瘤,这在诊断神经病理学中具有重要意义。缺氧研究的未来将操纵这些下游途径,提供进一步的生物标志物,通过这些生物标志物可以确定、分析和利用缺氧的存在及其影响。
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引用次数: 1
Functional remodeling of brain language networks 大脑语言网络的功能重塑
Pub Date : 2020-04-01 DOI: 10.4103/glioma.glioma_12_20
N. Hameed, Jinsong Wu
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引用次数: 0
A young adult patient with Li-Fraumeni syndrome-associated glioblastoma: Case discussion and literature review 一例年轻成人李-弗劳梅尼综合征相关胶质母细胞瘤患者:病例讨论和文献复习
Pub Date : 2020-04-01 DOI: 10.4103/glioma.glioma_17_20
Xiao-Yu Wu, S. Tian, Biling Liang, Qunying Yang, H. Ng, Shao‐xiong Wu, Q. Chang, Zhongping Chen
Li-Fraumeni syndrome is an autosomal dominant cancer predisposition syndrome caused by germ line alterations in the tumor suppressor gene TP53, with an incidence of 1 in 5000–1 in 20,000. Li-Fraumeni syndrome is associated with numerous malignancies, including astrocytoma. Here, we report the case of a female patient diagnosed with glioblastoma in the right temporal lobe at the age of 22 years. She was treated with surgery followed by radiation and chemotherapy and achieved a complete response. Not surprisingly, the patient relapsed 7 years later and underwent a second surgery and radiation concurrent with temozolomide followed by chemotherapy with various agents. The patient currently remains tumor-free. Genetic testing revealed that the tumor contained a germ line mutation of TP53 (p.R282W). Pertinent family history included a mother who suffered from leukemia. Therefore, given the patient's medical and family history, we consider this is a case of Li-Fraumeni syndrome associated with glioblastoma. The ethics approval is not applied since the case was in consultation with experts arranged through meeting organizer.
Li-Fraumeni综合征是一种常染色体显性遗传癌症易感性综合征,由肿瘤抑制基因TP53的种系改变引起,发病率为1/5000–1/2000。李·弗劳梅尼综合征与许多恶性肿瘤有关,包括星形细胞瘤。在此,我们报告了一例女性患者,22岁时被诊断为右颞叶胶质母细胞瘤。她接受了手术治疗,随后进行了放疗和化疗,并取得了完全缓解。毫不奇怪,该患者在7年后复发,并接受了第二次手术和替莫唑胺放疗,然后用各种药物进行化疗。患者目前没有肿瘤。基因检测显示,该肿瘤含有TP53的种系突变(第R282W页)。相关家族史包括一位患有白血病的母亲。因此,鉴于患者的病史和家族史,我们认为这是一例与胶质母细胞瘤相关的李·弗劳梅尼综合征。由于该案件是通过会议组织者安排的专家咨询的,因此未申请伦理批准。
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引用次数: 0
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