Brain tumor research and treatment最新文献

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Digital Pathology and Artificial Intelligence Applications in Pathology 数字病理学和人工智能在病理学中的应用

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2021.0032

H. Go

Digital pathology is revolutionizing pathology. The introduction of digital pathology made it possible to comprehensively change the pathology diagnosis workflow, apply and develop pathological artificial intelligence (AI) models, generate pathological big data, and perform telepathology. AI algorithms, including machine learning and deep learning, are used for the detection, segmentation, registration, processing, and classification of digitized pathological images. Pathological AI algorithms can be helpfully utilized for diagnostic screening, morphometric analysis of biomarkers, the discovery of new meanings of prognosis and therapeutic response in pathological images, and improvement of diagnostic efficiency. In order to develop a successful pathological AI model, it is necessary to consider the selection of a suitable type of image for a subject, utilization of big data repositories, the setting of an effective annotation strategy, image standardization, and color normalization. This review will elaborate on the advantages and perspectives of digital pathology, AI-based approaches, the applications in pathology, and considerations and challenges in the development of pathological AI models.

数字病理学正在彻底改变病理学。数字病理学的引入，使得全面改变病理诊断工作流程、应用和开发病理人工智能(AI)模型、生成病理大数据、进行心灵病理学成为可能。人工智能算法，包括机器学习和深度学习，用于数字化病理图像的检测、分割、配准、处理和分类。病理AI算法可用于诊断筛选、生物标志物形态计量学分析、病理图像中发现预后和治疗反应的新意义、提高诊断效率。为了开发一个成功的病理AI模型，需要考虑为主题选择合适的图像类型，利用大数据存储库，设置有效的标注策略，图像标准化和颜色归一化。本文将阐述数字病理学的优势和前景，基于人工智能的方法，在病理学中的应用，以及病理人工智能模型发展中的考虑和挑战。

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引用次数: 2

Peripheral T-Cell Lymphoma Presenting as a Scalp Mass. 外周t细胞淋巴瘤表现为头皮肿块。

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0004

Moo Seong Kim, Se Young Pyo, Ha Young Park, Hyuck Rae Jo, Jeongeun Kim

Peripheral scalp T-cell lymphoma is a very rare disease. We report a case of a 22-year-old man who presented an indolent large scalp mass in the right frontal scalp region. The patient's physical examination demonstrated no palpable mass in the chest, abdomen, and extremities. The brain CT revealed a high-density large scalp mass of the subgaleal layer in the right frontal and a small scalp mass of the subgaleal layer in the left frontal. The brain MRI showed multifocal enhancing masses in the bilateral dura, the subgaleal layer of the scalp, and the skull. The patient underwent removal of the tumor found in the right frontal scalp. The histologic diagnosis was peripheral T-cell lymphoma. Bone marrow aspiration showed the involvement of T-cell lymphoma. The patient received chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP protocol) for 3 cycles. The patient was discharged without neurological deficit. The patient showed no evidence of recurrence 15 months after surgery. We report a rare case of peripheral T-cell lymphoma mimicking benign scalp tumors.

外周头皮t细胞淋巴瘤是一种非常罕见的疾病。我们报告一个22岁的男子谁提出了一个无痛的大头皮肿块在右额部头皮区域。病人的体格检查显示胸部、腹部和四肢没有可触及的肿块。脑部CT示右侧额叶一高密度大的盔状下头皮肿块，左侧额叶一小的盔状下头皮肿块。脑部MRI显示双侧硬脑膜、头皮硬膜下层及颅骨多灶性强化肿块。患者接受了右侧额叶头皮肿瘤的切除手术。组织学诊断为外周t细胞淋巴瘤。骨髓穿刺显示浸润t细胞淋巴瘤。患者接受环磷酰胺、长春新碱、阿霉素、强的松龙化疗(CHOP方案)3个周期。病人出院时没有神经功能障碍。患者术后15个月无复发迹象。我们报告一例罕见的模拟良性头皮肿瘤的外周t细胞淋巴瘤。

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引用次数: 0

Recent Updates on Radiation Therapy for Pediatric Optic Pathway Glioma 放射治疗小儿视通路胶质瘤的最新进展

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0003

N. Kim, D. Lim

Optic pathway glioma (OPG) is a rare tumor located in optic nerve, optic tract, or optic chiasm. Treatment options for OPG include surgery, radiation therapy (RT), and chemotherapy. Although RT may provide favorable long-term outcomes in manner of either adjuvant or salvage aim, chemotherapy-first approach is increasingly performed due to possible late effects of RT. Proton beam RT may allow normal tissue sparing of radiation exposure compared to conventional X-ray treatment. Therefore, proton beam RT is expected to reduce complications from RT. This review discusses the recent updates on oncologic outcomes of OPG, late toxicities following RT, and compares the outcomes between X-ray treatment and proton beam RT.

视神经通路胶质瘤(OPG)是一种位于视神经、视束或视交叉的罕见肿瘤。OPG的治疗选择包括手术、放射治疗(RT)和化疗。尽管放疗在辅助或挽救目的方面可能提供有利的长期结果，但由于放疗可能的晚期效应，化疗优先的方法越来越多地被采用。与传统的x射线治疗相比，质子束放疗可能允许正常组织免于辐射暴露。因此，质子束放射治疗有望减少放射治疗的并发症。本文讨论了OPG肿瘤预后的最新进展，放射治疗后的晚期毒性，并比较了x线治疗和质子束放射治疗的结果。

引用次数: 5

Recent Update in Pharmacological Agents for Optic Pathway Glioma 光通路胶质瘤药物研究进展

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0006

Meerim Park

Optic pathway gliomas (OPGs) are insidious, debilitating low-grade tumors. They can affect the optic nerve, optic chiasm, and optic tracts and can be sporadic or associated with neurofibromatosis type 1 (NF1). The location of OPGs within the optic pathway typically precludes complete resection or optimal radiation dose. Treatment is unnecessary for sporadic and NF1-related OPGs that do not cause visual impairments. Chemotherapy is the mainstay of treatment for patients with progressive disease. However, outcomes following standard treatments have been mixed, and standardized outcome measurements are lacking. In recent years, newer molecularly targeted therapies such as anti-vascular endothelial growth factor (VEGF) monoclonal antibody, mitogen-activated protein kinase (MAPK) inhibitor, and mammalian target of rapamycin (mTOR) inhibitor, represent a promising treatment modality.

视神经胶质瘤是一种隐蔽的、使人衰弱的低级别肿瘤。它们可以影响视神经、视交叉和视束，并且可以是散发性的或与1型神经纤维瘤病（NF1）相关。OPG在光路内的位置通常排除了完全切除或最佳辐射剂量。对于不引起视觉损伤的散发性和与NF1相关的OPG，没有必要进行治疗。化疗是治疗进展性疾病的主要手段。然而，标准治疗后的结果喜忧参半，缺乏标准化的结果测量。近年来，新的分子靶向疗法，如抗血管内皮生长因子（VEGF）单克隆抗体、丝裂原活化蛋白激酶（MAPK）抑制剂和哺乳动物雷帕霉素靶点（mTOR）抑制剂，代表了一种有前景的治疗模式。

引用次数: 0

Combined Treatment With Radiotherapy and Immunotherapy for Isocitrate Dehydrogenase Mutant Brainstem Glioma in Adult: A Case Report 放疗与免疫联合治疗成人异柠檬酸脱氢酶突变脑干胶质瘤1例

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0009

Takayuki Morimoto, R. Matsuda, T. Nakazawa, F. Nishimura, I. Nakagawa

Brainstem gliomas are not common in adults, and the treatment strategies and their outcomes are limited. Immunotherapy is emerging as a promising new modality for the treatment of these gliomas. Here, we report the first case of brainstem glioma treated with a combination of radiotherapy and autologous formalin-fixed tumor vaccine (AFTV). A 32-year-old man presented with left facial numbness and right hemiparesis, and was referred to our department. MRI and open biopsy indicated brainstem glioma, and he was specifically diagnosed with isocitrate dehydrogenase 1-mutant diffuse astrocytoma of WHO grade II. He was treated with stereotactic radiotherapy followed by AFTV three months later. MRI conducted at 42 months after the combination therapy showed a 91% decrease in tumor volume, and the regression was maintained for 5 years. Thus, combination treatment with radiotherapy and immunotherapy may prove to be a promising alternative for the treatment of brainstem glioma.

脑干胶质瘤在成人中并不常见，治疗策略和结果有限。免疫疗法正在成为治疗这些胶质瘤的一种有前途的新方式。在这里，我们报告第一例脑干胶质瘤联合放疗和自体福尔马林固定肿瘤疫苗(AFTV)治疗。一个32岁的男人提出了左侧面部麻木和右侧偏瘫，并被转介到我科。MRI和开放性活检提示脑干胶质瘤，明确诊断为WHOⅱ级异柠檬酸脱氢酶1突变弥漫性星形细胞瘤。3个月后行立体定向放疗和AFTV治疗。联合治疗后42个月MRI显示肿瘤体积减小91%，并维持5年。因此，联合放疗和免疫治疗可能是治疗脑干胶质瘤的一种有前途的选择。

引用次数: 1

The Overview of Practical Guidelines for Gliomas by KSNO, NCCN, and EANO 由KSNO, NCCN和EANO提供的胶质瘤实用指南概述

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0001

Young Zoon Kim, Chae-Yong Kim, D. Lim

Gliomas have been histologically diagnosed as the third most common primary tumor of the central nervous system (CNS) in a relatively small portion of Korea. Despite the rarity of gliomas, the disease entity is very dynamic due to its various molecular characteristics, compared with other CNS tumors. The practice of managing glioma patients is not globally established as a precise standard guideline because of the different socio-medical environments of individual countries. The Korean Society for Neuro-Oncology (KSNO) published guidelines for managing adult glioma in 2019, and the National Comprehensive Cancer Network and European Association of Neuro-Oncology published guidelines in September 2021 and March 2021, respectively. However, these guidelines have several different recommendations in practice, including tissue management, adjuvant treatment after surgical resection, and salvage treatment for recurrent/progressive gliomas. Currently, the KSNO guideline working group is preparing an updated version of the guideline for managing adult gliomas. In this review, common features have been verified and different points are analyzed. Consequently, this review is expected to be informative and helpful to provide high quality evidence and a strong recommendation level for the establishment of new KSNO guidelines for managing gliomas.

胶质瘤已被组织学诊断为第三大常见的原发性肿瘤中枢神经系统(CNS)在韩国相对较小的部分。尽管胶质瘤罕见，但与其他中枢神经系统肿瘤相比，由于其多种分子特征，其疾病实体是非常动态的。由于各个国家不同的社会医学环境，管理胶质瘤患者的实践并没有在全球范围内建立一个精确的标准指南。韩国神经肿瘤学会(KSNO)于2019年发表了成人神经胶质瘤管理指南，国家综合癌症网络和欧洲神经肿瘤协会分别于2021年9月和2021年3月发表了指南。然而，这些指南在实践中有几个不同的建议，包括组织管理，手术切除后的辅助治疗，以及复发/进展性胶质瘤的挽救治疗。目前，KSNO指南工作组正在准备成人胶质瘤管理指南的更新版本。在这篇综述中，验证了它们的共同特征，分析了它们的不同点。因此，本综述有望为建立新的KSNO治疗胶质瘤指南提供信息和高质量的证据和强烈的推荐水平。

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引用次数: 13

Recurrent L3 Chordoma Presented as Intradural Extramedullary Mass With Distant Metastasis: A Case Report 复发的L3脊索瘤表现为硬膜内髓外肿块伴远处转移1例

Brain tumor research and treatment

Pub Date : 2022-04-01 DOI: 10.14791/btrt.2022.0007

S. Jang, Nayoung Han, E. K. Hong, H. Gwak

Here, we report a rare case of L3 chordoma progressed to an intradural extramedullary (IDEM) mass and distant metastasis to the fascia lata. A 64-year old female patient presented to a local university hospital due to back pain and received excisional biopsy for a L3 destructive bony lesion. Local radiation therapy was initially administered, assuming a malignancy of unknown origin, but she developed cerebrospinal fluid leakage during adjuvant radiation therapy, which was managed by wound revision and lumbar drainage. As the destructive lesion progressed, she visited our hospital for a second opinion 3 months after the biopsy. After review of outside pathology, we diagnosed the lesion to be a chordoma, and performed a L3 corpectomy with cage and plate fixation. One and a half years later, positron emission tomography and computed tomography (PET-CT) revealed a right tensor fascia lata hypermetabolic lesion. Excisional biopsy confirmed a distant metastasis of the chordoma. One year later, she complained of L2 radiating pain. PET-CT and CT myelogram revealed an IDEM lesion. Surgical excision confirmed the transdural invasion of the chordoma. To our knowledge, this is the first report of an iatrogenic IDEM invasion and distant metastasis to the tensor of the fascia lata by a L3 chordoma.

在此，我们报告一例罕见的L3脊索瘤进展为硬膜内髓外(IDEM)肿块并远端转移到阔筋膜。一名64岁女性患者因背部疼痛到当地大学医院就诊，并接受了L3破坏性骨病变的切除活检。最初进行局部放射治疗，假设恶性肿瘤来源不明，但在辅助放射治疗期间出现脑脊液漏，通过伤口翻修和腰椎引流治疗。随着破坏性病变的进展，她在活检后3个月来到我们医院寻求第二意见。在复查外部病理后，我们诊断病变为脊索瘤，并行L3椎体切除术并采用笼和钢板固定。一年半后，正电子发射断层扫描和计算机断层扫描(PET-CT)显示右侧阔筋膜张肌高代谢病变。切除活检证实脊索瘤远处转移。一年后，她抱怨L2放射性疼痛。PET-CT及CT骨髓造影示IDEM病变。手术切除证实脊索瘤经硬膜侵入。据我们所知，这是第一例由L3脊索瘤引起的医源性IDEM侵袭和远端转移到阔筋膜张肌的报道。

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引用次数: 0

WFNOS 2022 Abstract Book, March 24-27, 2022, Coex, Seoul, Korea. WFNOS 2022摘要书，2022年3月24-27日，韩国首尔Coex。

Brain tumor research and treatment

Pub Date : 2022-03-01 DOI: 10.14791/btrt.2022.10.Suppl

引用次数: 0

Current Immunotherapeutic Approaches for Malignant Gliomas. 恶性胶质瘤的当前免疫治疗方法。

Brain tumor research and treatment

Pub Date : 2022-01-01 DOI: 10.14791/btrt.2022.10.e25

Myung-Hoon Han, Choong Hyun Kim

Glioblastoma is the most common malignant central nervous system (CNS) tumor (48.3%), with a median survival of only about 14.6 months. Although the CNS is an immune-privileged site, activated T cells can cross the blood-brain barrier. The recent successes of several immunotherapies for various cancers have drawn interest in immunotherapy for treatment of malignant glioma. There have been extensive attempts to evaluate the efficiency of immunotherapy against malignant glioma. Passive immunotherapy for malignant glioma includes monoclonal antibody-mediated immunotherapy, cytokine-mediated therapy, and adoptive cell transfer, also known as chimeric antigen receptor T cell treatment. On the other hand, active immunotherapy, which stimulates the patient's adaptive immune system against specific tumor-associated antigens, includes cancer vaccines that are divided into peptide vaccines and cell-based vaccines. In addition, there is immune checkpoint blockade therapy, which increases the efficiency of immunotherapy by reducing the resistance of malignant glioma to immunotherapy. Despite centuries of efforts, immunotherapeutic successes for malignant glioma remain limited. However, many clinical trials of adoptive cell transfer immunotherapy on malignant glioma are ongoing, and the outcomes are eagerly awaited. In addition, although there are still several obstacles, current clinical trials using personalized neoantigen-based dendritic cell vaccines offer new hope to glioblastoma patients. Furthermore, immune checkpoint targeted therapy is expected to decipher the mechanism of immunotherapy resistance in malignant glioma in the near future. More studies are needed to increase the efficacy of immunotherapy in malignant glioma. We hope that immunotherapy will become a new treatment of malignant glioma.

胶质母细胞瘤是最常见的恶性中枢神经系统(CNS)肿瘤(48.3%)，中位生存期仅为14.6个月。尽管中枢神经系统是一个免疫特权部位，激活的T细胞可以穿过血脑屏障。最近几种免疫疗法对各种癌症的成功治疗引起了人们对恶性胶质瘤免疫治疗的兴趣。已经有广泛的尝试评估免疫疗法对恶性胶质瘤的疗效。恶性胶质瘤的被动免疫治疗包括单克隆抗体介导的免疫治疗、细胞因子介导的治疗和过继细胞转移，也称为嵌合抗原受体T细胞治疗。另一方面，主动免疫疗法刺激患者的适应性免疫系统对抗特定的肿瘤相关抗原，包括癌症疫苗，分为肽疫苗和细胞疫苗。此外，还有免疫检查点阻断疗法，通过降低恶性胶质瘤对免疫治疗的耐药性来提高免疫治疗的效率。尽管几个世纪以来的努力，免疫治疗对恶性神经胶质瘤的成功仍然有限。然而，许多过继性细胞转移免疫治疗恶性胶质瘤的临床试验仍在进行中，结果尚待期待。此外，尽管仍存在一些障碍，但目前使用个性化新抗原树突状细胞疫苗的临床试验为胶质母细胞瘤患者带来了新的希望。此外，免疫检查点靶向治疗有望在不久的将来破解恶性胶质瘤免疫治疗耐药的机制。需要更多的研究来提高免疫治疗对恶性胶质瘤的疗效。我们希望免疫疗法能成为恶性胶质瘤的一种新的治疗方法。

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引用次数: 4

Extraventricular Neurocytoma: Clinical Investigation of Heterogenous Prognosis. 脑室外神经细胞瘤:异质预后的临床研究。

Brain tumor research and treatment

Pub Date : 2022-01-01 DOI: 10.14791/btrt.2022.10.e30

Joonho Byun, Moinay Kim, Sang Woo Song, Young-Hoon Kim, Chang Ki Hong, Jeong Hoon Kim

Background: Extraventricular neurocytoma (EVN) is an extremely rare neuronal neoplasm that arises outside the ventricle. The clinical implication of the heterogenous prognosis of this rare tumor has not yet been clarified. Herein, we analyzed our institutional series of EVN.

Methods: A total of eight consecutive cases were enrolled and investigated. The prognosis of EVN was analyzed and compared to that of central neurocytoma (CN).

Results: There were two male and six female patients, and the median age was 36.5 years. The median tumor size was 38 mm, and the most common location of the tumor was the frontal lobe (3, 37.5%), followed by the parietal and temporal lobes. In brain imaging, four (50%) tumors showed peritumoral edema and three (37.5%) tumors showed calcification. All patients underwent gross total resection, and two (25%) underwent adjuvant radiotherapy. The 5-year overall survival (OS) was 55.6%, and the 2-year progression-free survival (PFS) was 42.9%. The OS and PFS of EVN were poor compared to those of CN. Although EVN is a single disease entity, individual patients showed varying prognosis. One patient showed no recurrence during the 7-year follow-up period; however, another patient had a recurrence 4 months after surgery and died 2 years later.

Conclusion: EVN may be a heterogenous disease entity. Additional cases with long-term followup are needed to develop optimal management protocols.

背景:脑室外神经细胞瘤(EVN)是一种发生在脑室外的极为罕见的神经肿瘤。这种罕见肿瘤的异质预后的临床意义尚未明确。在此，我们分析了我们的机构EVN系列。方法:连续入组8例。分析EVN的预后，并与中枢神经细胞瘤(CN)进行比较。结果:男性2例，女性6例，中位年龄36.5岁。肿瘤中位大小为38 mm，最常见的肿瘤部位为额叶(3.37.5%)，其次为顶叶和颞叶。在脑成像中，4例(50%)肿瘤表现为瘤周水肿，3例(37.5%)肿瘤表现为钙化。所有患者均行大体全切除，2例(25%)行辅助放疗。5年总生存率(OS)为55.6%，2年无进展生存率(PFS)为42.9%。与CN相比，EVN的OS和PFS较差。虽然EVN是一种单一的疾病实体，但个体患者的预后不同。1例患者随访7年无复发;然而，另一名患者术后4个月复发，2年后死亡。结论:EVN可能是一种异质性疾病。需要对其他病例进行长期随访，以制定最佳的管理方案。

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