Brain tumor research and treatment最新文献

We report a rare and diagnostically challenging case of a 39-year-old male patient who presented with symptoms of dizziness and headaches, without any focal neurological symptoms. Initial imaging studies suggested a germ cell tumor, and an endoscopic biopsy led to a preliminary diagnosis of a pineal parenchymal tumor of intermediate differentiation. However, histological evaluation following surgical resection revealed the final diagnosis to be an ectopic pituitary neuroendocrine tumor (PitNET), a condition that is exceedingly rare. Ectopic PitNETs are uncommon tumors that develop outside the normal anatomical location of the pituitary gland. Their atypical presentation often leads to misdiagnosis as other intracranial neoplasms. This case highlights the diagnostic challenges posed by ectopic PitNETs and contributes to the limited literature on this rare condition. It underscores the importance of maintaining a broad differential diagnosis in patients presenting with atypical intracranial neoplasms.

This paper discusses a rare case of a 49-year-old female diagnosed with a central nervous system-isolated neoplasm with histiocytic features, classified as histiocytic neoplasm, not otherwise specified (NOS). Despite comprehensive histopathological and genetic studies, accurately diagnosing the case proved challenging. Initial surgical findings and frozen biopsy suggested a low-grade glioma; however, subsequent immunohistochemistry and genetic analysis excluded known histiocytic subtypes such as ALK-positive histiocytosis and Erdheim-Chester disease. The patient's condition improved following occupational rehabilitation therapy for right upper motor weakness, as well as anticonvulsant and radiation therapy, and her neurological condition remains stable. This case underscores the diagnostic challenges of Histiocytic Neoplasms and the necessity for interdisciplinary collaboration and sophisticated diagnostic techniques.

Intracranial chondroma is a benign tumor arising from the rests of embryonic cartilages in the dura or dural folds, choroid plexus or the brain parenchyma. It is rare intracranially, but when it does occur, it is predominantly located at the skull base. Among the cohort of intracranial chondroma, the para-falcine location is the rarest. We report a challenging diagnosis and successful management of this rare intracranial para-falcine chondroma in a 53-year-old female patient.

Background: Advancements in surgery, chemotherapy, and radiotherapy have improved survival for brain tumor patients, increasing the risk of second primary tumors (SPTs) among long-term survivors. This study examines the types and risks of SPTs in brain tumor patients presenting at a tertiary care hospital.

Methods: This single-center, retrospective study explored occurrences of SPTs following primary brain tumors and occurrences of brain tumors as SPTs following primary extra neural tumors. A total of 41 patients were included and analyzed presenting with histologically confirmed SPTs between 1st January 2000 and 31st December 2020.

Results: The study included 41 patients with SPTs, primarily female (65.9%). Of these, 20 patients (48.7%) developed SPTs after a primary brain tumor, while 21 patients (51.2%) developed brain tumors as SPTs after extra-neural tumors. Among patients who developed SPTs after brain tumors (n=20), meningioma (n=8, 40.0%) and pituitary adenoma (n=6, 30.0%) were the most prevalent first primary tumors (FPTs) while breast tumors predominated as SPTs (n=4, 20.0%). Survival analysis indicated younger mean age (44.5 years) for patients marked alive, compared to those marked deceased (57.0 years) and those with unknown outcomes (63.0 years).

Conclusion: Based on this retrospective analysis, the median age at diagnosis was 44.5 years, with a considerable number of patients (36.6%) having uncertain outcomes at follow-up due to incomplete records. These findings highlight the need for improved follow-up data management to better assess long-term survival in patients with SPTs following brain tumors.

Background: Cognitive decline is commonly seen in brain tumor (BT) patients and is associated with a worsened prognosis. Cognitive rehabilitation (CR) for cancer-related cognitive dysfunction has been widely studied for non-central nervous system cancers; however, recent emerging research has commenced documenting CR strategies for BT patients and survivors. Our objective was to review the current literature on various CR modalities in patients and BT survivors.

Methods: The review was conducted in accordance with the PRISMA guidelines. The studies on CR were searched across 3 databases using a predefined search strategy. After removing duplicates, performing initial and full-text screenings, and applying inclusion criteria, relevant articles were selected. The demographic details, CR technique, cognitive tasks/tests administered, cognitive functions assessed, follow-up time, and outcomes of the intervention were assessed.

Results: A total of 15 studies were included in the review. Neuropsychologist-guided training sessions to improve memory, attention, and executive functioning are effective in improving the mentioned domains. Younger and more educated patients benefited the most. Holistic mnemonic training and neurofeedback were not shown to affect overall cognitive functioning. Computer-based training programs showed improvements in executive functions of pediatric BT survivors, however, feasibility studies showed conflicting results. Aerobic exercises improved executive functions and decreased symptoms of the tumor. Both yoga and combined aerobic and strength training improved overall cognitive functioning. Active video gaming may improve motor and process skills; however, no effect was seen on cognitive functioning.

Conclusion: Neuropsychologic training, computer-based programs, and physical exercise have been found effective in improving or preventing decline in cognitive functions of BT patients. Given the limited trials and methodological variations, a standardized CR program cannot be established at present. Ongoing trials are expected to provide valuable data in the near future.

This case introduces the differential diagnosis of a well-enhancing lesion in the prepontine cistern of a 55-year-old female patient who was diagnosed with recurrent metastatic breast cancer. The patient was diagnosed with breast cancer 11 years ago and underwent a mastectomy and subsequent adjuvant therapy. Tamoxifen had been given for 5 years, and the treatment was completed. Five years after, she found a lung nodule on her routine chest X-ray examination. Based on her past medical history, systemic cancer work-up was done and it revealed multiple lesions in T10 vertebra, lungs, and mediastinal lymph nodes. Trans-bronchial needle aspiration was performed and the biopsy was a metastatic breast cancer. Brain MRI was taken as she was complaining of headache and it showed a well-defined, ovoid enhancing 0.9-cm nodule in the right prepontine cistern. Neuro-oncology tumor board evaluated the lesion as more likely to be an asymptomatic neurogenic tumor rather than metastasis based on radiological features including brainstem surfaced location, slightly high signal intensity on T2-weighted image and no diffusion restriction. To rule out leptomeningeal metastasis, a serial cerebrospinal fluid cytology examination (×3) was done and negative for malignant cells. Follow-up brain MRIs of 2 and 9 months showed no significant changes in the pre-pontine enhancing lesion.

Background: Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial tumor with Central Nervous System (CNS) World Health Organization (WHO) grade II or III classification. Due to its rarity, there is no clear census on treatment. The purpose of this study is to identify the optimal treatment plan focused on extending overall survival (OS).

Methods: This is an institutional case series with review of the literature. Fifty-three publications were analyzed. Only cases with histological diagnosis of PTPR were included. Data collected included demographics, treatment modalities, disease progression, and OS.

Results: The analysis included 105 patients from the literature and 3 new cases (54 female, 50%) with an average age of 33.1 years (range 1-73 years). The average lesion size was 26.4 mm (range 5-50 mm) in longest axis. All patients underwent an initial resection. There were 46 cases of surgery alone. The remaining cases received adjuvant therapy including radiation (RT), stereotactic radiosurgery (SRS), chemotherapy (CT), or RT and CT. The average follow-up was 61.4 months (range 1-240 months). OS at 1 year was 96.9%, at 5 years was 87.5%, and at 10 years was 80.2%. Overall progression-free survival (PFS) was 57.4%. Statistical significance was observed in PFS in the surgery plus SRS group and surgery plus CT and RT group. Surgery with SRS had the best PFS (75%), and OS at 1 year (100%) and 5 years (88.9%). Surgery with CT and RT had the best OS at 10 years (85.7%).

Conclusion: We describe a case series and literature review of PTPR to help guide the most effective treatment strategies for this rare disease entity. We recommend surgery followed by SRS as the treatment of choice because of its best PFS and 5-year survival rates. We would also recommend adding chemotherapy in the event of disease progression or recurrence as adjuvant radiation and chemotherapy provided the best 10-year survival.

Background: Among gliomas, the most common primary malignant brain tumor, incidental gliomas account for 2.5%-5% of cases. The controversy over whether to pursue immediate treatment or adopt a wait-and-see approach remains, and more molecular and immunological evidence is needed for definitive treatment decisions.

Methods: Total RNA sequencing (RNA-seq) data and single cell RNA sequencing (scRNA-seq) data were retrospectively analyzed to compare the molecular and immunological tumor microenvironment differences between incidental glioma and symptomatic glioma samples. These were classified using symptom data from The Cancer Genome Atlas (TCGA) and public dataset.

Results: RNA-seq analysis of the GBMLGG dataset identified 343 genes upregulated in symptomatic glioma and 118 in incidental glioma, with 104 common genes upregulated in symptomatic glioma across both the TCGA and Chinese Glioma Genome Atlas (CGGA) datasets. Enrichment analysis revealed that these 104 genes in symptomatic glioma were significantly associated with immunological pathways. scRNA-seq analysis of glioma revealed 11 cell types, including T cells, myeloid cells, and oligodendrocytes, with the tumor necrosis factor (TNF) signaling pathway strongly influencing other cell types, particularly myeloid cells. Enrichment and survival analyses showed that TNF signaling is associated with temozolomide resistance and poorer prognosis in glioma patients.

Conclusion: The findings suggest that symptomatic glioma enhances inflammatory responses linked to poor prognosis and chemoresistance. This supports the hypothesis that immediate treatment of incidental glioma may improve patient outcomes over a wait-and-see approach.

Background: This preliminary study evaluates the safety and efficacy of CyberKnife radiosurgery (CKRS) for large-volume meningiomas (≥10 cm³), where surgical options may be limited due to tumor location or patient health conditions.

Methods: We retrospectively analyzed 18 patients with meningiomas treated with CKRS at Gyeongsang National University Hospital between 2010 and 2020. Tumor control and survival rates were evaluated, with follow-up imaging performed regularly.

Results: CKRS achieved a 5-year overall survival rate of 92.3% and a 5-year tumor control rate of 93.8%. Symptomatic peritumoral edema occurred in 61.1% of patients, with 16.7% requiring surgical intervention.

Conclusion: CKRS appears to be a promising option for patients with large meningiomas, showing good tumor control and manageable complications. Further studies with larger cohorts are necessary to confirm these findings.