A case of unclassified high‐grade glioma with polar spongioblastoma pattern

Abstract

Primitive polar spongioblastoma was first described by Russell and Cairns in 1947. However, the polar spongioblastoma pattern is often seen in many neuroepithelial tumors, and this category was deleted in the previous World Health Organization (WHO) classification. In 2010, Nagaishi et al. reported on a case involving a neuroepithelial tumor with the typical histological pattern of polar spongioblastoma and suggested that this tumor might not be suited to any of the neuroepithelial tumors in the current WHO classification. We report on an autopsy case involving an unclassified high-grade glioma with polar spongioblastoma pattern that was very similar to the case described by Nagaishi et al. A 44-year-old man who presented with a headache exhibited a tumor of the right frontal lobe on MRI. Histological diagnosis of the tumor obtained by gross total resection was high-grade glioma, which was composed of the parallel palisading of spindle tumor cells expressing GFAP, without microvascular proliferation (MVP) and necrosis. Conventional chemoradiotherapy was performed, but the case was complicated by cerebrospinal fluid (CSF) dissemination that resulted in multiple extraneural metastases through systemic diversionary CSF shunting. Finally, the patient died approximately 13 months after the initial treatment. Both the cerebral and Douglas pouch tumors that were obtained at autopsy were diagnosed as typical glioblastomas, and they were composed of the proliferation of atypical astrocytes with MVP and pseudopalisading necrosis without the formation of rhythmic palisading. Although the histological findings were different from that of the first operation, immunohistochemical and genetic profiles demonstrated almost the same results. This tumor was not classified as a typical glioblastoma by the initial findings, but it had the nature of a glioblastoma. These findings suggest that the tumor might be classified as a new subset of glioblastoma called glioblastoma with polar spongioblastoma pattern.

Massive Calcified Cerebellar Pilocytic Astrocytoma with Rapid Recurrence : A Rare Case

“…The term "primitive polar spongioblastoma" is used for tumors not included in the new WHO classification and composed of cells with a specific palisading sequence. This pattern can be seen in PAs (e.g., the second resection specimen of our patient) 4) . Tihan and Burger 13) have defined pilomixoid astrocytoma, which is an aggressive subtype of PAs.…”

Differentiating Alzheimer’s Disease from Dementia with Lewy Bodies Using a Deep Learning Technique Based on Structural Brain Connectivity

“…This consideration was based on the similarity of the type of network and image data and which suggested that machine learning, and especially the CNN model, was suitable for the estimation of the individual brain network. 31,32 The high accuracy of the CNN model in image recognition and classification is based on three features; the convolution layer, multilayered neural network classifier part and a optimization by a back propagation method. 33,34 The convolution layer extracts the features of matrix data by multiple filters and the multilayer (deep) convolution can extract the high dimensional features and its output is transmitted to following multiple layer neural network.…”

Cerebrospinal Fluid Dissemination and Neoplastic Meningitis in Primary Brain Tumors

“…Similarly, whole-brain or skull-base radiotherapy is often administered to patients with cranial neuropathies. [199][200][201][202][203][204][205][206][207][208][209][210] Radiotherapy is indicated for patients with bulky radiographic disease because the intra-CSF administration of chemotherapy is limited by diffusion to 2 to 3 mm of penetration into the tumor nodules. In addition, involved-field radiotherapy should be employed to correct abnormalities in CSF flow because normalizing CSF flow obstruction is associated with improvements in patient outcomes.…”

“…In addition, involved-field radiotherapy should be employed to correct abnormalities in CSF flow because normalizing CSF flow obstruction is associated with improvements in patient outcomes. [199][200][201][202][203][204][205][206][207][208][209][210] Rarely is whole-neuraxis ra-diotherapy used to treat neoplastic meningitis from solid tumors because of its association with significant levels of systemic toxicity (eg, severe myelosuppression, mucositis) and because it is not curative. [199][200][201][202][203][204][205][206][207][208][209][210] Chemotherapy Among all of the therapies used to manage neoplastic meningitis, chemotherapy is the single treatment modality used to treat the whole neuraxis, administered either intrathecally or systemically.…”

“…[199][200][201][202][203][204][205][206][207][208][209][210] Rarely is whole-neuraxis ra-diotherapy used to treat neoplastic meningitis from solid tumors because of its association with significant levels of systemic toxicity (eg, severe myelosuppression, mucositis) and because it is not curative. [199][200][201][202][203][204][205][206][207][208][209][210] Chemotherapy Among all of the therapies used to manage neoplastic meningitis, chemotherapy is the single treatment modality used to treat the whole neuraxis, administered either intrathecally or systemically. [199][200][201][202][203][204][205][206][207][208][209][210] In patients with solid tumors, the intra-CSF administration of chemotherapy is the mainstay of neoplastic meningitis management, and several groups suggest that administering chemotherapy to the CSF improves outcomes in these patients.…”