Clinicopathological Study of Diffuse Type Brainstem Gliomas: Analysis of 40 Autopsy Cases

Yoshimura, Junichi; Onda, Kiyoshi; Tanaka, Ryuichi; Takahashi, Hitoshi

doi:10.2176/nmc.43.375

Cited by 78 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MRS studies of gliomas in the adult population showed that increased levels of tCho, decreased metabolite ratios of NAA to tCho (NAA/ tCho) and Cr to tCho (Cr/tCho), and increased levels of lipids are indicators of malignant degeneration. 15 -22 DIBSGs are believed to progress to higher-grade gliomas (often glioblastomas at autopsy 6,8 ), consistent with deterioration and death of 90% of patients within 2 years after initial diagnosis. 3 Therefore, our general hypothesis was that metabolic progression may parallel disease progression and could be exploited (1) to assess disease …”

Section: Discussionmentioning

confidence: 99%

Metabolism of diffuse intrinsic brainstem gliomas in children

et al. 2008

View full text Add to dashboard Cite

Progress in the development of effective therapies for diffuse intrinsic brainstem gliomas (DIBSGs) is compromised by the unavailability of tissue samples and the lack of noninvasive markers that can characterize disease status. The purpose of this study was to compare the metabolic profile of DIBSGs with that of astrocytomas elsewhere in the CNS and to determine whether the measurement of metabolic features can improve the assessment of disease status. Forty in vivo MR spectroscopy (MRS) studies of 16 patients with DIBSG at baseline and after radiation therapy were retrospectively reviewed. Control data for baseline studies of DIBSGs were obtained from 14 untreated regular and anaplastic astrocytomas. All spectra were acquired with single-voxel, short echo-time (35 ms), point-resolved spectroscopy. Absolute metabolite concentrations (mmol/kg) and lipid intensities (arbitrary units) were determined. At baseline, creatine and total choline (tCho) were significantly lower in DIBSGs than in astrocytomas elsewhere in the CNS (4.3 +/- 1.1 vs. 7.5 +/- 1.9 mmol/kg, p < 0.001; 1.9 +/- 0.7 vs. 4.2 +/- 2.6, p < 0.001). Serial MRS in individual subjects revealed increasing levels of tCho (p < 0.05) and lipids (p < 0.05) and reduced ratios of N-acetylaspartate, creatine, and myoinositol relative to tCho (all p < 0.01). Metabolic progression defined by increased tCho concentration in serial MRS preceded clinical deterioration by 2.4 +/- 2.7 months (p < 0.04). Low tCho of DIBSG at baseline is consistent with low proliferative tumors. Subsequent metabolic changes that have been associated with malignant degeneration preceded clinical deterioration. MRS provides early surrogate markers for disease progression.

show abstract

Section: Discussionmentioning

confidence: 99%

Metabolism of diffuse intrinsic brainstem gliomas in children

et al. 2008

View full text Add to dashboard Cite

show abstract

“…When tissue from diagnostic biopsy or postmortem examination is obtained, the majority of these neoplasms are found to be high-grade astrocytomas. 14,15 High-grade astrocytomas, in particular glioblastoma multiforme, are among the most vascularized human tumors. 16 Histologically identical neoplasms arising outside the brainstem in children and adults have an increased predisposition to develop intratumoral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma

Broniscer

Laningham

Kocak

et al. 2006

Cancer

View full text Add to dashboard Cite

BACKGROUNDChildren with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG.METHODSAll available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10‐year interval (1992–2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow‐up, all patients had died of tumor progression.RESULTSThe authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6‐month and 12‐month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% ± 5.5% and 24.4% ± 6.5%, respectively. The same estimates for symptomatic cases were 8.9% ± 4% and 17.8% ± 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas.CONCLUSIONSAlthough IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event. Cancer 2006. © 2006 American Cancer Society.

show abstract

“…At autopsy, most lesions have progressed to higher-grade tumors such as anaplastic astrocytoma or glioblastoma. 4,[15][16][17][18][19] Therefore, biochemical changes that are associated with malignant transformation can be studied by serial MR spectroscopy in these tumors. We observed metabolic changes indicative of malignant transformation, reported elsewhere, 20 that have been also previously reported by Laprie et al 21 and Thakur et al 22 for this patient population.…”

Section: Citrate In Pediatric Brain Tumorsmentioning

confidence: 99%