Histopathological implications of ventricle wall 5-aminolevulinic acid-induced fluorescence in the absence of tumor involvement on magnetic resonance images

Moon, Ju Hyung; Kim, Se Hoon; Shim, Jin‐Kyoung; Roh, Tae Hoon; Sung, Kyu Bo; Lee, Ji Hyun; Park, Junseong; Choi, Jihun; Kim, Eui Hyun; Kim, Sun Ho; Kang, Seok‐Gu; Chang, Jong Hee

doi:10.3892/or.2016.4881

Cited by 21 publications

(10 citation statements)

References 47 publications

(46 reference statements)

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“…In pediatric patients, these two regions are well known for their preponderance to harbor diffuse gliomas [36] . We also found tumor cell accumulation in the periventricular areas, an observation that fits well with neurosurgical [37] and oncological [38] clinical data. In contrast, few tumor cells invaded the hippocampus and certain limbic structures.…”

Section: Discussionsupporting

confidence: 88%

Patterns of Invasive Growth in Malignant Gliomas—The Hippocampus Emerges as an Invasion-Spared Brain Region

et al. 2018

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BACKGROUND: Widespread infiltration of tumor cells into surrounding brain parenchyma is a hallmark of malignant gliomas, but little data exist on the overall invasion pattern of tumor cells throughout the brain. METHODS: We have studied the invasive phenotype of malignant gliomas in two invasive mouse models and patients. Tumor invasion patterns were characterized in a patient-derived xenograft mouse model using brain-wide histological analysis and magnetic resonance (MR) imaging. Findings were histologically validated in a cdkn2a−/− PDGF-β lentivirus-induced mouse glioblastoma model. Clinical verification of the results was obtained by analysis of MR images of malignant gliomas. RESULTS: Histological analysis using human-specific cellular markers revealed invasive tumors with a non-radial invasion pattern. Tumors cells accumulated in structures located far from the transplant site, such as the optic white matter and pons, whereas certain adjacent regions were spared. As such, the hippocampus was remarkably free of infiltrating tumor cells despite the extensive invasion of surrounding regions. Similarly, MR images of xenografted mouse brains displayed tumors with bihemispheric pathology, while the hippocampi appeared relatively normal. In patients, most malignant temporal lobe gliomas were located lateral to the collateral sulcus. Despite widespread pathological fluid-attenuated inversion recovery signal in the temporal lobe, 74% of the “lateral tumors” did not show signs of involvement of the amygdalo-hippocampal complex. CONCLUSIONS: Our data provide clear evidence for a compartmental pattern of invasive growth in malignant gliomas. The observed invasion patterns suggest the presence of preferred migratory paths, as well as intra-parenchymal boundaries that may be difficult for glioma cells to traverse supporting the notion of compartmental growth. In both mice and human patients, the hippocampus appears to be a brain region that is less prone to tumor invasion.

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Section: Discussionsupporting

confidence: 88%

Patterns of Invasive Growth in Malignant Gliomas—The Hippocampus Emerges as an Invasion-Spared Brain Region

et al. 2018

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“…e phenomenon of ventricle wall 5-ALA-induced fluorescence has been well described [44] and this may serve as a confounder when operating in the brainstem/fourth ventricle. [56] In four of the six cases, in which we did enter the fourth ventricle as part of our surgical approach to the brainstem lesion, we did observe very vague fluorescence of the ventricular floor/ependyma beyond the area of solid tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Given the eloquence of this area, we could not perform biopsies in this region to determine if these areas of enhancement did indeed harbor tumor cells or other reactive changes as found in the 5-ALA-induced fluorescing ependyma of the lateral ventricles. [44,50,62,82] Unlike supratentorial malignant tumors, for which the extent of tumor resection (EOR) has a predictive value for outcome, [11,49,75,76] the goal for BSG will always be maximal safe resection, seeking a balance between GTR and postoperative neurological function. [87] We attained a GTR in 3 (37%) cases, NTR in 3 cases (37%), and STR in 2 cases (25%).…”

Section: Discussionmentioning

confidence: 99%

5-aminolevulinic acid-guided surgery for focal pediatric brainstem gliomas: A preliminary study

Labuschagne¹

2020

Surgical Neurology International

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Background: There is a growing body of literature supporting the use of 5-aminolevulinic acid (5-ALA) in the pediatric population, however, its use is still considered “off label” in this setting. In this retrospective study, we report our experience using 5-ALA in pediatric patients with focal brainstem gliomas (BSGs). Methods: Patients younger than 16 years presenting with a newly diagnosed BSG that was focal in nature were considered suitable for treatment with 5-ALA-assisted surgery. Exclusion criteria included MRI features suggestive of a diffuse intrinsic pontine glioma. A single dose of 5-ALA was administered preoperatively. Intraoperative fluorescence was recorded as “solid,” “vague,” or “none.” The effectiveness of the fluorescence was graded as “helpful” or “unhelpful.” Results: Eight patients underwent 5-ALA-assisted surgery. There were four tumors located in the pons, two midbrain tumors, and two cervicomedullary tumors. Histological analysis demonstrated three diffuse astrocytomas, three pilocytic astrocytomas, and two anaplastic astrocytomas. Solid fluorescence was found in three of the eight cases, vague fluorescence was found in two cases, and no fluorescence was found in three cases. Fluorescence was useful in 3 (37%) cases. No patients experienced any complications attributable to the administration of the 5-ALA. Conclusion: With a total fluorescence rate of 62.5% but a subjectively assessed “usefulness” rate of only 37.5%, the role of 5-ALA in BSG surgery is limited. Given the toxicological safety, however, of the agent, caution is perhaps needed before dismissing the use of 5-ALA entirely.

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“…The areas that were stained brightly by fluorescence were excised with the help of a microscope so that high fluorescence uptake specimens could be included. Every fresh specimen was placed into a sterile centrifuge tube (SPL Life Sciences Co., Pocheon, Korea) on ice and weighed on the same electronic precision balance (Sartorius TE4101-L; Sartorius Weighing Technology GmbH, Göttingen, Germany) within 1 h. 24 25 26 27 28 29 30 31 …”

Section: Methodsmentioning

confidence: 99%

Influence of the Amount of Fresh Specimen on the Isolation of Tumor Mesenchymal Stem-Like Cells from High-Grade Glioma

et al. 2021

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Purpose A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

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Histopathological implications of ventricle wall 5-aminolevulinic acid-induced fluorescence in the absence of tumor involvement on magnetic resonance images

Cited by 21 publications

References 47 publications

Patterns of Invasive Growth in Malignant Gliomas—The Hippocampus Emerges as an Invasion-Spared Brain Region

Patterns of Invasive Growth in Malignant Gliomas—The Hippocampus Emerges as an Invasion-Spared Brain Region

5-aminolevulinic acid-guided surgery for focal pediatric brainstem gliomas: A preliminary study

Influence of the Amount of Fresh Specimen on the Isolation of Tumor Mesenchymal Stem-Like Cells from High-Grade Glioma

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