著者

永根 基雄

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.22, no.3, pp.8-20, 2015-12-26 (Released:2015-12-26)

参考文献数

51

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Gliomas represent the most frequent malignant neoplasms that arise in the central nervous system. Astrocytic tumors comprise 78% of all gliomas and their histological grade (I – IV) is defined according to the current WHO classification. Although the prognosis of grade IV glioblastoma (GBM), the most malignant form of gliomas, is still detrimental, there have been progress in the management of these tumors since a number of confirming phase III clinical trials have been conducted in the last decade to provide with standard of care(SOC) therapies. Here I will focus on such pivotal trials for astrocytic tumors and discuss issues that need to be solved in the future studies.

著者

中田 光俊

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.23, no.3, pp.1-8, 2017-02-08 (Released:2017-02-08)

参考文献数

27

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Drug repositioning refers to the discovery of new indications for approved or failed drugs and the application of the newly identified drugs to the management of diseases other than the drug’s intended disease. It reduces the risk of developmental failure, cost, and time of development. In this review, candidate drugs identified so far based on drug repositioning for malignant glioma are summarized.

著者

浅野 研一郎

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.23, no.1, pp.1-13, 2016-04-28 (Released:2016-04-28)

参考文献数

72

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Needless to say, pediatric cancer therapy, especially leukemia, had remarkably progressed and successful changed in last century. However, the chemo-radiation therapy of diffuse intrinsic pontine glioma (DIPG) has still been behind the success story of pediatric cancer therapy. Although, neurosurgical pioneers had tried a lot of new project to cure pediatric DPIG, nothing of new effective protocols have been accepted with satisfactory long term survival. So, we review the pediatric DIPG therapies of neurosurgical pioneers, reconsider temozolomide based protocol, discuss to need brain biopsy, and look for the new direction of pediatric DIPG in the near future.

著者

立花 修

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.22, no.2, pp.12-21, 2015-09-12 (Released:2015-09-12)

参考文献数

53

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Rathke cleft cysts (RCCs) are benign cystic lesions of the sella that arise from remnants of the embryonic Rathke residual pouch. RCCs are common incidental findings in 4-33% of autopsy cases and on imaging, and most remain asymptomatic. However, RCCs can become sufficiently large and rupture to cause severe headache, visual field defects and hypothalamic pituitary dysfunctions. Asymptomatic RCCs are typically followed by serial imaging, while symptomatic RCCs are managed by surgical decompression. Although a headache and the visual disturbance are improved by surgical treatment, the pituitary insufficiency is not often improved. It is thought that an irreversible disorder due to the local chronic inflammation involves the pituitary gland. MRI reveals well-demarcated homogenous lesions with variable intensity that is highly dependent on the protein concentration of cyst contents, which can range from clear, CSF-like fluid to thick, mucoid material. Rates of recurrence after surgical treatment range from 11 to 18 % in large series, and higher rates of recurrence are associated with inflammation and reactive squamous metaplasia in the cyst wall. As the natural history of RCCs remains unclear and the mechanism of progression of these cysts is not understood, it might be difficult to determine when we should do the intervention of the surgery.

著者

河本 圭司

出版者

近畿脳腫瘍病理検討会

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.19, no.1, pp.45-48, 2010-12-01 (Released:2014-04-28)

著者

寺本 明

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.22, no.2, pp.1-6, 2015-09-12 (Released:2015-09-12)

参考文献数

28

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The first transcranial surgery of the pituitary tumor was performed by Horsley V in 1889. In 1907 Scholoffer H succeeded in the transsphenoidal surgery (TSS) for a pituitary tumor of an acromegalic patient via the superior nasal approach. The prototype of TSS has been established by Cushing H (sublabial & submucosal approach) and Hirsh O(endonasal & submucosal approach) in 1910.Then, in 1960’s Hardy J had developed TSS using X-ray fluoroscopy and surgical microscope. Since then, with the rapid progress of endocrinology and imaging diagnoses such as CT scan and MRI, TSS has grown and flourished for several decades. In 1990s the endoscope has been introduced to TSS and has rapidly spread in terms of its wider and clearer operative view. Now the endoscopic TSS has been used not only for the pituitary surgery, but also the midline skull base surgery.

著者

廣瀬 雄一

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.23, no.2, pp.13-21, 2016-09-16 (Released:2016-09-16)

参考文献数

32

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Gliomas have been diagnosed according to the histological classification published by the World Health Organization (WHO). However, recent advance in tumor genetics validated clinical value of genetic analysis in glioma management, and genetic classification is considered to have advantage to histological classification in predicting the patients’ outcome. In 2016, WHO revised classification of tumors of the central nervous system, and remarkable revision was made in various tumors. Of them, classification of diffuse glioma of lower grade was advanced in practical manner. Those tumors are classified by key genetic aberrations including mutation of isocitrate dehydrogenase 1/2 gene (IDH1/2) and codeletion of chromosomal arms 1p and 19q. Mutation in TP53, ATRX and promoter of TERT are helpful in subgrouping the tumors.In this review, biological aspects of genetic aberrations applied to 2016 WHO classification are discussed to help understanding of oncology in relation with management for grade II-III diffuse gliomas.

著者

中村 光利 山田 修一 松田 良介 杉本 正 中瀬 裕之

出版者

Kinki Brain Tumor Pathology Conference

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.19, no.1, pp.12-18, 2010-12-01 (Released:2014-04-28)

参考文献数

25

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The current practice of relying solely on microscopic examinations for histological classification of gliomas and, consequentially, determination of optimal treatment, appears to be insufficient. As a result of the increasing use of molecular markers in tumor classification, there is an emerging emphasis in the genetic profiles of distinct subtypes of glioma. These subtypes of glioma constitute distinct disease entities that evolve through different genetic pathways, and are likely to differ in prognosis and response to therapy. Status of O6-methylguaninemethyltransferase(O6-MGMT) gene is associated with the resistance to temozolomide(TMZ). We have previously found methylation or expression mosaicism of O6-MGMT in gliomas, resulting in problems on tumor sampling and respose to TMZ. An assessment of O6-MGMT methylation mosaicism in heterogeneous glioma may provide a more accurate assessment for the response to TMZ. Oligodendroglioma is recognized as a particular subtype of gliomas that shows remarkable response to chemotherapy(procarbazine + CCNU + vincristine(PCV), making their correct diagnosis important. Loss of heterozygosity(LOH) on chromosomes 1p and 19q is correlated with sensitivity to PCV chemotherapy with increased survival in anaplastic oligodendroglioma cases(WHO grade III). This article reviews biological and molecular approaches to glioma classification that have the potential to increase the efficacy of treatments for these tumors.

著者

篠山 隆司 田中 一寛 西原 賢在 長嶋 宏明 甲村 英二

出版者

近畿脳腫瘍病理検討会

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.23, no.3, pp.09-15, 2017-02-08 (Released:2017-02-08)

参考文献数

28

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The diagnosis of primary central nervous system lymphoma (PCNSL) is commonly obtained via a stereotactic biopsy. The use of radiographic images (CT, MRI, and PET) frequently fails to distinguish PCNSLs from other brain diseases. Flow-cytometry based and cytological analyses of cerebrospinal fluid (CSF) are useful for the evaluation of leptomeningeal PCNSLs, however, these tests are usually insensitive to focal PCNSLs.Recently, several useful diagnostic biomarkers in CSF for PCNSL were reported. Among these CSF biomarkers, CSF interleukin-10 (IL-10) and C-X-C motif ligand 13 (CXCL13) are the most promising useful diagnostic biomarkers for PCNSLs. Both CSF IL-10 and CXCL13 have high sensitivity and specificity for diagnosing in PCNSL patients, and moreover, the combination IL-10 and CXCL13 is quite highly specific tool for diagnosis of PCNSL. However, there are several problems in these markers. Our goal in this review is to highlight and update the diagnostic biomarkers in CSF for the patients with PCNSLs, and describe future directions.

著者

沖田 典子 丸野 元彦 吉澤 秀憲 鈴木 強

出版者

近畿脳腫瘍病理検討会

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.20, no.1, pp.50-53, 2014 (Released:2014-05-07)

参考文献数

19

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Glioblastoma is the most common and malignant primary brain tumor. Factors such as age, Karnofsky performance score (KPS), and extent of resection have been shown to be prognostic for survival in newly diagnosed malignant glioma patients. O6-methylguanine DNA-methyltransferase (MGMT) promoter methylation status is also a prognostic factor in newly diagnosed glioblastoma patients. IDH1 mutation detected by direct sequencing or by immunochemistry of its more frequent form has been reported to be a strong and independent prognostic factor in gliomas whatever the grade. 1p/19q deletions are prognostic factors in oligodendroglial tumors and predict better survival after both chemotherapy and radiotherapy. Expression of immunohistochemical staining for α-Internexin was reported to correlate with 1p/19q deletions.We have two glioblastoma long term survivors and these cases showed similar clinical and radiological presentation with other glioblastoma cases who relapsed and survived less than a year. We investigated immunohistochemical staining for IDH1-R132H, MGMT and α-Internexin in these two cases and all stainings were negative. We should have more attention for other prognostic factors in glioblastoma long term survivors.

著者

森内 秀祐

出版者

近畿脳腫瘍病理検討会

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.18, no.1, pp.1-6, 2009-11-01 (Released:2014-04-22)

参考文献数

8

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We experienced 7 cases of immunosuppressed patients with enhancing intracerebral lesions on CT and MRI at our hospital in the period between 2004 and 2008. The cases included 6 patients infected with HIV and 1 rheumatoid arthritis patient. Patients aged between 40 and 56, and they consisted of 6 males and 1 female. HIV patients are generally first treated for HIV associated benign diseases or infectious diseases, including Cryptococcus infections, fungal infections, and so on. When these treatments are not effective, a differential diagnosis for malignant lymphoma is required before considering radiation therapy and chemotherapy. We performed open biopsies on all cases, and used a computer aided navigation system to assist in our minimal invasive surgery. The average total volume of specimens attained by biopsy was about 1cm3 and enough to undertake an immunohistochemical study, a flow cytometric study, and a gene translication study of gamma immunoglobulin genes. The final diagnosis of the 7 cases were diffuse large B cell lymphoma, adult T cell lymphoma, toxoplasmosis, a lymphoproliferative state due to an EB virus infection, and immuno-reconstruction syndrome after treatments for HIV. Despite the fact that CT and MRI image studies were similar between patients, final diagnosis differed and included malignant diseases. In conclusion, we consider it difficult to make an accurate diagnosis of CT and MRI enhancing intracerebral lesions in immunosuppressed patients, and regard it as very important to undertake open biopsies to make a final diagnosis and to differentiate between a variety of disorders in such patients.