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Cancer Reports (Hoboken, N.J.) Jan 2024Lifestyle is associated with meningioma risk in the general population.
BACKGROUND
Lifestyle is associated with meningioma risk in the general population.
AIMS
We assessed longitudinal associations between lifestyle-associated factors and subsequent meningiomas in childhood cancer survivors.
METHODS AND RESULTS
Childhood cancer survivors age ≥18 years in the St. Jude Lifetime Cohort Study were evaluated for body composition, self-reported physical activity, cardiopulmonary fitness, muscle strength, smoking, and alcohol consumption at baseline. Time to first meningioma analyses were performed, adjusted for sex, age at diagnosis and baseline assessment, treatment decade, and childhood cancer treatment exposures. The study included 4,072 survivors (47% female; [mean (SD)] 9 (6) years at diagnosis; 30 (8.5) years at the start of follow-up, with 7.0 (3.3) years of follow-up). 30% of the participants were survivors of acute lymphoblastic leukemia and 29% of the participants had received cranial radiation. During follow-up, 90 participants developed ≥1 meningioma, of whom 73% were survivors of acute lymphoblastic leukemia, with cranial radiation being the strongest risk factor (relative risk [RR] 29.7, 95% confidence interval [CI] 10.6-83.2). Muscle strength assessed by knee extension was associated with a lower risk of developing a meningioma in the adjusted analyses (RR 0.5, 95% CI 0.2-1.0, p = 0.04 for quartiles 3-4 vs. 1). No other lifestyle-associated variable was associated with subsequent meningioma.
CONCLUSION
Independent of cranial radiation, muscle strength was associated with a lower risk of developing a subsequent meningioma in childhood cancer survivors.
Topics: Humans; Child; Female; Adolescent; Male; Meningioma; Cohort Studies; Cancer Survivors; Life Style; Meningeal Neoplasms; Precursor Cell Lymphoblastic Leukemia-Lymphoma
PubMed: 38009808
DOI: 10.1002/cnr2.1944 -
International Journal of Surgery Case... Dec 2023Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for...
INTRODUCTION
Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for safe transsphenoidal surgeries because of nearby vital structures. They exhibit variable pneumatization and often have an intersinus septum. This case emphasizes the importance of understanding sphenoid sinus anatomy, particularly in the context of transsphenoidal surgeries. It also introduces a novel case involving a congenital roof defect, previously unreported in medical literature.
CASE PRESENTATION
A 52-year-old male presented with left cheek swelling that progressed to the eyelid, accompanied by low visual acuity, nasal symptoms, and a high temperature. Clinical examination revealed purulent discharge. A CT scan indicated opacity in the left maxillary sinus and a roof defect in the left sphenoid sinus. However, endoscopic surgery revealed the sphenoid sinus to be normal. This indicates that the defect is congenital. A biopsy from the maxillary sinus lesion confirmed lymphoma, and he was sent to the oncology hospital. There was no extension of the maxillary sinus lesion into the sphenoid sinus. This unique case had no history of drainage, taste issues, meningitis, or pituitary surgery.
DISCUSSION
The complete absence of the sphenoid sinus roof is a unique and rare anatomical anomaly with significant implications for surgical procedures. Transsphenoidal surgery, which benefits from endoscopic advancements, provides enhanced visualization but also poses risks due to the proximity to critical structures. Pneumatization of the sphenoid sinus typically reaches maturity during adolescence, with individual variations in extent, Septations, extensions, and asymmetry are common in sphenoid sinus anatomy. This underscores the need for surgeon awareness and adjusted surgical approaches in such rare instances.
CONCLUSIONS
We emphasize the importance of a thorough anatomical understanding through precise radiological study before any sinus surgery due to the possibility of unexpected anatomical abnormalities.
PubMed: 38006739
DOI: 10.1016/j.ijscr.2023.109089 -
Seminars in Neurology Dec 2023Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a... (Review)
Review
Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a comprehensive overview of the current understanding of CNSL encompassing its epidemiology, pathophysiology, clinical presentation, diagnosis, treatment modalities, and prognosis. Although the main focus is on primary CNS lymphoma (PCNSL), ocular lymphoma, primary leptomeningeal lymphoma, and secondary CNS lymphoma are also discussed. The pathobiology of CNSL involves the infiltration of malignant lymphocytes within the CNS parenchyma or leptomeninges. Various risk factors and immunological mechanisms contribute to its development, including immunodeficiency states, chronic inflammation, and genomic alterations. Accurate diagnosis is crucial for appropriate management, given the heterogeneous clinical presentation. The neuroimaging, systemic imaging, and other modalities for diagnosis and evaluation for extent of disease involvement will be discussed. Additionally, the importance of histopathological examination, cerebrospinal fluid (CSF) analysis, and molecular testing in confirming the diagnosis and guiding treatment decisions are highlighted. The treatment landscape for CNSL has evolved significantly. Therapeutic approaches encompass a multimodal strategy combining high-dose methotrexate-based chemotherapy, consolidation with whole-brain radiation therapy, and high-dose chemotherapy with stem cell rescue. Recent advancements in targeted therapies and immunomodulatory agents offer promising avenues for future treatment options. We review the clinical outcomes and prognostic factors influencing the survival of CNSL patients, including age, performance status, disease stage, and genetic abnormalities.
Topics: Humans; Brain Neoplasms; Cranial Irradiation; Lymphoma, Non-Hodgkin; Lymphoma; Central Nervous System Neoplasms; Central Nervous System
PubMed: 37995744
DOI: 10.1055/s-0043-1776783 -
Neurology India 2023Acute lymphoblastic leukaemia/lymphoma (ALL) is a systemic disease which primarily involves bone marrow or lymphoid organs. Extranodal presentation of ALL is uncommon,... (Review)
Review
Acute lymphoblastic leukaemia/lymphoma (ALL) is a systemic disease which primarily involves bone marrow or lymphoid organs. Extranodal presentation of ALL is uncommon, and ALL presenting as a dural mass is exceedingly rare. Here we present a case of primary dural B-cell ALL which was preoperatively diagnosed as meningioma on clinico-radiological grounds. A 27-year-old female patient presented with left hemicranial headache for one month's duration along with progressive vision loss of in both eye and altered behaviour. Contrast enhanced magnetic resonance imaging (CE-MRI) suggest dural based mass with dural tail sign. Histopathological examination of the resected specimen revealed B-cell ALL. Further systemic investigations didn't suggest any peripheral blood, bone marrow or lymph node involvement. To the best of our knowledge, only two cases of primary dural ALL have been reported in the literature so far. This report highlights the diagnostic difficulty in extramedullary precursor lymphoid neoplasm.
Topics: Female; Humans; Adult; Meningioma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lymphoma; Radiography; Meningeal Neoplasms
PubMed: 37929440
DOI: 10.4103/0028-3886.388108 -
Der Nervenarzt Feb 2024Primary central nervous system lymphomas (PCNSL) are rare highly aggressive diffuse large B cell non-Hodgkin lymphomas confined to the brain, meninges, the spinal cord... (Review)
Review
Primary central nervous system lymphomas (PCNSL) are rare highly aggressive diffuse large B cell non-Hodgkin lymphomas confined to the brain, meninges, the spinal cord and the eyes. Although the implementation of high-dose methotrexate-based chemotherapy has significantly improved the prognosis of PCNSL during the last decades, about one third of patients show refractory disease and about half of the patients eventually relapse after having achieved complete response. This highlights the need for novel treatment strategies. The most promising progress has been made in the field of molecular targeted therapy that interferes with the oncogenic signaling pathways of PCNSL. These include inhibitors of Bruton tyrosine kinase and inhibitors of the PI3K/mTOR signaling pathway. In addition, the thalidomide analogues lenalidomide and pomalidomide, which belong to the class of immunomodulators, show efficacy in the treatment of PCNSL. As immune evasion appears to play a relevant pathogenetic role in PCNSL, immunotherapies in the treatment of PCNSL are the subject of intensive research. Promising initial clinical data are available for both immune checkpoint inhibitors and cellular immunotherapy with chimeric antigen receptor (CAR) T cells. Before the widespread clinical application of these novel therapies, the efficacy needs to be confirmed in larger prospective studies. Despite high response rates, targeted therapies and immunotherapy often fail to achieve lasting tumor control. Therefore, novel approaches are currently being investigated in combination protocols.
Topics: Humans; Lymphoma, Non-Hodgkin; Prospective Studies; Neoplasm Recurrence, Local; Lymphoma; Central Nervous System; Central Nervous System Neoplasms; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37910181
DOI: 10.1007/s00115-023-01561-w -
The International Journal of... Oct 2023This study presents a comprehensive analysis of the clinical characteristics of 31 patients exhibiting cerebrospinal fluid (CSF) and/or serum positivity for GFAP-IgG,...
OBJECTIVE
This study presents a comprehensive analysis of the clinical characteristics of 31 patients exhibiting cerebrospinal fluid (CSF) and/or serum positivity for GFAP-IgG, with a specific emphasis on 24 cases demonstrating only GFAP-IgG positivity. The investigation thoroughly evaluates their clinical, radiological, and laboratory features, as well as treatment responses, with the objective of offering clinicians potential diagnostic and therapeutic approaches.
METHODS
A total of 31 patients with GFAP-IgG in the CSF and/or serum were registered between August 2016 and August 2021 at the General Hospital of Ningxia Medical University and Huashan Hospital of Fudan University. We retrospectively reviewed their clinical records.
RESULTS
Overall, the patients were positive with GFAP-IgG in their CSF (15/31), in serum (6/31), and both CSF and serum (10/31). Among them, two were eventually diagnosed with astroglioma and primary central nervous system lymphoma, respectively; one patient had typical multiple sclerosis; three exhibited overlapping GFAP-IgG and aquaporin-4-IgG (AQP4-IgG); and one patient was coexisting N-methyl-D-aspartate receptor IgG. The remaining 24 patients were only GFAP-IgG positive. In total, 22 out of the 24 patients had abnormal MRI outcomes, involving the brain, meninges, and spinal cord. Besides, seven of the 24 patients developed optic neuritis. The CSF protein levels positively correlated with the Expanded Disability Status Scale score (EDSSs). Significantly decreased EDSSs, modified Rankin Scale score, GFAP-IgG titer, CSF protein level, and CSF white blood cell counts were observed after immunomodulatory therapy.
CONCLUSION
The clinical manifestations of GFAP-IgG exhibit a wide range of phenotypes that lack specificity. These findings emphasize the significance of not exclusively relying on the presence of antibodies to diagnose GFAP-A, but rather integrating them with the clinical phenotypes. GFAP-IgG testing enables the diagnosis of autoimmune GFAP astrocytopathy, a treatable autoimmune disease affecting the central nervous system. This condition provides opportunities for investigating innovative mechanisms of CNS autoimmunity and inflammation.
PubMed: 37897492
DOI: 10.1080/00207454.2023.2277664 -
Cytopathology : Official Journal of the... Oct 2023The current World Health Organization (WHO) classification of central nervous system (CNS) tumours includes several neoplasms that, while occurring in this location, are...
The current World Health Organization (WHO) classification of central nervous system (CNS) tumours includes several neoplasms that, while occurring in this location, are more frequently seen extracranially. These include mesenchymal, melanocytic and haematolymphoid neoplasms, as well as metastases. A few of these entities are exclusive of the CNS and have no extracranial counterpart. Despite their diverse histogenesis, these neoplasms share a peculiar predilection for involving meningeal structures. In fact, in the context of an intraoperative pathologic consultation of a meningeal tumour, virtually all these entities should be considered as potential diagnoses. Metastases in the CNS are very common. Most are carcinomas that cytologically resemble their site of origin. Loss of differentiation with cell dissociation and anaplasia and presence of accompanying fibrillary brain parenchyma can be a source of diagnostic problems. In this review, we intend to show the most relevant cytologic features of these tumours, and it is especially aimed at their analysis during intraoperative studies.
PubMed: 37877651
DOI: 10.1111/cyt.13317 -
The Neurologist Mar 2024The differential diagnosis of a spinal intradural extramedullary mass lesion is broad and includes meningioma, schwannoma, neurofibroma, leptomeningeal metastasis, and...
INTRODUCTION
The differential diagnosis of a spinal intradural extramedullary mass lesion is broad and includes meningioma, schwannoma, neurofibroma, leptomeningeal metastasis, and myxopapillary ependymoma. Though rare, lymphoma should be included in the differential diagnosis of a dural mass lesion.
CASE REPORT
A 38-year-old man presented with back pain that progressed over 1 month with associated focal tenderness over his mid to lower thoracic spine. He developed intermittent numbness of the bilateral lower extremities, nuchal rigidity, difficulty sleeping, and night sweats. A magnetic resonance imaging of the thoracic spine demonstrated a dorsal intradural extramedullary enhancing lesion from T7 to T10 extending outside the spinal canal. Dural thickening across the entire circumference of the spinal cord was noted. Computed tomography (CT)-guided biopsy of the thoracic lesion was performed, and pathology was consistent with follicular lymphoma. Fluorodeoxyglucose positron emission tomography:CT demonstrated no systemic disease. Bone marrow biopsy was negative for malignancy. Symptoms resolved with dexamethasone therapy. He was treated with bendamustine and rituximab with follow-up positron emission tomography:CT 2 months later demonstrating a complete response.
CONCLUSIONS
Lymphoma can rarely present as an isolated dural lesion and should be considered in the differential diagnosis of intradural extramedullary spinal mass lesions. Prompt diagnosis and initiation of treatment can lead to complete response and resolution of symptoms.
Topics: Male; Humans; Adult; Lymphoma, Follicular; Spinal Cord; Meninges; Meningeal Carcinomatosis; Cervical Vertebrae; Magnetic Resonance Imaging
PubMed: 37839092
DOI: 10.1097/NRL.0000000000000535 -
Neurology(R) Neuroimmunology &... Nov 2023Persistent impaired immunity is possible even years after B-cell depleting therapies. This may favor the occurrence of infections, including infectious meningitis and...
OBJECTIVES
Persistent impaired immunity is possible even years after B-cell depleting therapies. This may favor the occurrence of infections, including infectious meningitis and encephalitis. In this study, we report a case of chronic enterovirus meningoencephalitis in prolonged B-cell depletion years after rituximab therapy.
METHODS
This is a case report from a German academic hospital. In addition to repeated clinical examinations, repeated brain MRI and extended CSF and laboratory diagnostics were performed. We used the CARE checklist when writing our report.
RESULTS
A 38-year-old man presented with high fever (>40°C), severe headache, and progressive neurologic and cognitive deficits. As result of previous lymphoma therapy with rituximab years ago, prolonged B-cell aplasia was detected. To restore humoral immunity, the patient received repeated infusions of immunoglobulins. In the end, a complete restitution of the physical and mental condition was achieved with the established therapy.
DISCUSSION
This case report should emphasize the importance of assessing humoral immunity even years after B-cell depletion therapy, especially in case of opportunistic infections.
Topics: Male; Humans; Adult; Rituximab; Enterovirus; Enterovirus Infections; Meningoencephalitis; B-Lymphocytes
PubMed: 37813597
DOI: 10.1212/NXI.0000000000200171 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2023Pathogenesis of peritumoral cerebral edema is unclear and potentially associated with glymphatic system dysfunction. Diffusion tensor MRI (DT-MRI) with analysis of ALPS...
BACKGROUND
Pathogenesis of peritumoral cerebral edema is unclear and potentially associated with glymphatic system dysfunction. Diffusion tensor MRI (DT-MRI) with analysis of ALPS (Analysis along the Perivascular Space) index may be valuable for assessment of edema. This approach visualizes fluid flow along perivascular spaces of deep cerebral veins.
OBJECTIVE
To assess glymphatic system function in supratentorial tumors and healthy volunteers using DT-MRI.
MATERIAL AND METHODS
There were 52 patients (59% men) aged 43 (28-64) years with supratentorial tumors (meningioma - 20, grade 3-4 glioma - 15, metastases - 9, lymphoma - 8). Tumors and perifocal edema did not involve deep cerebral veins. The control group included 6 healthy volunteers aged 34-66 years. MRI protocol (Signa HDxt, 3 T) contained standard T1, T2, T2FLAIR, DWI and post-contrast T1 (3D BRAVO). DT-MRI had the following parameters: TR=10 000 ms, TE=102 ms, FOV=240 mm, isotropic voxel size 3×3×3 mm, 60 directions of diffusion gradients. Measurements were carried out at b-factor 0 and 1000 s/mm. Analysis was carried out in the ReadyView software.
RESULTS
Right- and left-sided ALPS indices were similar in the control group (=0.917). Perifocal edema (regardless of histological type of tumor) in the ipsilateral hemisphere was accompanied by significantly lower ALPS index (<0.005), while these values in contralateral (intact) hemisphere were similar in both groups (=0.7).
CONCLUSION
We found significantly lower ALPS index in deep parts of the affected hemisphere in patients with perifocal edema. These data can indicate the role of glymphatic system dysfunction in pathogenesis of this pathology.
Topics: Male; Humans; Female; Diffusion Tensor Imaging; Brain Neoplasms; Glymphatic System; Magnetic Resonance Imaging; Edema; Meningeal Neoplasms; Supratentorial Neoplasms
PubMed: 37830468
DOI: 10.17116/neiro20238705145