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World Journal of Clinical Cases Jun 2024Meningioma in the cerebellopontine angle (CPA) without dural attachment is extremely rare. We report a unique case of meningioma derived from the superior petrosal vein...
BACKGROUND
Meningioma in the cerebellopontine angle (CPA) without dural attachment is extremely rare. We report a unique case of meningioma derived from the superior petrosal vein without dural attachment.
CASE SUMMARY
A 44-year-old right-handed woman presented with a two-month history of headache and tinnitus. Brain magnetic resonance imaging showed a well-defined contrast-enhancing lesion in the right CPA without a dural tail sign. Tumor resection was performed using a right retro sigmoid approach. A dural attachment was not seen at the tentorium or posterior surface of the petrous pyramid. The tumor was firmly adherent to the superior petrosal vein. The origin site was cauterized and resected with the preservation of the superior petrosal vein. A diagnosis of meningothelial meningioma was made. The patient's headache and tinnitus gradually disappeared, and a recurrence was not observed five years after the surgery.
CONCLUSION
The rare occurrence of meningioma without dural attachment makes it difficult to determine dural attachment before surgery. The absence of dural attachment makes it easy to completely resect such tumors. Vessels related to tumors should be removed carefully, considering the possible presence of tumor stem cells in the microvessels.
PubMed: 38898871
DOI: 10.12998/wjcc.v12.i17.3156 -
Scientific Reports Jun 2024This study examined the association between hearing loss in sporadic vestibular schwannoma patients and the proteome of perilymph (PL), cerebrospinal fluid (CSF), and...
This study examined the association between hearing loss in sporadic vestibular schwannoma patients and the proteome of perilymph (PL), cerebrospinal fluid (CSF), and vestibular schwannoma. Intraoperative sampling of PL and of CSF, and biopsy of vestibular schwannoma tissue, was performed in 32, 32, and 20 patients with vestibular schwannoma, respectively. Perilymph and CSF in three patients with meningioma and normal hearing were also sampled. The proteomes were identified by liquid chromatography coupled to high-resolution tandem mass spectrometry. Preoperative hearing function of the patients was evaluated with pure tone audiometry, with mean values at frequencies of 500, 1000, 2000, and 4000 Hz (PTA4) in the tumor-affected ear used to delineate three hearing groups. Analysis of the PL samples revealed significant upregulation of complement factor H-related protein 2 (CFHR2) in patients with severe to profound hearing loss after false discovery rate correction. Pathway analysis of biofunctions revealed higher activation scores in the severe/profound hearing loss group of leukocyte migration, viral infection, and migration of cells in PL. Upregulation of CFHR2 and activation of these pathways indicate chronic inflammation in the cochlea of vestibular schwannoma patients with severe to profound hearing loss compared with patients with normal hearing or mild hearing loss.
Topics: Humans; Neuroma, Acoustic; Female; Male; Middle Aged; Proteome; Perilymph; Hearing Loss; Adult; Aged; Cerebrospinal Fluid; Audiometry, Pure-Tone
PubMed: 38898156
DOI: 10.1038/s41598-024-64352-6 -
Neurologia Medico-chirurgica Jun 2024NF2-related schwannomatosis (NF2; previously termed neurofibromatosis type 2) is a tumor-prone disorder characterized by development of multiple schwannomas and...
NF2-related schwannomatosis (NF2; previously termed neurofibromatosis type 2) is a tumor-prone disorder characterized by development of multiple schwannomas and meningiomas. The diagnostic criteria of NF2 have been regularly revised. Clinical criteria for NF2 were first formulated at the National Institutes of Health Consensus Conference in 1987 and revised in 1990. Revised criteria were also proposed by the Manchester group in 1992 and by the National Neurofibromatosis Foundation (NNFF) in 1997. The 2011 Baser criteria improved the sensitivity of diagnostic criteria, particularly for patients without bilateral vestibular schwannomas. Revisions to the Manchester criteria were published in 2019, with replacement of "glioma" by "ependymoma," removal of "neurofibroma," addition of an age limit of 70 years for development of vestibular schwannomas, and introduction of molecular criteria, which led to the most widely used criteria. In 2022, the criteria were reviewed and updated by the international committee of NF experts. In addition to changes in diagnostic criteria, the committee recommended the use of "schwannomatosis" as an umbrella term for conditions that predispose to schwannomas. Each type of schwannomatosis was classified by the gene containing the disease-causing pathogenic variant. Molecular data from NF2 patients led to further clarification of the diagnostic criteria for NF2 mosaic phenotypes. Given all these changes, the diagnostic criteria of NF2 may be confusing. Herein, to help healthcare professionals who diagnose NF2 conditions in the clinical setting, we review the historical development of diagnostic criteria.
PubMed: 38897938
DOI: 10.2176/jns-nmc.2024-0067 -
Cancers Jun 2024Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical...
Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor's location relative to the optic nerve's long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits.
PubMed: 38893267
DOI: 10.3390/cancers16112148 -
Cancers Jun 2024Although primary studies have reported the safety and efficacy of LITT as a primary treatment in glioma, they are limited by sample sizes and institutional variation in... (Review)
Review
Although primary studies have reported the safety and efficacy of LITT as a primary treatment in glioma, they are limited by sample sizes and institutional variation in stereotactic parameters such as temperature and laser power. The current literature has yet to provide pooled statistics on outcomes solely for primary brain tumors according to the 2021 WHO Classification of Tumors of the Central Nervous System (WHO CNS5). In the present study, we identify recent articles on primary CNS neoplasms treated with LITT without prior intervention, focusing on relationships with molecular profile, PFS, and OS. This meta-analysis includes the extraction of data from primary sources across four databases using the Covidence systematic review manager. The pooled data suggest LITT may be a safe primary management option with tumor ablation rates of 94.8% and 84.6% in IDH-wildtype glioblastoma multiforme (GBM) and IDH-mutant astrocytoma, respectively. For IDH-wildtype GBM, the pooled PFS and OS were 5.0 and 9.0 months, respectively. Similar to rates reported in the prior literature, the neurologic and non-neurologic complication rates for IDH-wildtype GBM were 10.3% and 4.8%, respectively. The neurologic and non-neurologic complication rates were somewhat higher in the IDH-mutant astrocytoma cohort at 33% and 8.3%, likely due to a smaller cohort size.
PubMed: 38893250
DOI: 10.3390/cancers16112131 -
Cancers May 2024Maximal resection with the preservation of neurological function are the mainstays of the surgical management of high-grade meningiomas. Surgical morbidity is strongly... (Review)
Review
Maximal resection with the preservation of neurological function are the mainstays of the surgical management of high-grade meningiomas. Surgical morbidity is strongly associated with tumor size, location, and invasiveness, whereas patient survival is strongly associated with the extent of resection, tumor biology, and patient health. A versatile microsurgical skill set combined with a cogent multimodality treatment plan is critical in order to achieve optimal patient outcomes. Continued refinement in surgical techniques in conjunction with directed radiotherapeutic and medical therapies will define future treatment.
PubMed: 38893100
DOI: 10.3390/cancers16111978 -
Cureus May 2024Hypertrophic pachymeningitis (HP) is a rare inflammatory disease of the central nervous system. It typically manifests in the cranium; cases involving the spinal cord...
Hypertrophic pachymeningitis (HP) is a rare inflammatory disease of the central nervous system. It typically manifests in the cranium; cases involving the spinal cord are rare (8.6%). This report includes two cases of spinal HP encountered among 666 spinal operative cases. The purpose of this study is to present the initial imaging findings, final diagnosis, and course of treatment in these two cases of spinal HP and to present the possible risk of misdiagnosis with a literature review. In case 1, a 69-year-old female presented with back pain. The initial radiological diagnosis with magnetic resonance imaging (MRI) was a meningioma. However, her blood test showed a mild elevation of C-reactive protein level (3.16 mg/dL), with positive IgG4 and myeloperoxidase anti-neutrophil cytoplasmic antibody results, suggesting an autoimmune disease. We performed a biopsy of the thickened dura and an expansive duraplasty. Serological and pathological diagnosis suggested IgG4-related HP. In case 2, a 67-year-old male presented with bilateral thigh pain. MRI revealed a mass resembling a disc hernia at the L2/3 intervertebral level. The mass was surgically removed. Pathological examination and cerebrospinal fluid analysis confirmed the diagnosis of HP associated with IgG4-related disease. In both cases, immunosuppressive therapy was administered, and follow-up MRI scans revealed the disappearance of the mass. The study concludes that a spinal HP can potentially be misdiagnosed when its images resemble those of tumors or disc hernias owing to its rarity.
PubMed: 38887326
DOI: 10.7759/cureus.60546 -
Journal of Investigative Medicine High... 2024Rectal signet ring cell carcinoma represents a rare subtype of colorectal adenocarcinoma known for its aggressive biological nature and poor prognosis. Although the...
Rectal signet ring cell carcinoma represents a rare subtype of colorectal adenocarcinoma known for its aggressive biological nature and poor prognosis. Although the co-occurrence of colorectal carcinoma with other tumors has been reported, the uncommon phenomenon of tumor-to-tumor metastasis, first described in 1930, remains rare. The most frequent donor neoplasms are lung or breast carcinomas, whereas cerebral meningiomas have been reported to be the most frequent recipient neoplasms. Here we report a case of a typical lipomatous tumor harboring metastatic signet ring cell rectal carcinoma. It is about a 42-year-old man diagnosed with rectal signet ring cell carcinoma and treated with concurrent radiotherapy and chemotherapy followed by an anterior resection and manual coloanal anastomosis with a temporary ileostomy. During the surgery, an abdominal wall lipoma was discovered and excised. A histopathological examination revealed infiltration of the fibro adipose tissue by a mucinous adenocarcinoma with a contingent of signet ring cells. The patient died 12 months after adjuvant chemotherapy due to peritoneal progression. To the best of our understanding, this represents the initial documented instance of tumor-to-tumor metastasis from rectal signet cell carcinoma to a conventional nonvascular lipoma. Consequently, even if one of these tumors appears clinically and radiologically benign, it is prudent to entertain the prospect of tumor-to-tumor metastasis. Thus, a comprehensive pathologic study of both tumors is highly recommended.
Topics: Humans; Carcinoma, Signet Ring Cell; Male; Rectal Neoplasms; Adult; Fatal Outcome; Lipoma; Adenocarcinoma, Mucinous
PubMed: 38884543
DOI: 10.1177/23247096241261309 -
Behavioural Neurology 2024The most common and aggressive tumor is brain malignancy, which has a short life span in the fourth grade of the disease. As a result, the medical plan may be a crucial...
The most common and aggressive tumor is brain malignancy, which has a short life span in the fourth grade of the disease. As a result, the medical plan may be a crucial step toward improving the well-being of a patient. Both diagnosis and therapy are part of the medical plan. Brain tumors are commonly imaged with magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT). In this paper, multimodal fused imaging with classification and segmentation for brain tumors was proposed using the deep learning method. The MRI and CT brain tumor images of the same slices (308 slices of meningioma and sarcoma) are combined using three different types of pixel-level fusion methods. The presence/absence of a tumor is classified using the proposed Tumnet technique, and the tumor area is found accordingly. In the other case, Tumnet is also applied for single-modal MRI/CT (561 image slices) for classification. The proposed Tumnet was modeled with 5 convolutional layers, 3 pooling layers with ReLU activation function, and 3 fully connected layers. The first-order statistical fusion metrics for an average method of MRI-CT images are obtained as SSIM tissue at 83%, SSIM bone at 84%, accuracy at 90%, sensitivity at 96%, and specificity at 95%, and the second-order statistical fusion metrics are obtained as the standard deviation of fused images at 79% and entropy at 0.99. The entropy value confirms the presence of additional features in the fused image. The proposed Tumnet yields a sensitivity of 96%, an accuracy of 98%, a specificity of 99%, normalized values of the mean of 0.75, a standard deviation of 0.4, a variance of 0.16, and an entropy of 0.90.
Topics: Humans; Brain Neoplasms; Magnetic Resonance Imaging; Meningioma; Multimodal Imaging; Tomography, X-Ray Computed; Deep Learning; Sarcoma; Image Processing, Computer-Assisted; Brain; Neural Networks, Computer; Meningeal Neoplasms
PubMed: 38882177
DOI: 10.1155/2024/4678554 -
NPJ Precision Oncology Jun 2024Neurofibromatosis type 2 (NF2) is a tumor suppressor gene implicated in various tumors, including mesothelioma, schwannomas, and meningioma. As a member of the ezrin,... (Review)
Review
Neurofibromatosis type 2 (NF2) is a tumor suppressor gene implicated in various tumors, including mesothelioma, schwannomas, and meningioma. As a member of the ezrin, radixin, and moesin (ERM) family of proteins, merlin, which is encoded by NF2, regulates diverse cellular events and signalling pathways, such as the Hippo, mTOR, RAS, and cGAS-STING pathways. However, the biological role of NF2 in tumorigenesis has not been fully elucidated. Furthermore, cross-cancer mutations may exert distinct biological effects on tumorigenesis and treatment response. In addition to the functional inactivation of NF2, the codeficiency of other genes, such as cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B), BRCA1-associated protein-1 (BAP1), and large tumor suppressor 2 (LATS2), results in unique tumor characteristics that should be considered in clinical treatment decisions. Notably, several recent studies have explored the metabolic and immunological features associated with NF2, offering potential insights into tumor biology and the development of innovative therapeutic strategies. In this review, we consolidate the current knowledge on NF2 and examine the potential connection between cancer metabolism and tumor immunity in merlin-deficient malignancies. This review may provide a deeper understanding of the biological roles of NF2 and guide possible therapeutic avenues.
PubMed: 38879686
DOI: 10.1038/s41698-024-00627-5