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Temozolomide is an orally administered chemotherapeutic drug that has become a standard treatment for malignant gliomas. Severe toxicity of temozolomide is rare, especially shortly after administration. We report a 37-year-old male patient diagnosed with anaplastic astrocytoma following tumor resection. He was treated postoperatively with cranial radiation and adjuvant temozolomide 150 mg/m² for six planned cycles. However, 3 days after finishing the first cycle of temozolomide, the patient's condition deteriorated. Laboratory results showed thrombocytopenia and lymphopenia, and chest X-ray revealed an infiltrate in the right segment of the lung, suggesting pneumonia. These conditions were thought to be caused by temozolomide. Although temozolomide is generally well tolerated by glioma patients, several adverse effects have been reported. In addition, malignancy, corticosteroids, and chemotherapy are known to increase the risk of immunosuppression. Close monitoring of patients treated with temozolomide is warranted, especially brain tumor patients, due to the risk of myelosuppression and severe infection. The work was approved by the Health Research Ethics Committee of DR Mohammad Hoesin Hospital (No. 130/kepkrsmh/2020) on December 15, 2020.

Background and Aim: Many studies have demonstrated the value of neuronavigation guided by fluorescence staining for treating glioma patients. Here, we compared the rate of overall survival (OS) and the extent of tumor resection among patients who underwent surgery with neuronavigation and fluorescence versus conventional techniques. Materials and Methods: In this case-control observational study, data from 162 patients with supratentorial glioma who underwent surgery from January 2016 to November 2017 were retrospectively analyzed, including a neuronavigation and fluorescence treatment group (combined group, n = 53) and a conventional microsurgery group (control group, n = 109). The extent of tumor resection, World Health Organization (WHO) pathological grade, eloquent areas involved, tumor diameter, preoperative Karnofsky Performance Status score, underlying diseases, chemotherapy, hospitalization days, length of operation, intraoperative blood loss, and postoperative molecular pathological indictors were recorded. OS rates were compared using the Cox proportional hazards regression model. The study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (approval No. 2019048). Results: The total resection rate was 60.4% in the combined group and 27.5% in the control group. Multivariate logistic regression analysis revealed that involvement of eloquent areas (odds ratio [OR] = 0.455, 95% confidence interval [CI]: 0.214–0.966, P = 0.040) and the use of the combined technique (OR = 3.634, 95% CI: 1.758–7.510, P < 0.001) were independent prognostic factors affecting total glioma resection. Eloquent areas were implicated in 79 patients. Multiple logistic regression analysis revealed that the combined technique (OR = 6.041, 95% CI: 1.705–21.403, P = 0.005) was an independent prognostic factor affecting total resection. The average follow-up period was 16.4 months. Cox regression analysis revealed that the WHO tumor grade (hazard ratio [HR] = 4.782, 95% CI: 1.620-14.119, P = 0.005), chemotherapy regimen (HR = 0.324, 95% CI: 0.181–0.579, P < 0.001), IDH mutation (HR = 0.366, 95% CI: 0.154–0.870, P = 0.023), and total resection (HR = 0.458, 95% CI: 0.248–0.846, P = 0.013) were independent factors affecting the prognosis of glioma patients. Conclusions: The use of neuronavigation with fluorescent staining appears to improve the tumor resection range and the OS rate, which is an independent factor affecting the degree of resection of supratentorial glioma. The WHO tumor grade, chemotherapy regimen, IDH mutation, and total resection were independent factors affecting the prognosis of glioma patients.

Intratumoral metastasis is rare, and in the brain, meningiomas are the most common type of primary brain tumors to harbor metastases. We report a case of angiomatous microcystic meningioma associated with intratumoral metastatic lung adenocarcinoma in a patient with no prior history of malignancy, in which the pronounced atypia of the meningioma potentially mimics or masks the minute focus of metastatic cancer. A meticulous search for intratumoral metastasis within the meningioma is recommended if metastasis is clinically suspected. A formal ethical approval for the single case report is waived by the Institutional Review Board of National University Health System, Singapore.

Online since 6^th Sep 2017.