Glioma

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Although the 2021 World Health Organization classification update of the central nervous system tumors redefined "pilomyxoid astrocytoma" as high-grade astrocytoma with piloid features (HGAP), the craniocerebral HGAP exhibits poorer clinical outcomes when compared to pilocytic astrocytoma. However, in the spinal cord, the paucity of information of HGAP cases inhibits the judgment of prognosis and optimal management approaches for patients with spinal HGAP. Here, we summarized the clinical characteristics, management methods, and prognosis of ten cases of spinal HGAP reported in the literature and two cases of spinal HGAP who underwent tumor surgery in our institution. Here, the detailed clinical information we provided may help clinical decision-making for such rare childhood lesions. This study was approved by the Human Research Ethics Committees in our institution on June 29, 2021.

Spinal cord and spine system diseases are complex and diverse, and prognosis is often poor. Therefore, early diagnosis is essential, especially for spinal system tumors, which are malignant nervous system tumors that have the highest mortality and disability rates. Accurate diagnosis avoids unnecessary operations. Traditional medical imaging diagnosis remains at the level of anatomical morphology, and there is a considerable amount of useful information that can be extracted and utilized. Radiomics is a new method of medical imaging diagnosis that is committed to improving image analysis and is capable of extracting a large number (more than 200 types) of quantitative features from medical images. Numerous studies on the application of radiomics in various systems of the body have been conducted. We reviewed current research on radiomics in spinal cord and spine system diseases and discussed the progress and challenges to provide a basis for improving the diagnosis and identification of spinal cord and spine system diseases and offer evidence-based support for precision medicine.

Spinal glioblastoma multiforme (GBM) that originates from the conus medullaris is rare as only 28 cases have been reported. It is highly aggressive and usually initially presents with low back pain, sensory and motor impairment of the lower extremities, and bladder dysfunction. We herein report a unique case of GBM in the conus medullaris with leptomeningeal dissemination that initially presented with increased intracranial pressure without hydrocephalus. The patient was first diagnosed with tuberculous meningitis and received antituberculosis therapy, but the symptoms did not resolve and even worsened. Subsequent radiological imaging clearly disclosed an intramedullary lesion at the T12 level with the progression of leptomeningeal enhancement. Subtotal resection of the intramedullary lesion was performed, and pathological examination revealed the presence of GBM. To our knowledge, our case was the first with holocordal and intracranial leptomeningeal dissemination that initially presented with intracranial hypertension in the absence of hydrocephalus. Awareness of this unusually lethal condition is significant for proper diagnosis, timely treatment, and consideration of clinical prognosis.

Background and Aim: Intramedullary spinal cord glioma has no evident boundary with normal spinal cord tissue. The rate of successful surgical resection of intramedullary spinal cord glioma is low. Well-established animal models for intramedullary spinal cord glioma can help promote translation from related basic therapy research to clinical applications. In this study, we established a rat model of intramedullary spinal cord glioma. Materials and Methods: A total of 23 male Sprague-Dawley (SD) rats were randomized into blank control (n = 3) and experimental (n = 20) groups. The blank control group received intramedullary injection of Dulbecco's modified Eagle medium (DMEM) and the experimental group was injected with DMEM containing C6 glioma cells. The neurological states of these rats were evaluated using the Basso, Beattie, and Bresnahan scale (BBB). Tumor sizes were measured by magnetic resonance imaging. The histopathological analysis was performed to observe the growth of infiltrating tumors. All procedures involving animals were approved by the Ethics Committee of the Laboratory Animal Facility Biomedical Analysis Center, Tsinghua University (Beijing, China; approval No. 17-WGH1). Results: On postoperative 7 days, the experimental group presented with a significant progressive decrease in motor function (mean BBB score 15.00 ± 1.20) compared with the blank control group (20.67 ± 0.47, P < 0.01). All rats in the experimental group showed exponential tumor growth and had an average survival of up to 5 weeks after tumor cell implantation. The tumor sizes were 3.18 ± 0.21 mm³, 68.55 ± 3.38 mm³, and 345.28 ± 22.57 mm³ on postoperative 7, 14, and 28 days. The histopathological analysis illustrated that the growth of infiltrating tumors followed the longitudinal axis of the spinal cord. Conclusions: Thus, we have established a SD rat model of intramedullary spinal cord glioma, and we found that our findings are reproducible and homogeneous. These positive results provide solid bases for further studies of intramedullary spinal cord glioma.

Epithelioid glioblastoma (eGB) is an uncommon morphological variant of isocitrate dehydrogenase wild-type GB that commonly presents as a cerebral mass in young adults and children. Here, we report the case of a 22-year-old man who presented with a cerebellar tumor. With the provisional diagnosis of pilocytic astrocytoma and adult medulloblastoma, he underwent suboccipital craniotomy with gross total excision of the tumor. On histopathological examination, he was diagnosed with eGB. Cerebellar presentation of eGB is a rare event that has not been previously described in the literature. The present case also highlights the need for differentiating eGB from its morphological mimics by carefully interpreting histopathological and immunohistochemical examination findings.

Online since 6^th Sep 2017.