The 2016 updated World Health Organization Classification of Tumors of the Central Nervous System shows an increasing number of entities under the classification of neuronal and mixed neuronal-glial tumors. Despite being a biogenetically heterogeneous group of tumors, the members frequently display some overlapping histological and clinical features, leading to diagnostic dilemmas among neuropathologists, especially when the aid of advanced molecular and immunohistochemical tools is not available. Nonetheless, meticulous assessment of the morphological features with careful interpretation of the immunophenotypes can be rewarding often without the investment of an expensive molecular investigation. We propose a method of approaching the neuronal-glial tumors based on pattern recognition. We briefly discuss the key histological features that are helpful in narrowing down the differentials, with the aid of immunohistochemistry or available molecular information, directing the pathologist toward the correct diagnosis.

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Glioblastoma (GBM) is the most common and fatal type of malignant central nervous system tumor with high invasion. The median overall survival of GBM is only around 14 months by standard treatment, which conventionally consists of surgical resection, followed by radiotherapy and adjuvant chemotherapy with temozolomide (TMZ). Currently, TMZ, carmustine, lomustine, and bevacizumab are the therapeutic drugs for GBM approved by the US Food and Drug Administration. Due to the progress of molecular genetics in tumor therapy, new targeted therapy drugs are continuously emerging for GBM. Meanwhile, immunotherapies, such as immune checkpoint inhibitors, tumor vaccines, and chimeric antigen receptor T (CAR-T) cell therapy, have also made great achievements in clinical trials. The combination of molecular targeted therapy and immunotherapy of GBM has become the focus of current research. It shows promise in GBM treatment and gives new hope to patients. This review focuses on recent advances in targeted therapy and immunotherapy and discusses their combined treatment of GBM.

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The investigation and development of recently introduced agents or radiological measurements caused emergent misunderstandings to the response assessment of glioma. To date, the classical Macdonald criteria and the response assessment of neuro-oncology (RANO) criteria have been used successively for the evaluation of glioma outcome. However, ongoing efforts on complementary assessments are necessary to combat this malignancy. In this review, we highlight the shortcomings of the current criteria and introduce the initiative effort of RANO guideline and its offspring. We also discuss some future barriers for accurate assessment of treatment response in glioma.

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Background: Spinal cord glioblastoma multiforme (SCGBM) is an extremely rare malignant tumor. The study aims to present the clinical and imaging features of SCGBM. Methods: The clinical and magnetic resonance imaging (MRI) characteristics of 12 pathologically proven SCBGM patients were retrospectively analyzed. Results: Three major MRI findings are as follows: (1) Mixed hypo-isointense signal on T1-weighted image (T1WI) and hyper-isointense signal on T2WI in all cases, (2) All except two patients demonstrated slight syringomyelia at upper or lower side of the lesion, and (3) Post-gadolinium-diethylenetriamine pentaacetic acid, a heterogeneously enhanced lesion with the crab foot-like shape on the map was seen in 11/12 cases. Clinically, pain in neck and waist was reported in 7 cases (58%) and progressive weakness of both lower extremities in 6 patients (50%). Gross total resection in 3 cases (25%) and subtotal resection in 9 cases (75%) were achieved. The most common postoperative complication was spinal instability, developed in 3 patients. The progress-free survival of surgery, surgery + temozolomide (TMZ), and surgery + TMZ + radiation treated patients was 2.50, 7.75, and 12.66 months, respectively. The overall survival of surgery, surgery + TMZ, and surgery + TMZ + radiation treated patients was 5.50, 15.25, and 24.00 months, respectively. Conclusion: The study reported MRI features in a large series of SCGBM. The trimodal therapy could provide longer survival for SCGBM patients.

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Background: YKL-40 has been reported to be associated with the prognosis of glioma patients. However, expression of YKL-40 was detected at protein or mRNA level in different studies. This may result in conclusion bias. This study is to investigate the prognostic value of increased YKL-40 protein versus mRNA expression in glioma patients. Methods: A comprehensive systematic search and review were performed using PubMed, EMBASE, and NKI databases to identify literature (published before May 1, 2018) that evaluated the association between YKL-40 and survival in glioma patients. Results: Thirteen relevant studies, involving 2139 patients, were included in this study. Elevated YKL-40 expression was associated with worse overall survival (OS) in glioma patients (hazard ratio [HR] = 1.44, 95% confidence interval [CI]: 1.27–1.63, P < 0.001), especially in high-grade glioma (anaplastic glioma: HR = 1.37, 95% CI: 1.09–1.74, P = 0.008; glioblastoma multiform: HR = 1.52, 95% CI: 1.33–1.73, P < 0.001). The increased YKL-40 protein level in serum (detected by ELISA) or in tumor tissues (detected by immunohistochemistry) was associated with worse OS (ELISA: HR = 1.43, 95% CI: 1.29–1.59, P < 0.001; immunohistochemistry: HR = 1.52, 95% CI: 1.20–1.93, P = 0.001). However, the association between elevated YKL-40 mRNA level (detected by real-time PCR) with worse OS was not significant (HR = 1.44, 95% CI: 0.73–2.83, P = 0.29, I² = 68.3%). In addition when status of IDH1 mutation or/and O⁶-methylguanine-DNA methyltransferase promoter was incorporated as multivariate, increased expression level of YKL-40 was not associated with poorer survival (HR = 1.39, 95% CI: 0.99–1.93, P = 0.055). Conclusion: YKL-40 protein level, rather than mRNA level, may be a valuable biomarker to assess the prognosis in glioma patients.

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