Glioblastoma - Diffuse guerilla war by Dr Paloma Jimenez Arribas Jonathan McFarland
A fascinating presentation about Glioblastoma, comparing it to
Guerrila warfare by Dr Paloma Jimenez Arribas , a resident Neurosurgeon at Son Espases Hospital in Palma de Mallorca
TUMORES DE LA CAPA MENINGOTELIAL
SON DEL 13 AL 26% DE LAS NEOPLASIAS INTRACRANEALES
DELECION DEL CROMOSOMA 22q
INMUNOHISTOQUIMICA:
VIM, EMA, CEA, R. Progesterona
MENINGIOMA ATIPICO KI67; 7.2%
MENINGIOMA ANAPLASICO KI 67; 14.7%
KI67 >O IGUAL A 4.2; ALTO
EL HALLAZGO DE INVASION CEREBRAL ES INDICADOR DE RECURRENCIA FRECUENTE (GRADO II OMS).
Glioblastoma - Diffuse guerilla war by Dr Paloma Jimenez Arribas Jonathan McFarland
A fascinating presentation about Glioblastoma, comparing it to
Guerrila warfare by Dr Paloma Jimenez Arribas , a resident Neurosurgeon at Son Espases Hospital in Palma de Mallorca
TUMORES DE LA CAPA MENINGOTELIAL
SON DEL 13 AL 26% DE LAS NEOPLASIAS INTRACRANEALES
DELECION DEL CROMOSOMA 22q
INMUNOHISTOQUIMICA:
VIM, EMA, CEA, R. Progesterona
MENINGIOMA ATIPICO KI67; 7.2%
MENINGIOMA ANAPLASICO KI 67; 14.7%
KI67 >O IGUAL A 4.2; ALTO
EL HALLAZGO DE INVASION CEREBRAL ES INDICADOR DE RECURRENCIA FRECUENTE (GRADO II OMS).
Angiosarcomas are rare and represent less than 2 percent of all sarcomas. The most frequently involved primary sites are heart, liver and breast with over 100 cases of each reported. Angiosarcomas of the lungs are usually metastasis. Differential diagnosis of vascular neoplasm metastatic to the lungs includes Kaposi sarcoma, epithelioid hemangioendothelioma, and angiosarcoma.
Primary angiosarcoma of the lung is extremely rare and is usually diagnosed quite late due to low index of suspicion.
Reported chest radiograph findings have ranged from normal to multiple nodular densities with or without pleural effusions to diffuse alveolar infiltrates compatible with pulmonary haemorrhage. Metastatic angiosarcoma lung lesions are commonly multiple. There have been reported as solid nodular or thin-walled cysts, with haemorrhagic change.
The HPE was consistent with an epithelioid angiosarcoma and this was also supported by positive reaction for factor VIII-related antigen, CD34 and CD31, which are specific markers for tumours derived from the endothelium.
Predisposing factors for angiosarcomas include polyvinyl chloride and thorium dioxide exposure, postmastectomy and postirradiation states (cutaneous angiosarcoma) and chronic empyema for pleural space angiosarcomas.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
Angiosarcomas are rare and represent less than 2 percent of all sarcomas. The most frequently involved primary sites are heart, liver and breast with over 100 cases of each reported. Angiosarcomas of the lungs are usually metastasis. Differential diagnosis of vascular neoplasm metastatic to the lungs includes Kaposi sarcoma, epithelioid hemangioendothelioma, and angiosarcoma.
Primary angiosarcoma of the lung is extremely rare and is usually diagnosed quite late due to low index of suspicion.
Reported chest radiograph findings have ranged from normal to multiple nodular densities with or without pleural effusions to diffuse alveolar infiltrates compatible with pulmonary haemorrhage. Metastatic angiosarcoma lung lesions are commonly multiple. There have been reported as solid nodular or thin-walled cysts, with haemorrhagic change.
The HPE was consistent with an epithelioid angiosarcoma and this was also supported by positive reaction for factor VIII-related antigen, CD34 and CD31, which are specific markers for tumours derived from the endothelium.
Predisposing factors for angiosarcomas include polyvinyl chloride and thorium dioxide exposure, postmastectomy and postirradiation states (cutaneous angiosarcoma) and chronic empyema for pleural space angiosarcomas.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
Discover Islam presentation about Ramadan and fasting delivered to NHS Healthcare professionals. Clear contextual and cultural understanding of Ramadan and fasting. Health advice and guidance about common medical matters including diabetes, migraines, and dehydration.
Inspiring assembly for Foxdell Junior School days before the SATs exams. Tied into the current value of the month - excellence and shared some highly secret content!
POLYTRONGLASS strives to continue on extending its specialty and innovation in the research and development, production and sales of transparent LED displays. The current “X-Glass” product models include the XT, XW, XR, XD and XN series, which are designed for a wide range of applications such as storefront window displays, restaurant chains, shopping malls, airports, museums, financial institutions, trade shows, events, festivals, stage production, media architecture and many other areas. With pixel pitch ranges from 5mm to 31.25mm and brightness from 6000nit to 7500nit, “X-Glass” products are by far the clearest and brightest display in the world. Our clients include brands like ZARA, Land Rover, Lamborghini, Chow Sang Sang, WINLUN Bank, BlueShore Financial and etc.
Property Times eMagazine March 2014 - Dubai No.1 Realty News Magazine. Property Times Magazine Dubai. Read Property News Online. Dubai Real Estate News Magazine Online. Real Estate Market in Dubai
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This seminar is presented as a part of weekly journal club and seminar regularly conducted at Apollo hospital,Kolkata Department of Radiation oncology.
O.O.Bogomolets National Medical University's AchivementMevar Nirav
An Indian Student of final year of MBBS in O.O.Bogomolets National Medical University has researched clinical case presentation of craniofacial meningioma with associated acromegaly, diabetes mellitus type-2 labyrinthine tumour. This research is a very big achievement in Ukraine.
Predictability of vascular conflict by mri in trigeminalAmit Ghosh
Microvascular decompression is the only surgical option that allows for long-term pain relief while avoiding any sensory disturbance. In our opinion it remains the treatment of choice for all patients with drug-resistant typical TN.
Intracranial aneurysms are rare in childhood. Approximately
0.5%–4.6% of intracranial aneurysms occur in patients 18
years of age or younger
Here is a case report.
2. Clinical Profile
48 years, female, history of headache and few episodes
of vomiting with few episodes of vacant look off and
on over 10 days.
On examination, no neurological deficit.
3.
4.
5. SURGICAL MANAGEMENT
She underwent
1. RIGHT FRONTO PARIETAL PARASAGGITAL
CRANIOTOMY, INTERHEMISPHERIC APPROACH,
TRANSCALLOSAL EXCISION OF TUMOUR
Intra-operative frozen section was reported as a Low
Grade lesion, so 2nd tumour has been operated.
2. LEFT FRONTAL SUPRAORBITAL CRANIOTOMY
AND EXCISION OF LESION on 29.05.2015
19. Post operative period was uneventful,.
She was covered with pre and post operative
anticonvulsants and corticosteroids.
EVD and surgical drain removed on POD 3 , Sutures
removed on POD10
Advised Radiotherapy after 2 weeks
20. DEFINITION OF MULTICENTRIC /
MULTIFOCAL
Multifocal glioma consists of tumours separated by
white matter tracts within the same hemisphere.
Multicentric glioma consists of tumors in opposite
hemispheres or separated by the tentorium.
21. MULTIFOCAL / MULTICENTRIC
GBM
Batzdorf et al. (1963) distinguish between
"Multicentric" and "Multifocal"
Showalter et al. (2007) suggests that "the clinical
utility of this... may be scant."
Lim et al. (2007) hypothesize that multifocal GBM is
a subtype of GBM arising from Subventricular zone
(SVZ) stem cells
22. -
The incidence of solitary, multiple, and multicentric
gliomas a series of 209 gliomas was 72.2%, 25.4%, and
2.4%, respectively
U. Batzdorf and N. Malamud, “The problem of multicentric
gliomas,” Journal of Neurosurgery, vol. 20, pp. 122–136, 1963.
23. TYPES OF GBM
TYPE1: SVZ+, CTX +
TYPE 2: SVZ +, CTX –
TYPE 3: SVZ -, CTX +
TYPE 4: SVZ -, CTX -
24. MULTICENTRIC / MULTIFOCAL:
INCIDENCE
Multiple glioma in the form of multifocal or
multicentric is uncommon entity.
Incidence in literature varies from 0.15% to
25.4%
Even more uncommon is the Intraventricular
GBM as one of the tumors
25. PATHOLOGY
Still there is no unified theory regarding the pathogenesis of
multifocal and multicentric GBM, several hypotheses have been
developed.
The traditionally held view of the pathogenesis of
multifocal/multicentric GBM is by three possible pathways.
1) First, a previously known primary high-grade glioma spreads
through the cerebrospinal fluid or white matter tracts to other
locations.
2) Second, multiple areas of high-grade glioma arise de
novo from initially non-neoplastic cells that are influenced by
genetic defect.
3) Third and last, initially diffuse low-grade glioma develops
separate from separate areas of malignant transformation within
itself, hence giving rise to multifocal/multicentric GBM.
26. .
Some literature proposes that the pathogenesis of
multiple and multicentric GBM may involve neural
stem cells within the subventricular zone or could
result from tumor dissemination along established
CNS routes, such as white matter tracts and CSF
pathways.
Neural stem cells have been found to express matrix
metalloproteinases, which are proteolytic enzymes
implicated in tumor spread . Furthermore, the SVZ is
thought to be a highly permissive environment for
tumor growth and cellular migration.
27. Currently there is no clear
guidelinesregarding the optimal
management of MF/MC GBM, role of
surgery for MF/MC remains
controversial.
Aggressive resection of one tumor focus, biopsy alone followed by
chemotherapy and radiation treatment, and multiple craniotomies during
a single operation have all been described with no clear indication of which
modality is superior
TREATMENT MODALITIES
28. REFERENCES
Andrea Arcos b, Lorena Romero b,∗, Ramón Serramito a, José M. Santína, Antonio Prieto
a, Miguel Gelabert a, Miguel Ángel Arráez b: Multicentric glioblastoma multiforme.
Report of 3 cases, clinical and pathological study and literature review: neuroc i rugia. 2 0
1 2;23(5):211–215
Zamponi N1, Rychlicki F, Ducati A, Regnicolo L, Salvolini U, Ricciuti RA.: Multicentric
glioma with unusual clinical presentation.: Childs Nerv Syst. 2001 Jan;17(1-2):101-5.
Sophia F. Shakur,1 Esther Bit-Ivan,2 William G. Watkin,2 Ryan T. Merrell,3 andHamad I.
Farhat: Multifocal and Multicentric Glioblastoma with Leptomeningeal Gliomatosis: A
Case Report and Review of the Literature: Case Reports in Medicine
Volume 2013 (2013), Article ID 132679, 8 pages
http://dx.doi.org/10.1155/2013/132679
Yusuf ZC, Do¤a GÜRKANLAR, Erdener T‹MURKAYNAK: Multicentric Gliomas: Still
Remains a Controversial Issue: Turkish Neurosurgery 2005, Vol: 15, No: 2, 71-75