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BackgroundRed cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR), and platelet count (PLT) routinely tested as part of the complete blood count are indicative of systemic inflammation. The prognostic significance of NLR and PLT in cancer was demonstrated in many studies while the role of RDW has been hardly investigated. The present study aimed to assess the association of RDW, NLR, and PLT with survival and tumor grade in glioma patients.MethodsClinical data from 178 patients with primary gliomas treated in a single institution were retrospectively analyzed. Receiver operating characteristic curves for cutoff value determination, Kaplan–Meier survival analysis, various bivariate tests, and univariate and multivariate Cox regression analyses were performed.ResultsPatients with high RDW (≥13.95) and NLR (≥4) levels had worse overall survival (OS) (Wilcoxon test, P<0.026 and P<0.003, respectively) while the effect of thrombocytosis (≥400×109/L) on prognosis was not significant. Besides, a strong association between RDW and NLR was found (Spearman’s rho =0.230, P<0.02; χ2=8.887, P<0.03; Mann–Whitney U-test, P<0.017). Moreover, RDW and NLR were significantly associated with tumor grade. In univariate Cox analysis, elevated NLR (hazard ratio, HR 1.385; confidence interval, CI 1.020–1.881, P<0.037), older age (HR 0.452, CI 0.329–0.621, P<0), and higher tumor grade (HR 1.624, CI 1.187–2.223, P<0.002) were associated with poor outcomes. In the multivariate analysis, tumor grade, age, and Karnofsky performance score were identified as being independently prognostic for OS.ConclusionPreoperative NLR and RDW values can help to evaluate disease progression and outcomes in patients with gliomas, thereby contributing to patient follow-up optimization.

Primary CNS lymphomas, a rare malignant form of non-Hodgkin's lymphoma, account for 3%-6% of all primary brain neoplasms. 4 There has been an increase in the incidence of malignant lymphoma in the last 3 decades. The differentiation of malignant lymphomas from gliomas or malignant gliomas by conventional MRI can be difficult. Malignant lymphomas and glioblastomas require different treatments; glioblastomas are treated by extensive resection, whereas malignant lymphomas are usually addressed by biopsy. Therefore, a differential diagnosis is of high clinical relevance. Moreover, even with advanced MRI techniques that yield physiological inabbreviatioNs ADC = apparent diffusion coefficient; ADCMIN = minimum absolute ADC; b-n = b value of n sec/mm 2 ; cho = choline; Cr = creatine; DWI = diffusionweighted imaging; FLAIR = fluid-attenuated inversion recovery;1 H-MRS = proton MR spectroscopy; mI = myoinositol; MRS = MR spectroscopy; NAA = N-acetyl aspartate; ROI = region of interest; VOI = volume(s) of interest. submitted January 10, 2014. accepted September 10, 2014. iNclude wheN citiNg Published online March 6, 2015; DOI: 10.3171/2014.9.JNS14106. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The following grants funded this study: grant-in-aid nos. 25462262 and 23592091 from the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research. H-MRS at 3 T, and the diagnoses were histologically confirmed. results Using a short echo time 1 H-MRS, large lipid peaks were observed in all 17 patients with a malignant lymphoma, in 39 patients (79.6%) with a Grade IV glioma, and in 10 patients (30.3%) with a Grade III glioma. A focus on homogeneously enhanced tumors revealed large lipid peaks in 15 malignant lymphomas that were free of central necrosis on Gd-enhanced T1-weighted images. Conversely, in the 7 homogeneously enhanced gliomas (glioblastoma and anaplastic astrocytoma, n = 2 each; anaplastic oligodendroglioma, diffuse astrocytoma, and pilomyxoid astrocytoma, n = 1 each), lipid peaks were small or absent. coNclusioNs Large lipid peaks on 1 H-MRS images of tumors without central necrosis were characteristic of malignant lymphomas. Conversely, small or absent lipid peaks in intraaxial tumors without central necrosis were strongly suggestive of glioma.

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Secondary brain tumors rarely arise after cranial irradiation; among them, meningiomas and glioblastomas are the most common and secondary oligodendroglial tumors the most rare. We present a 48-year-old man who developed an oligodendroglial tumor 38 years after receiving 50 Gy of cranial irradiation to a pineal tumor. He underwent gross total removal of a calcified, ring-enhanced mass in the right temporal lobe. The tumor was histologically diagnosed as anaplastic oligodendroglioma. Our review of previously reported secondary oligodendroglial tumors that developed after cranial irradiation revealed that these rare tumors arose after low-dose cranial irradiation or at the margin of a field irradiated with a high dose. We suggest that secondary oligodendroglial tumors arising after cranial irradiation are more aggressive than primary oligodendrogliomas.

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