Ganglioglioma represents a benign central nervous tumor, occurring predominantly in the pediatric population and affecting the temporal lobe. It is also renowned for its epileptogenic potential. However, to date, there are numerous uncertain features about this tumor, especially about its grading system. In the former World Health Organization (WHO) Classification of central nervous tumors system, gangliogliomas could have been attributed one out of three grades: grade I (benign), grade II (atypical), and grade III (anaplastic). The new classification systems have renounced to atypical ganglioglioma nomenclature, due to the lack of histopathological criteria for this entity. Another controversial aspect of grade I ganglioglioma is its potential to transform into a malignant tumor, namely, most frequently an anaplastic ganglioglioma. Based on our knowledge, there are no literature reviews to date focusing on anaplastic transformation potential. The present paper encompasses all anaplastic transformation of gangliogliomas and has analyzed the time frame between the two events, the age of the patients and its relationship to the complete or subtotal resection and administration of radiotherapy. Thirty-three cases of malignant transformation of ganglioglioma have been reported so far in the literature, with 54.54% of them undergoing progression to anaplastic ganglioglioma and 21.21% to anaplastic ganglioglioma. Median age was 26 years, and the cases were evenly distributed between the two genres. Only 27.27% of all evaluated cases had been administrated adjuvant radiotherapy, and only 44% of the latter have had an incomplete tumoral resection.
METASTATIC LYMPHADENOPATHY IN COLON CANCER (Abstract): INTRODUCTION:The incidence and prevalence of colon cancer is increasing in the last decades, in Romania. The aim of this paper is to evaluate the place of metastatic lymphadenopathy as risk factor for postoperative morbidity and mortality. MATHERIAL AND METHODS: We perfomed a prospective study; 126 patients with colon cancer were included and prospectively reviwed. RESULTS: The men / women ratio was 70 / 56. The mean age was 65.26 years old (range 20-89 years). Most cases were in stage III (n=72, 57.14%) and IV (n=49, 38.89%) with tumors located more frequently on the left colon (n=86, 68.25%) and especially on the sigmoid colon (n=64, 50.79%). 33.33% patients (n=42) were operated in emergency. Colic wall invasion depth (pT 3 =49, 38.9%, pT 4 =72, 57.1%) were accompanied by an increase in the number of affected regional lymph nodes (pN 1 =29, 23.0%, pN 2 =43, 34.1%). Postoperative complications occurred only in patients in stages III (n=11, 15.41%) and IV (n=15, 30.61%). The 30 days postoperative mortality rate was 19.04% (n=24), mostly in stage pT 4 tumors (n=18, 25%). Metastatic adenopathy was found as risk factor for postoperative mortality rate: 16.66% (n=4) deaths for pN 1 , 30.23% (n=13) for pN 2 and resoectively 13.07% (n=7) mortality rate for pN 0 . The five years survival rate was 100% for stage I, 59.64% for stage II, 33.57% for stage III and nul for stage IV. CONCLUSIONS: The presence of metastatic adenopathy is crucial in assessing the informational value of early and late postoperative evolution.
A study of astrocytomas occurring in children (mean age 9.13 years) is reported. Two hundred sixty-one cases operated within 10 years (1986-1995) were reviewed. The subtentorial localization was preponderant and was seen in 145 cases (55.04%). The pathological results for supratentorial astrocytomas show an important number of high-grade, malignant astrocytomas--74 cases (64.3%). Surgery was the most important aspect of the treatment. The microscopic tumoral removal was total in 201 cases (77%), subtotal in 37 cases (14.2%); bioptic sampling was done in only 23 cases (8.8%). In grade III and IV astrocytomas, radiotherapy (high-voltage) and chemotherapy were routinely used. The patients were followed-up, both clinically and by CT, between 6 months and 10 years. Neurological evaluation (6 months post-operative) shows a preponderance of minimal sequelae (71%). Clinical signs of recurrences occurred in 56 cases (21.45%). In 37 cases (66.07%), a surgical indication was retained. Cumulative probability of survival of children with intracranial astrocytomas at 1 year was 0.714 and at 5 years was 0.655.
BACKGROUND The clinical course and prognostic of gliomas depend on the tumor histological and molecular features. The histopathological diagnosis requests well-trained specialists and multi-step operational procedures for sample preparation. Faster and more objective protocols should be implemented in support of pathologists. The Quantitative Phase Imaging based methods are biologically proved to be efficient in revealing, without any labeling, important characteristics of the living specimens having different structural complexity. We used Digital Holographic Microscopy (DHM) to acquire QPIs and to analyze glioma samples in order to discriminate glioma tissues of various malignancy grades. MATERIAL AND METHODS Grade II glioma (GM) and grade IV glioblastoma (GBM) tissues were collected from patients who underwent surgery. For each sample, two consecutive slices were fixed with formalin, embedded in paraffin and cut at 4 µm thickness. One slice was stained using hematoxylin and eosin (H&E) and the other slice was left unstained. The pathologist diagnosed H&E slides as GM or GBM and the corresponding unstained slides were accordingly labeled. Holograms of unstained sections were acquired using a LyncéeTec DHM®-R1000 digital holographic microscope (at 664.5 nm). QPIs were reconstructed using the Koala dedicated software, and then the distribution of the phase shift values in the image was characterized by various statistical parameters (mean, variance, kurtosis, skewness, energy, entropy). RESULTS A total of 78 images were analyzed, 33 for grade II gliomas and 45 for grade IV glioblastomas, the areas being randomly selected, as the tissue is highly homogeneous. Lower values of Mean, Variance and Energy and higher values of Kurtosis and Entropy were found for GM compared to GBM (Mann-Whitney test was performed for proofing the statistically significance). No statistical difference was observed for Skewness. As the thickness of the samples was constant, variations of these parameters may be attributed to different distributions of the refractive index within the samples, which in turn is directly related to the protein content and structural features of the tissue. CONCLUSION The analyze of unstained biopsies of glioma tumors based on DHM could be used for faster and more accurate diagnosis, offering efficient optical markers to distinguish between levels of malignancy with high statistical confidence. Our findings can be further exploited for automatic evaluation and classification of malignant tissues, parameters provided by QPIs being used as classifiers for a supervised machine algorithm. This method can be adapted for fresh samples, being thus a promising method for intraoperative diagnostic.
Gangliogliomas are central nervous system tumors located in the temporal lobe of young patients, frequently associated with epilepsy. In this paper, we propose a grading system based solely on histopathological criteria. We reevaluated all cases of ganglioglioma, atypical ganglioglioma, and anaplastic ganglioglioma diagnosed between 2011 and 2020 in the Pathology Department of the Emergency Clinical Hospital Bagdasar-Arseni, based on the type of glial mitoses, the number of neuronal and glial mitoses, presence of necrosis, microvascular proliferation, eosinophilic granular bodies, hypercellularity, presence and disposition of inflammatory infiltrate and atypical pleomorphism. Based on the proposed grading system, a score of 0–4 corresponded to a benign ganglioglioma, 5–9 to an atypical ganglioglioma, and 10–18 to an anaplastic ganglioglioma. The survival rates were 90% for benign ganglioglioma, 71.43% for atypical ganglioglioma, and 62.54% for anaplastic ganglioglioma. One case of benign ganglioglioma underwent a malignant transformation into anaplastic ganglioglioma, and recurrences were noticed in 28.57% of atypical ganglioglioma cases and 30.7% of all anaplastic gangliogliomas. The presence of rare glial mitoses and hypercellularity was correlated with mortality in cases of atypical ganglioglioma. We believe this histopathological scoring system could be used as a three-tier system to identify atypical ganglioglioma cases that are bound to have an aggressive course of evolution and require close follow-up. The other option would be to convert it to a two-tier grading system that can separate low-grade gangliogliomas from high-grade ones. The latter category can encompass both atypical and anaplastic ganglioglioma due to the high mortality of both entities.
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