Background. Currently, the frequency of occurrence of neoplasms is emerging in the world. Under conditions of a general tumor, brain tumors are rare (0.7–1.5 %). However, high mortality, disability, limited life expectancy of patients, high economic and social inferiority, raise concerns about the medical organization of care, development and social adaptation. Of particular importance among the causes of primary brain tumors is the congenital or acquired growth of immunodeficiency. The growth in the number of drug addicts led to the elimination of the annual epidemic at the end of the 70s and the increase in the number of patients with immunodeficiency syndrome (AIDS), due to which the growth of a brain tumor began to develop in this population group. The number of Russian patients with lymphoma is also steadily increasing.Objective. Consider an illustrative clinical case that reflects the expected continuity in patients with ordinary CNS lymphoma.Design and methods. A 50-year-old patient with moderate memory loss was examined using various methods: MRI, PET-CT and etc.Results. Based on histological and immunohistochemical studies, diffuse large B-cell lymphoma of the CNS was diagnosed. There was a positive trend in the reduction of tumor size after radiation therapy.Conclusion. Primary CNS lymphoma is becoming an active epidemiological problem of society, requiring comprehensive multidisciplinary monitoring. Only high vigilance in terms of lymphoma and well-coordinated work of multidisciplinary specialists can help to perform the correct diagnostics and patient management.
Background: Ranking third in the cause of death structure, venous thromboembolism (VTE) is a frequent complication in patients with central nervous system tumors.Objective: To assess the incidence of venous thrombosis and its risk factors in glioma patients based on retrospective data.Methods: Our retrospective study included 186 glioma patients from the Neurosurgery Department of Almazov National Medical Research Centre.Results: The VTE incidence was 8% in patients with brain neoplasms. Comparative analysis of 2 groups to identify VTE predictors showed that the probability of thrombosis increases with factors leading to the patient immobilization: altered mental status (40% [n = 6] in the VTE group vs 18% [n = 30] in the non-VTE group, OR: 3.1 [95% СI: 0.8–10.6], P = .080), neurological deficit (67% [n = 50] vs 29% [n = 10], OR: 4.8 [95% СI: 1.4–18.7], P = .007), and bed rest for more than 3 days (33% vs 4%, OR: 13.1 [95% СI: 2.7–62.8], P < .001). Based on the validation results, Caprini and IMPROVEDD risk scores have high negative predictive values: 0.99 [95% СI: 0.93–1.00] vs 0.97 [95% СI: 0.93–0.99] (P = .317). Caprini risk score has a specificity of 48.2% and a sensitivity of 93.3% (AUC = 78.98); the threshold value for high-risk VTE detection is 5.5 points. IMPROVEDD risk score has a specificity of 82.5% and a sensitivity of 73.3% (AUC = 81.1); the threshold value for high-risk VTE detection is 4.5 points.Conclusion: Our study revealed VTE risk factors in glioma patients, such as neurological deficit, prolonged bed rest (more than 3 days), and a high-grade tumor. We demonstrated high negative predictive values of Caprini and IMPROVEDD risk scores and determined their threshold values to be validated in a further prospective study. Due to the high incidence of VTE and risks of hemorrhage in patients with central nervous system tumors, personalized venous thrombosis risk calculators should be developed, providing for features of thrombosis pathogenesis in this patient group. Received 12 December 2022. Revised 7 April 2023. Accepted 31 May 2023. Funding: The study was supported by Ministry of Science and Higher Education of Russian Federation (No. 075-15-2022-301). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: K.A. Pishchulov, M.A. SimakovaData collection and analysis: K.A. Pishchulov, S.I. ParkhomenkoStatistical analysis: V.L. LukinovDrafting the article: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. MoiseevaCritical revision of the article: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. MoiseevaFinal approval of the version to be published: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. Moiseeva
The research of the blood-brain barrier began at the turn of the 18th19th centuries. To date due to the large number of studies conducted, it is obvious that this system has an impossibly complex structure at the organ, tissue and molecular genetic levels. Scientific interest in the changes in the blood-brain barrier that occur during pathological neoplastic processes is increasing. As it turned out, the restructuring of this system is an important and integral stage in the pathogenesis of glioblastoma, a tumor of the central nervous system with the most unfavorable prognosis. Heterogeneous structure with the formation of areas of altered cellular composition, uneven and uncontrolled permeability, provided by a large number of transport vesicles and the destruction of tight contacts between endotheliocytes, active outflow of molecules from the parenchyma due to the continuous synthesis of new portions of ABC-carrier proteins, the creation of an immature vascular network under the influence of high expression of VEGF by tumor cells the main characteristics of the hematopoietic barrier, formed in glioblastoma and supporting its survival. The further research of the features of the structure and mechanisms of functioning of the blood-brain barrier in glioblastoma is a new and promising task in modern neurooncology, the solution of which will not only expand the understanding of the biology of the most common and malignant brain tumor but will also improve the effectiveness of treatment of patients and improve the prognosis.
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