World Neurosurg
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The 2016 World Health Organization Classification of Tumours of the Central Nervous System was revised to include a new diagnostic entity, diffuse midline glioma, H3 K27M-mutant (DMG-K27M), a highly aggressive tumor with a mean survival time of 1 year after diagnosis. DMG-K27M is classified as a World Health Organization grade IV tumor regardless of histopathologic features, and there is currently no effective treatment for it despite ongoing research. ⋯ There are currently no effective therapeutic options for treatment of DMG-K27M. The slow tumor growth and prolonged survival time (≥ 3 years) in the absence of intervention in this case serve as a reminder that much is still not known about histone H3 lysine 27-to-methionine mutation and how it impacts the pathophysiology, diagnosis, treatment, and prognosis of the disease. Careful evaluation is warranted to determine if early intervention is the best approach when treating DMG-K27M.
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Case Reports
MRI reveals a pronounced treatment response of a IDH- and BRAF-wildtype epithelioid glioblastoma.
We here report findings on magnetic resonance imaging from a 60-year-old patient with an epithelioid glioblastoma of the corpus callosum treated with radiotherapy in combination with concomitant and adjuvant temozolomide. Neuropathology revealed a highly aggressive molecular subtype of the epithelioid glioblastoma without an isocitrate dehydrogenase and B-Raf proto-oncogene mutation or a O6-methylguanine-DNA-methyltransferase promoter hypermethylation. This subtype is typically associated with an unfavorable clinical course and poor overall survival. Unexpectedly, the first follow-up magnetic resonance imaging 10 weeks after chemoradiation completion revealed an early and almost complete treatment response.
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Subependymomas are rare in the spinal cord. They are typically expansile, intramedullary spinal cord masses, eccentrically located with minimal gadolinium enhancement. ⋯ This is the first case, to our knowledge, where imaging revealed a mass appearing to be completely extramedullary with a primary exophytic component. Therefore, subependymomas should remain on the differential for masses in the spinal cord that appear extramedullary and exophytic.
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Brain metastasis (BM) from breast cancer is increasingly encountered clinically because of the continuing success in the oncological control of the primary disease. Data-driven reports on the surgical treatment of BM from breast cancer are sparse in sub-Saharan Africa. ⋯ Surgical resection is feasible for BM from breast cancer even in low-resource clinical practice. It has a salutary effect on the patients' quality of life.
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The relationship between noncontrast computed tomography (CT) markers, which predict the expansion of spontaneous intracerebral hemorrhage (sICH) under conservative treatment, and postoperative rebleeding (PR) after treatment by directly removing the sICH is unknown. This study investigated the relationship between noncontrast CT markers and PR in patients with sICH treated by endoscopic surgery. ⋯ The blend sign is likely to be a strong predictor for PR in patients who undergo endoscopic surgery for sICH. To improve the prognosis of patients with sICH, further studies are needed to establish new treatment strategies and surgical procedures.