• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.381-385
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• 2009

The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report. Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord. Two years later, posterior fusion was necessary for progressive kyphosis in the cervical spine. He was well for approximately 7 years after the primary surgery. Two months ago, he presented with partial weakness and incoordination with gait difficulty. MRI Scan demonstrated multiple small lesions in the cerebellar vermis and left hemisphere. After suboccipital craniectomy and posterior cervical exposure, the small masses in the cerebellar vermis and hemispheres were excised to a large extent by guidance of an intraoperative navigation system. The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II). When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.

• Investigative Magnetic Resonance Imaging
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• 제5권2호
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• pp.130-137
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• 2001

목적: 대뇌 교종(glioma)에서 상대적 뇌혈액용적(relative cerebral blood volume, rCBV)과 종양의 조직학적 등급(grade)을 비교하고자 하였다. 대상 및 방법 대뇌 교종으로 진단된 총 16명의 환자에서 수술 전에 고식적 T1 및 T2 강조 자기 공명영상 및 조영제를 이용한 관류 자기공명영상을 시행하였다. 교종은 교아세포종(glioblas tora)이 7예, 역형성 성상세포종(anaplastic astrocytoma)이 2예, 역형성 핍지교세포종(anaplastic oligodendroglioma)이 1예, 저등급 성상세포종(low-grade astrocytoma)이 5예, 저등급 핍지교종(low-grade oligodendroglioma)이 1예 있었다. 관류 자기공명영상으로 얻은 교종의 최대 rCBV을 종양의 조직학적 진단 및 등급과 비교 하였다. 결과: 교아세포종의 최대 rCBV은 반대편 정상 백질과 비교하여 433%-1330% (펑균 790%)로 현저히 증가되어 있었다. 강한 조영증강을 보인 역형성 핍지교종 1예의 최대 rCBV은 502%로 증가되어 있었으나 조영증강되지 않는 역형성 성상세포종 2예의 최대 rCBV은 각각66%, 284%로 비교적 낮았다. 저등급 성상세포종의 최대 rCBV은 80%-369% (굉균 202 %)였다. 저등급 핍지교종 1예는 최대 rCBV이 1450%로 교아세포종 보다 높았다. 결론: 관류 자기공명영상을 이용한 rCBV수치는 교아세포종과 저등급 성상세포종은 분명히 구분되었으나 조영증강되지 않는 역형성 성상세포종파 저등급 성상세포종 간에는 차이가 없었다.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.485-490
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• 2000

Objective : To study the expression of apoptosis and bcl-2 in the astrocytic tumors. Patients and Methods : A total of thirty-eight astrocytomas(9 cases in low grade astrocytoma, 12 cases in anaplastic astrocytoma and 17 cases in glioblastoma) are included in this study. Immunohistochemical stain for bcl-2 using monoclonal antibody, in situ end labelling technique for apoptosis were used. Results : The malignant group(anaplastic astrocytoma and glioblastoma) showed significantly higher apoptosis positive index(PI) compared to the benign group(low grade astrocytoma)(1.35 vs 0.14). However apoptosis PI and bcl-2 PI were not significantly different among three groups. Correlation between apoptosis PI and bcl-2 PI was not statistically significant(p=0.58). Conclusion : This result suggest that apoptosis PI and bcl-2 PI are not related the degree of malignancy in astrocytic neoplasm, but apoptosis PI in malignant group was higher possibly due to greater DNA damage.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.261-264
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• 2014

We report perfusion weighted imaging (PWI) findings of nonenhanced anaplastic astrocytoma in a 30-year-old woman. Brain magnetic resonance imaging showed a nonenhanced brain tumor with mild peritumoral edema on the right medial frontal lobe and right genu of corpus callosum, suggesting a low-grade glioma. However, PWI showed increased relative cerebral blood volume, relative cerebral blood flow, and permeability of nonenhanced brain tumor compared with contralateral normal brain parenchyma, suggesting a high-grade glioma. After surgery, final histopathological analysis revealed World Health Organization grade III anaplastic astrocytoma. This case demonstrates the importance of PWI for preoperative evaluation of nonenhanced brain tumors.

• Asian Pacific Journal of Cancer Prevention
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• 제15권3호
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• pp.1333-1337
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• 2014

Background: Astrocytic tumors, the most common primary glial tumors of the central nervous system, are classified from low to high grade according to the degree of anaplasia and presence of necrosis. Despite advances in therapeutic management of high grade astrocytic tumors, prognosis remains poor. In the present study, the frequency and prognostic significance of c-erb-B2 in astrocytic tumors was investigated. Materials and Methods: Records of 72 patients with low- and high-grade astrocytic tumors were evaluated. The expression of C-erbB-2 was determined immunohistochemically and intensity was recorded as 0 to 3+. Tumors with weak staining (1+) or no staining (0) were considered Her-2 negative, while tumors with moderate (2+) and strong (3+) staining were considered Her-2 positive. Results: Of the 72 patients, 41 (56.9%) had glioblastoma (GBM), 10 (13.9%) had diffuse astrocytoma, 15 (20.8%) had anaplastic astrocytoma, 6 (8.3%) had pilocytic astrocytoma. C-erbB-2 overexpression was detected in the tumor specimens of 17 patients (23.6%). Six (8.3%) tumors, all GBMs, exhibited strong staining, 2 (2.7%) specimens, both GBMs, exhibited moderate staining, and 9 specimens, 5 of them GBMs (12.5%), exhibited weak staining. No staining was observed in diffuse astrocytoma and pilocytic astrocytoma specimens. Median overall survival of patients with C-erbB-2 negative and C-erbB-2 positive tumors were 30 months (95%CI: 22.5-37.4 months) and 16.9 months (95%CI: 4.3-29.5 months), respectively (p=0.244). Conclusions: Although there was no difference in survival, C-erbB-2 overexpression was observed only in the GBM subtype.

• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.375-379
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• 2017

Midbrain gliomas are relatively rare neoplasms with a generally benign prognosis, with dissemination or metastasis not previously reported. We describe here a woman, in whom magnetic resonance imaging scans showed hydrocephalus and a tegmental lesion in the upper aqueduct. Endoscopic third ventriculostomy and biopsy were performed; during surgery, a second small lesion was observed in the infundibular recess. Histologically, the two lesions had the characteristics of low grade astrocytoma, suggesting that the midbrain astrocytoma may have been disseminated via the cerebral spinal fluid to the infundibular recess. Postoperatively this patient received radiotherapy for nearly one month. Although patients with these tumors are not usually administered adjunctive therapy, radiation and, combined modality therapy, including surgery, radiotherapy, and chemotherapy, may be beneficial in patients with midbrain gliomas with dissemination.

• Journal of Korean Neurosurgical Society
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• 제57권6호
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• pp.469-472
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• 2015

Undifferentiated sarcomas are rarely identified in the intracranial region. A 23-year-old man was admitted with a chief complaint of headache. Initial magnetic resonance images showed signs of low-grade glioma in the frontal lobe. Stereotactic biopsy was performed, and a diagnosis of diffuse astrocytoma was confirmed. Three months later, the patient presented with a high-grade tumor as seen on imaging studies. He underwent total resection of the tumor and histopathological tests identified an undifferentiated sarcoma. The patient died eight months later due to massive tumor bleeding. To the best of our knowledge, this is the first report of undifferentiated sarcoma arising from low-grade glioma without any chemotherapy or radiotherapy.

• Radiation Oncology Journal
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• 제13권1호
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• pp.1-7
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• 1995

목적 :양성 성상세포종에 대한 방사선치료의 효과를 평가하고 방사선치료 결과에 지대한 영향을 미치는 인자를 규명한다. 방법 : 1979년 부터 1990년 까지 서울대학교병원에서 개두술(36예) 또는 조직생검(10예) 등을 통하여 양성 성상세포종임을 확인한 후 방사선치료를 시행한 46명의 치료성적을 분석하였다. 20명은 세계보건기구에서 설정한 조직 분화도 I등급이었고 26명은 II등급이었다. 방사선치료는 통상적 분할 치료법에 따랐으며 총방사선량은 45 내지 60Gy(중앙값 54Gy)이었다. 추적관찰기간의 중앙간은 60개월이었다. 결과 : 전체환자 46명의 2년 및 5년 생존율은 $80\%$ 및 $72\%$이었고, 2년 및 5년 무진행 생존율은 $75\%$ 및 $63\%$이었다. 조직학적 분화도가 유의성이 가장 큰 예후 인자임이 확인되었으며 조직학적 유형과 운동수행능력 또한 생존율에 영향을 미침을 확인하였다. 방사선 치료에 따른 중증의 합병증은 발생하지 않았다. 결론 : 생존율은 양호하였으나 치료 실패의 주요소는 국소적 종양치유 실패였다. 확인된 3종의 양호 한 예후인자와 아울러 연령 및 수술적 절제범위 등도 향후 치료방침 결정시 고려되어야 할 것이다.

• Journal of Korean Neurosurgical Society
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• 제62권3호
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• pp.313-320
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• 2019

Brain tumors are the second most common type of structural brain lesion that causes chronic epilepsy. Patients with low-grade brain tumors often experience chronic drug-resistant epilepsy starting in childhood, which led to the concept of long-term epilepsy-associated tumors (LEATs). Dysembryoplastic neuroepithelial tumor and ganglioglioma are representative LEATs and are characterized by young age of onset, frequent temporal lobe location, benign tumor biology, and chronic epilepsy. Although highly relevant in clinical epileptology, the concept of LEATs has been criticized in the neuro-oncology field. Recent genomic and molecular studies have challenged traditional views on LEATs and low-grade gliomas. Molecular studies have revealed that low-grade gliomas can largely be divided into three groups : LEATs, pediatric-type diffuse low-grade glioma (DLGG; astrocytoma and oligodendroglioma), and adult-type DLGG. There is substantial overlap between conventional LEATs and pediatric-type DLGG in regard to clinical features, histology, and molecular characteristics. LEATs and pediatric-type DLGG are characterized by mutations in BRAF, FGFR1, and MYB/MYBL1, which converge on the RAS-RAF-MAPK pathway. Gene (mutation)-centered classification of epilepsy-associated tumors could provide new insight into these heterogeneous and diverse neoplasms and may lead to novel molecular targeted therapies for epilepsy in the near future.

• Radiation Oncology Journal
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• 제15권1호
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• pp.1-10
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• 1997

목적 : 저분화 성상세포종 치료에 있어서 방사선 치료 역할을 생존율과 치료 실패 양상으로 평가하고 생존율에 영향을 미치는 예후인자를 분석한다. 대상 및 방법 : 1990년 1월부터 1995년 12월까지 서울 중앙 병원에서 아전절제술과 조직생검으로 확진된 저분화 성상세포종 환자 중 천막 하부를 제외한 총 51(남:여=28:23)예를 대상으로 하여 후향적으로 방사선 치료 성적을 분석하였다. 방사선 치료는 최저 4820cGy, 최고 6000cGy를 분할 치료하였고 치료 부위는 종양에 2-3cm 여유를 두고 국소조사하였다. 추적률은 $96\%$이었으며 추적 관찰 기간의 중앙값은 48개월이었다. 생존율은 Kaplan-Meier법으로 분석하였다. 결과 : 총 51예의 2년 및 5년 전체 생존율은 $83.4\% 및 $54.8\% 이었고 2년 및 5년 무진행 생존율은 $67.4\% 및 $48.7\%이였다. 전체 생존율에 영향을 주는 예Gn인자는 Karnofsky 수행도 (p=0.024), T 병기(p=0.014), 조직학적 유형(p=0.012), 방사선 조사야(p=0.003), 방사선 반응도(p=0.0004)이었다. 그러나 절제 정도(아전 절제술 대 생검) 및 방사선 선량(56OOcGy 이상 대 이하)은 생존율에 영향을 주지 못했다. 방사선치료후에 진행을 보이지 않은 45예중 17예 ($37.8\%)에서 국소 재발을 보였으며, 6예에서는 방사선 치료 직후 진행을 보여 총 23예 ($45.1\%)에서 국소실패를 보였다. 2예를 제외한 28예의 무진행 생존자들은 모두 신체적으로 지능적으로 정상이었다. 결론 : 본 연구에서는 비교적 추적 기간이 짧지만 저분화 성상세포종에 대한 방사선 치료후 5년 생존율과 무진행 생존율은 $54.8\%와 $48.7\%로 우수하였다. Karnofsky 수행도가 높을수록, T병기가 낮을수록, Pilocytic 유형인 경우, 방사선 치료에 반응할수록 양호한 예후를 보였다. 그러나 주 치료 실패 요인인 국소실패율을 감소시키기 위한 다각도의 연구가 필요하리라 사료된다.