BACKGROUND: Numerous studies reported a usefulness of 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) in high grade gliomas. However, fluorescence patterns and intensities are variable among gliomas. In this study, we report our extensive experience with FGS in various gliomas, focusing on epidemiological data of fluorescence patterns. METHODS: A total of 827 histologically proven glioma patients out of 900 brain tumor patients who had undergone FGS using 5-ALA during the period of 8.5 years between July 2010 and January 2019 were analyzed. Indications of FGS in glioma surgery are evidence for possible high-grade foci in putative gliomas in preoperative MRI. RESULTS: Among the 827 gliomas, the number of cases corresponding to 2016 World Health Organization (WHO) grade IV, III, II, and I are 528 (58.7%), 193 (21.4%), 87 (9.7%) and 19 (2.1%), respectively. In terms of fluorescence rate, grade IV gliomas showed positive fluorescence in 95.4% of cases including strong intensity in 85.6%. Grade III gliomas showed fluorescence in about half of cases (55.0%), but 45.0% of the cases showed no fluorescence at all. Anaplastic oligodendroglioma had a higher positive rate (63.9%) than anaplastic astrocytoma (46.2%). Both grade II and I gliomas still showed positive fluorescence in about one-fourth of cases (24.1% and 26.3% respectively). Among them ependymoma and pilocytic astrocytoma were fluorescence-prone tumors. CONCLUSION: This epidemiological data of 5-ALA fluorescence in various grades of glioma provides a basic reference to the clinical application of FGS with 5-ALA in glioma surgery.
Astrocytoma ; Brain Neoplasms ; Ependymoma ; Fluorescence ; Glioblastoma ; Glioma ; Humans ; Magnetic Resonance Imaging ; Oligodendroglioma ; World Health Organization

We report a case of solitary primary leptomeningeal glioma. The mass was totally removed under awake surgery. Intraoperatively, no parenchymal involvement was noted. Histopathological study revealed a predominant anaplastic oligodendroglioma component and a focal anaplastic astrocytoma component, which was consistent with an anaplastic oligoastrocytoma. Adjuvant tomotherapy was followed and the tumor has not recurred until 12 months after surgery. A focal type of primary leptomeningeal glioma is extremely rare. We report a rare case of solitary primary leptomeningeal anaplastic oligoastrocytoma.
Astrocytoma ; Glioma* ; Oligodendroglioma

A total of 47 glial tumors of the brain was studied for the demonstration of glial fibrillary acidic protein(GFA) in tumor cells. This study was primarily aimed to confirm the applicability in the differential diagnosis of various glial tumors occuring in central nervous system. Intracellular positivity was observed only in well differentiated and moderately differentiated astrocytoma cells. GFA was negative in primitive glioma and oligodendroglioma. In glioblastoma multiforme pleomorphic cells were positive for GFA while spindle cells were negative. Elongated ependymoma cells arranged particularly around blood vessels were moderately positive for GFA while most cuboidal cells and round cells were negative. GFA was most helpful for the diagnosis of mixed glioma, where a sharp distinction could be made among different cellular component based on GFA staining. In conclusion it was confirmed that GFA is very useful tool for the diagnosis of different glial tumors of central nervous system.
Astrocytoma ; Blood Vessels ; Brain* ; Central Nervous System ; Diagnosis ; Diagnosis, Differential ; Ependymoma ; Glial Fibrillary Acidic Protein* ; Glioblastoma ; Glioma ; Oligodendroglioma

OBJECTIVE: Growth of cerebral gliomas depends on their neovascularization and invasion into the adjacent neural tissue. There are several extracellular and intracellular factors affecting its growth. Tenascin(TN) is a type of extracellular matrix(ECM) protein which may be responsible for the migration of neoplastic cells and tumor angiogenesis, but its exact role has not been established. We studied the relation between the expression of TN and the histological grade of the glial cell tumors as well as to determine the expression of TN-C in tumor vessel. PATIENTS AND METHODS:In the fifty-six patients with glial cell tumors, we characterized the expression of tenascin-C(TN-C) in the neoplastic vessel, intercellular network, and tumor cell by immunohistochemistry using monoclonal antibody. The relationship between the histological malignancy and TN-C expression was evaluated. In addition, TN-C expression of the tumor vessels was also examined. RESULTS: The tumors included 32 glioblastomas, 13 astrocytomas, 4 pilocytic astrocytoma, 3 anaplastic astrocytoma, 1 pleomorphic xanthoastrocytoma, 1 oligodendroglioma, 1 anaplastic oligodendroglioma, and 1 mixed oligoastrocytoma. TN-C expression in intercellular network of glioblastoma, anaplastic astrocytoma, and astrocytoma was 87. 5%, 66.7%, and 61.5%, respectively. There was a close relationship between the TN-C expression and histological grade of the glial cell tumors. In 28(87.5%) of 32 glioblastomas, TN-C was significantly expressed in the tumor vessels(p<0.05). CONCLUSION: Present results demonstrate that TN-C in the glial cell tumors may be identified as a one of the related factors contributing to malignant progression. And also, enhanced expression of TN-C in the tumor vessels of glioblastoma indicate the possibility that TN-C could be involved in neoplastic angiogenesis.
Astrocytoma ; Glioblastoma ; Glioma* ; Humans ; Immunohistochemistry ; Neuroglia* ; Oligodendroglioma ; Tenascin*

Malignant gliomas, including glioblastomas, anaplastic astrocytomas and anaplastic oligodendrogliomas, are the most common primary neoplasm of the human nervous system. Although the results of radiotherapy and chemotherapy such as temozolomide have improved the prognosis of patient with high grade gliomas, generally the outcomes are still miserable due to the resistance to current therapies. Therefore, recent trials and researches have focused on overcoming the resistance to standard chemo- and radiotherapy of malignant gliomas and are demonstrating the outstanding results. In the present review, we provide an overview of current status of the conventional therapies for malignant gliomas and recent advances for overcoming the resistance to the therapies.
Astrocytoma ; Dacarbazine ; Glioblastoma ; Glioma ; Humans ; Nervous System ; Oligodendroglioma ; Prognosis

The World Health Organization (WHO) classification of central nervous system (CNS) tumors was revised in 2016 with a basis on the integrated diagnosis of molecular genetics. We herein provide the guidelines for using molecular genetic tests in routine pathological practice for an accurate diagnosis and appropriate management. While astrocytomas and IDH-mutant (secondary) glioblastomas are characterized by the mutational status of IDH, TP53, and ATRX, oligodendrogliomas have a 1p/19q codeletion and mutations in IDH, CIC, FUBP1, and the promoter region of telomerase reverse transcriptase (TERTp). IDH-wildtype (primary) glioblastomas typically lack mutations in IDH, but are characterized by copy number variations of EGFR, PTEN, CDKN2A/B, PDGFRA, and NF1 as well as mutations of TERTp. High-grade pediatric gliomas differ from those of adult gliomas, consisting of mutations in H3F3A, ATRX, and DAXX, but not in IDH genes. In contrast, well-circumscribed low-grade neuroepithelial tumors in children, such as pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and ganglioglioma, often have mutations or activating rearrangements in the BRAF, FGFR1, and MYB genes. Other CNS tumors, such as ependymomas, neuronal and glioneuronal tumors, embryonal tumors, meningothelial, and other mesenchymal tumors have important genetic alterations, many of which are diagnostic, prognostic, and predictive markers and therapeutic targets. Therefore, the neuropathological evaluation of brain tumors is increasingly dependent on molecular genetic tests for proper classification, prediction of biological behavior and patient management. Identifying these gene abnormalities requires cost-effective and high-throughput testing, such as next-generation sequencing. Overall, this paper reviews the global guidelines and diagnostic algorithms for molecular genetic testing of brain tumors.
Adult ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Central Nervous System ; Child ; Classification ; Diagnosis ; Ependymoma ; Ganglioglioma ; Genes, myb ; Glioblastoma ; Glioma ; Humans ; Molecular Biology ; Neoplasms, Neuroepithelial ; Neurons ; Oligodendroglioma ; Promoter Regions, Genetic ; Telomerase ; World Health Organization

Despite concentrated basic and clinical research efforts including the initial successful combination of surgery, radiotherapy and chemotherapy with BCNU, significant progress in the treatment of human brain tumors have been slow and looks for more successful strategies developed based upon the information from animal model system. It is to recreate in the laboratory under experimental condition a model of human brain tumors. Although no unique model of the numerous animal tumors resembling the spontaneous human brain tumors developed in these days, experimental animal models to have own specific adventages can be induced by exposure to oncogenic viruses or chemical carcinogens. Intracerebral injection of oncorna viruses can produce glioblastoma mutiformes, astrocytomas and sarcomas, while medulloblastoma, choroids plexus papilloma and ependymomas can be induced by papova viruses, and human adenovirus may cause neuroblastoma, medulloepithelioma and retinoblastomas. Chemical induction in adult animals and transplacental chemical induction were ependymoblastomas, glioma, gliosarcoma and malignant neurinomas. Reproducibility of location, cell type, and time of tumor appearances;expense;growth in tissue culture;trauma to brain;nature of vasculature, and amount of brain and tumor tissue available for examination are the variables to be considered in choosing a model to use in evaluating drug and other therapies, cell kinetics and immunological studies.
Adenoviruses, Human ; Adult ; Animals ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Carcinogens ; Carmustine ; Choroid ; Drug Therapy ; Ependymoma ; Glioblastoma ; Glioma ; Gliosarcoma ; Humans ; Kinetics ; Medulloblastoma ; Models, Animal ; Neurilemmoma ; Neuroblastoma ; Neuroectodermal Tumors, Primitive ; Oncogenic Viruses ; Papilloma ; Radiotherapy ; Retinoblastoma ; Sarcoma

Intrathird ventricular tumors that mainly occupy the ventricle cavity without extending to the neighbouring structures are rare. These tumors are developed from the choroids plexus, tela, ependyma, subjacent neuroglia and embryonic cell rest. The authors experienced 11 cases of rare intrathird ventricular tumors during the past 10 years. During the same period, number of surgically proven brain tumors were 990 and intrathird ventricular tumors comprised 1.1%. These are two cases of choroids plexus papillomas, three craniopharyngiomas, two germ cell tumors, one meningioma, one glioependymal cyst, one ependymoma, one astrocytoma. Suprasellar craniopharyngiomas, thalamic gliomas, optic and hypothalamic gliomas were excluded. The age distribution was from 6 years old to 59 years old. The clinical manifestation was characteristic in that they usually had the sudden intermittent headache without specific localizing signs. Surgical approach to this area is by transcallosal or transcortical approach. Surgical total removal was quite feasible by either approach and outcome was rather favorable.
Age Distribution ; Astrocytoma ; Brain Neoplasms ; Child ; Choroid ; Craniopharyngioma ; Ependyma ; Ependymoma ; Glioma ; Headache ; Humans ; Meningioma ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; Neuroglia ; Optic Nerve Glioma ; Papilloma ; Papilloma, Choroid Plexus

Intrathird ventricular tumors that mainly occupy the ventricle cavity without extending to the neighbouring structures are rare. These tumors are developed from the choroids plexus, tela, ependyma, subjacent neuroglia and embryonic cell rest. The authors experienced 11 cases of rare intrathird ventricular tumors during the past 10 years. During the same period, number of surgically proven brain tumors were 990 and intrathird ventricular tumors comprised 1.1%. These are two cases of choroids plexus papillomas, three craniopharyngiomas, two germ cell tumors, one meningioma, one glioependymal cyst, one ependymoma, one astrocytoma. Suprasellar craniopharyngiomas, thalamic gliomas, optic and hypothalamic gliomas were excluded. The age distribution was from 6 years old to 59 years old. The clinical manifestation was characteristic in that they usually had the sudden intermittent headache without specific localizing signs. Surgical approach to this area is by transcallosal or transcortical approach. Surgical total removal was quite feasible by either approach and outcome was rather favorable.
Age Distribution ; Astrocytoma ; Brain Neoplasms ; Child ; Choroid ; Craniopharyngioma ; Ependyma ; Ependymoma ; Glioma ; Headache ; Humans ; Meningioma ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; Neuroglia ; Optic Nerve Glioma ; Papilloma ; Papilloma, Choroid Plexus

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.
Astrocytoma ; Blood-Brain Barrier ; Capillaries ; Carboplatin* ; Glioblastoma ; Glioma* ; Humans ; Incidence ; Oligodendroglioma