Management for Different Glioma Subtypes: Are All Low-Grade Gliomas Created Equal?

2019 ◽  
pp. 133-145 ◽  
Author(s):  
Martin C. Tom ◽  
Daniel P. Cahill ◽  
Jan C. Buckner ◽  
Jörg Dietrich ◽  
Michael W. Parsons ◽  
...  
Keyword(s):  
Molecular Genetic ◽  
World Health ◽  
Low Grade ◽  
Lower Grade ◽  
Future Directions ◽  
Molecular Alterations ◽  
Lower Grade Glioma ◽  
Grade 3 ◽  
Health Organization

Following the identification of key molecular alterations that provided superior prognostication and led to the updated 2016 World Health Organization (WHO) Central Nervous System (CNS) Tumor Classification, the understanding of glioma behavior has rapidly evolved. Mutations in isocitrate dehydrogenase (IDH) 1 and 2 are present in the majority of adult grade 2 and 3 gliomas, and when used in conjunction with 1p/19q codeletion for classification, the prognostic distinction between grade 2 versus grade 3 is diminished. As such, the previously often used term of “low-grade glioma,” which referred to grade 2 gliomas, has now been replaced by the phrase “lower-grade glioma” to encompass both grade 2 and 3 tumors. Additional molecular characterization is ongoing to even further classify this heterogeneous group of tumors. With such a colossal shift in the understanding of lower-grade gliomas, management of disease is being redefined in the setting of emerging molecular-genetic biomarkers. In this article, we review recent progress and future directions regarding the surgical, radiotherapeutic, chemotherapeutic, and long-term management of adult lower-grade gliomas.

scholarly journals Succinate Dehydrogenase–Deficient Renal Cell Carcinoma

2018 ◽  
Vol 143 (5) ◽  
pp. 643-647 ◽  
Author(s):  
Tsung-Heng Tsai ◽  
Wen-Ying Lee
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Succinate Dehydrogenase ◽  
Renal Cell ◽  
World Health ◽  
Low Grade ◽  
Long Term Follow Up ◽  
Health Organization

Succinate dehydrogenase (SDH)–deficient renal cell carcinoma is a recently recognized distinct subtype of renal cell carcinoma in the 2016 World Health Organization classification. It is associated with SDH gene germline mutations, which also cause paraganglioma/pheochromocytoma, gastrointestinal stromal tumor, and pituitary adenoma. The tumor most commonly presents in young adulthood. The tumors are arranged in solid nests or in tubules and frequently show cystic change. The tumors are composed of cuboidal to oval cells with round nuclei, dispersed chromatin, and inconspicuous nucleoli. The cytoplasm is eosinophilic or flocculent but not truly oncocytic. The most distinctive histologic feature is the presence of cytoplasmic vacuoles or inclusions. Loss of SDH subunit B immunostaining is needed for a definite diagnosis. The prognosis is good for low-grade tumors but worse for tumors with high-grade nuclei, sarcomatoid change, or coagulative necrosis. Long-term follow-up is indicated.

Treatment of Adult Lower-Grade Glioma in the Era of Genomic Medicine

2016 ◽  
pp. 75-81 ◽  
Author(s):  
Susan M. Chang ◽  
Daniel P. Cahill ◽  
Kenneth D. Aldape ◽  
Minesh P. Mehta
Keyword(s):  
Molecular Genetic ◽  
Genomic Medicine ◽  
Genetic Alterations ◽  
World Health ◽  
Low Grade ◽  
Lower Grade ◽  
Cell Of Origin ◽  
Low Grade Gliomas ◽  
Molecular Features ◽  
Anaplastic Gliomas

By convention, gliomas are histopathologically classified into four grades by the World Health Organization (WHO) legacy criteria, in which increasing grade is associated with worse prognosis and grades also are subtyped by presumed cell of origin. This classification has prognostic value but is limited by wide variability of outcome within each grade, so the classification is rapidly undergoing dramatic re-evaluation in the context of a superior understanding of the biologic heterogeneity and molecular make-up of these tumors, such that we now recognize that some low-grade gliomas behave almost like malignant glioblastoma, whereas other anaplastic gliomas have outcomes comparable to favorable low-grade gliomas. This clinical spectrum is partly accounted for by the dispersion of several molecular genetic alterations inherent to clinical tumor behavior. These molecular biomarkers have become important not only as prognostic factors but also, more critically, as predictive markers to drive therapeutic decision making. Some of these, in the near future, will likely also serve as potential therapeutic targets. In this article, we summarize the key molecular features of clinical significance for WHO grades II and III gliomas and underscore how the therapeutic landscape is changing.

scholarly journals Behavior-Oriented Nomogram for the Stratification of Lower-Grade Gliomas to Improve Individualized Treatment

2020 ◽  
Vol 10 ◽  
Author(s):  
Ruo-Lun Wei ◽  
Li-Wei Zhang ◽  
Jian-Guo Li ◽  
Feng-Dong Yang ◽  
Ya-Ke Xue ◽  
...  
Keyword(s):  
Dna Methyltransferase ◽  
Predictive Performance ◽  
Individualized Treatment ◽  
World Health ◽  
Low Grade ◽  
Lower Grade ◽  
Validation Group ◽  
Who Grade ◽  
Health Organization ◽  
Cortical Involvement

Secondary glioblastomas (sGBM) are derived from previously lower-grade [World Health Organization (WHO) grades II or III] gliomas. Lower-grade benign-behaving gliomas may retain their former grade following recurrence, or may become malignant higher-grade glioblastomas. Prediction of tumor behavior in lower-grade gliomas is critical for individualized glioma therapy. A total of 89 patients were included between January 2000 and January 2019 in the present study to establish a nomogram via univariate and multivariate logistic regression analyses. Nomogram predictive performance was tested in the validation group. We then analyzed 36 O-6-methylguanine-DNA methyltransferase (MGMT) unmethylated lower-grade gliomas from patients seen at West China Hospital of Sichuan University. Survival statistics were calculated with the Kaplan-Meier method. Two clinical factors (molecular diagnosis and WHO grade), five radiological factors (location, cortical involvement, multicentricity, uniformity, and margin enhancement), one biomarker (1p19q codeletion), and a combination of three biomarkers (IDH+/ATRX-/TP53-) were associated with glioma upgrading. Nomograms positive for these prognostic factors had an AUC of 0.880 in the derivation group and 0.857 in the validation group. The calibration and score-stratified survival curves for the derivation group and validation group were good. An operational nomogram was published at https://warrenwrl.shinyapps.io/DynNomapp/. The overall survival of secondary gliomas in the MGMT-unmethylated cohort were influenced independently by the use of temozolomide during the treatment of formerly low-grade gliomas (p=0.00096). Clinical and radiological factors and biomarker-based behavior-oriented nomograms may offer a feasible identification tool for the detection of sGBM precursors. This method may further assist neurosurgeons with the stratification of lower-grade glioma cases and thus the development of better, more individualized treatment plans.

scholarly journals GENE-13. GENOMIC AND RADIOMIC LANDSCAPE OF IDH WILDTYPE-TERT PROMOTER MUTATION IN LOWER-GRADE GLIOMAS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi100-vi100
Author(s):  
Shuai Liu ◽  
Chuanbao Zhang ◽  
Xiaoguang Qiu
Keyword(s):  
World Health ◽  
Genetic Lineage ◽  
Lower Grade ◽  
Imaging Data ◽  
Who Grade ◽  
Non Invasive ◽  
Tert Promoter ◽  
Genome Wide ◽  
Lower Grade Glioma ◽  
Health Organization

Abstract BACKGROUND Recently, a rare subset of lower grade glioma (LoG), characterized by wild-type isocitrate dehydrogenase (IDH) and mutated TERT promoter (IDHWT-TERTpMut), has been highlighted for its dismal clinical behavior and classified as world health organization (WHO) grade IV. METHODS We examined this distinct tumor subset through genome-wide analysis of 745 gliomas and radiomic analysis of 129 LoGs. RESULTS We found that the prognosis and genetic lineage of IDHWT-TERTpMut LoGs were similar to those of glioblastoma. Importantly, a signature of 7 radiomic features from magnetic resonance imaging data differentiated IDHWT-TERTpMut LoGs from other LoGs. In addition, we found the radiomic related genes involved in many tumorigenic processes. CONCLUSIONS Overall, our findings suggest that the biological characteristics of IDHWT-TERTpMut LoGs and the radiomic signature could help in the non-invasive diagnosis of this tumor subtype.

scholarly journals Psychometric validation of the Chinese version of the PaArticular Scales among elderly residents in long-term care facilities with joint contractures

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-chang Chen ◽  
Keh-chung Lin ◽  
Chen-Jung Chen ◽  
Shu-Hui Yeh ◽  
Ay-Woan Pan ◽  
...  
Keyword(s):  
World Health Organization ◽  
Long Term Care ◽  
Chinese Version ◽  
World Health ◽  
Term Care ◽  
Joint Contractures ◽  
The World ◽  
Health Organization

Abstract Background Joint contractures, which affect activity, participation, and quality of life, are common complications of neurological conditions among elderly residents in long-term care facilities. This study examined the reliability and validity of the Chinese version of the PaArticular Scales in a population with joint contractures. Methods A cross-sectional study design was used. The sample included elderly residents older than 64 years with joint contractures in an important joint who had lived at one of 12 long-term care facilities in Taiwan for more than 6 months (N = 243). The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the World Health Organization Quality of Life scale and the World Health Organization Disability Assessment Schedule. Results The Chinese version of the PaArticular Scales had excellent reliability, with a Cronbach α coefficient of 0.975 (mean score, 28.98; standard deviation, 17.34). An exploratory factor analysis showed three factors and one factor with an eigenvalue > 1 that explained 75.176 and 62.83 % of the total variance in the Activity subscale and Participation subscale, respectively. The subscale-to-total scale correlation analysis showed Pearson correlation coefficients of 0.881 for the Activity subscale and 0.843 for the Participation subscale. Pearson’s product-moment correlation revealed that the correlation coefficient (r) between the Chinese version of the PaArticular Scales and the World Health Organization Disability Assessment Schedule was 0.770, whereas that for the World Health Organization Quality of Life scale was − 0.553; these values were interpreted as large coefficients. Conclusions The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan and has acceptable levels of reliability and validity. However, the Chinese version must be further tested for applicability and generalizability in future studies, preferably with a larger sample and in different clinical domains.

AVALIAÇÃO DA RELAÇÃO DO NÚMERO DE SINTOMÁTICOS RESPIRATÓRIOS E OS CASOS CONFIRMADOS DE TUBERCULOSE EM PALMAS-TO NO PERÍODO DE 2015-2016

2018 ◽  
Vol 5 (2) ◽  
pp. 29-33
Author(s):  
Robson de Sousa ◽  
Maria do Socorro Rocha Sarmento Nobre
Keyword(s):  
Early Identification ◽  
World Health ◽  
Epidemiological Surveillance ◽  
Cross Sectional ◽  
Public Health Activity ◽  
Transmission Chain ◽  
Keywords Tuberculosis ◽  
Health Organization ◽  
Term Objective

RESUMO Estratégia usada internacionalmente a busca ativa de sintomáticos respiratórios permite identificar precocemente pessoas com tosse por tempo igual ou superior a três semanas consideradas com suspeita de tuberculose pulmonar visando à descoberta dos casos bacilíferos. É uma atividade de saúde pública e deve ser realizada por todos os serviços de saúde de forma permanente. Com o objetivo de identificar os casos, interromper a cadeia de transmissão e reduzir a incidência da doença a longo prazo.  Objetivo: Conhecer os números de casos notificados de tuberculose e realizar um comparativo com os indicadores de sintomático respiratório no município de Palmas/TO entre os anos de 2015 e 2016. Método: O estudo é do tipo descritivo, de corte transversal e documental direta. Conclusão: Verifica-se que o número confirmado de TB da pesquisa do SR tanto para o ano de 2015 quanto para o ano de 2016 está muito aquém dos casos novos notificados, foi possível perceber a descontinuidade dos pacientes que são encaminhados para avaliação e que não há segmentos principalmente em relação ao resultado dos exames.   Palavras-chave: Tuberculose. Vigilância Epidemiológica. Organização Mundial da Saúde. ABSTRACT A strategy used internationally for the active search of respiratory symptomatic patients allows early identification of people with cough for a time equal to or greater than three weeks considered with suspicion of pulmonary tuberculosis in order to discover the bacilliferous cases. It is a public health activity and must be performed by all health services on an ongoing basis. In order to identify the cases, interrupt the transmission chain and reduce the incidence of the disease in the long term. Objective: To know the numbers of reported cases of tuberculosis and to carry out a comparison with the indicators of respiratory symptomatology in the municipality of Palmas / TO between the years 2015 and 2016. Method: The study is descriptive, cross-sectional and direct documentary. Conclusion: It is verified that the confirmed number of TB of the RS research for both the year 2015 and the year 2016 is well below the new cases reported, it was possible to perceive the discontinuity of the patients that are referred for evaluation and which are not mainly related to the results of the exams. Keywords: Tuberculosis. Epidemiological surveillance. World Health Organization.

scholarly journals Genetic Abnormalities, Clonal Evolution, and Cancer Stem Cells of Brain Tumors

2018 ◽  
Vol 6 (4) ◽  
pp. 85 ◽  
Author(s):  
Ugo Testa ◽  
Germana Castelli ◽  
Elvira Pelosi
Keyword(s):  
Brain Tumors ◽  
Clonal Evolution ◽  
Pediatric Brain Tumors ◽  
Genetic Alterations ◽  
World Health ◽  
Driver Mutations ◽  
Low Grade ◽  
High Grade ◽  
Genetic Profiling ◽  
Health Organization

Brain tumors are highly heterogeneous and have been classified by the World Health Organization in various histological and molecular subtypes. Gliomas have been classified as ranging from low-grade astrocytomas and oligodendrogliomas to high-grade astrocytomas or glioblastomas. These tumors are characterized by a peculiar pattern of genetic alterations. Pediatric high-grade gliomas are histologically indistinguishable from adult glioblastomas, but they are considered distinct from adult glioblastomas because they possess a different spectrum of driver mutations (genes encoding histones H3.3 and H3.1). Medulloblastomas, the most frequent pediatric brain tumors, are considered to be of embryonic derivation and are currently subdivided into distinct subgroups depending on histological features and genetic profiling. There is emerging evidence that brain tumors are maintained by a special neural or glial stem cell-like population that self-renews and gives rise to differentiated progeny. In many instances, the prognosis of the majority of brain tumors remains negative and there is hope that the new acquisition of information on the molecular and cellular bases of these tumors will be translated in the development of new, more active treatments.

scholarly journals World Health Organization Sub-Types, Initial Treatment Outcome and Prognostic Study of Unselected Adult Patients with Acute Myeloid Leukaemia in Shanghai: An Analysis of 623 Cases

2009 ◽  
Vol 37 (4) ◽  
pp. 1191-1201 ◽  
Author(s):  
Y Ma ◽  
X Wang ◽  
X Xu ◽  
G Lin
Keyword(s):  
Prognostic Factor ◽  
Acute Myeloid Leukaemia ◽  
World Health Organization ◽  
Myeloid Leukaemia ◽  
Treatment Effect ◽  
Developed Countries ◽  
World Health ◽  
Health Organization ◽  
Acute Myeloid

This study investigated the complete remission (CR) rate and survival of 623 newly diagnosed patients with acute myeloid leukaemia (AML) in Shanghai, China, classified according to World Health Organization and French–American–British criteria, and compared the differences in treatment effect with those reported in developed countries and those reported in Shanghai from 1984 to 1994. Total CR rate was 66.5%, median survival was 18 months and estimated survival at 3 years was 30.8%. The 3-year relapse rate was 55.1%. These data showed that the CR rate was similar to that achieved in studies from developed countries, but long-term survival was worse. The CR rate and survival were increased markedly compared with data previously collected in Shanghai (1984-1994). Induction chemotherapeutic regimens based on idarubicin, daunorubicin or homoharringtonine all had similar CR rates and survivals. Karyotype was the most important prognostic factor. Multilineage dysplasia in de novo AML was not an independent prognostic factor. Improvement in the long-term treatment effect in China is an important challenge for the future.

scholarly journals Coronavirus Pandemic: Coping with the Psychological Outcomes, Mental Changes, and the “New Normal” During and After COVID-19

2020 ◽  
pp. 07-19
Author(s):  
Hiba Takieddine ◽  
Samaa AL Tabbah
Keyword(s):  
Healthcare Providers ◽  
Well Being ◽  
World Health ◽  
Vulnerable Groups ◽  
Public Health Response ◽  
New Normal ◽  
The World ◽  
Health Organization ◽  
The Impact

Coronavirus disease 2019 (COVID-19) is a highly infectious disease that has rapidly swept across the world, inducing a considerable degree of fear, worry and concern in the population at large and among certain groups in particular, such as older adults, healthcare providers and people with underlying health conditions. Authorities around the world tried to prevent the virus spread by imposing social distancing measures, quarantining citizens and isolating infected persons. Apart from its physical impact, COVID-19 pandemic has brought numerous changes to people’s lives. It changed daily routines, caused worldwide economic crisis, increased unemployment, and placed people under emotional and financial pressures. It affected people psychologically and mentally especially in terms of emotions and cognition. During the acute crisis, everyone to varying degrees experienced fear of infection, somatic concerns, worries about the pandemic’s consequences, loneliness, depression, stress, as well as increased alcohol and drug use. As part of its public health response, the World Health Organization (WHO) has worked with partners to develop a set of new guidelines and messages that can be used to prevent, manage, and support mental and psychological well-being in different vulnerable target groups during the outbreak. Whether people like it or not, the psychological sequela of this pandemic will emerge and persist for months and years to come leading to long-term consequences. New lifestyles and “New Normals” will surely emerge. The main purpose of this review is to summarize the impact of coronavirus pandemic on the psychological and mental health of people around the world especially vulnerable groups. It also presents the relevant intervention actions and recommendations to cope efficiently and effectively with the psychological short-term and long-term outcomes, mental changes, and the “New Normal” during and after COVID-19. Keywords: COVID-19; Coronavirus, Psychological; Mental; New Normal

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