Postoperative assessment of the efficiency of the radical removal of glioblastomas in the cerebral hemispheres

The paper analyzes the capacities of computed tomography (CT) and magnetic resonance imaging (MRI) in the postoperative period to evaluate the efficiency of surgical removal of the most malignant type of gliomas of the cerebral hemispheres. A total of 45 patients with different histological forms of cerebral hemispheral gliomas were examined, 37 of them with glioblastomas. Comparison of the results obtained by CT and MRI within the first 24 hours indicated that the latter was of greater informative value in all cases. At the same time only the use of a strict methodological approach to postoperatively estimating the remaining portions of glioblastomas makes it possible to apply these two methods as objective criteria for evaluating the efficiency of removal of a glioblastoma and hence the efficiency of subsequent therapeutic protocols. Contrast-enhanced MRI may be regarded as the method of choice in the primary assessment of patients with suspected recurrent glioblastoma.     

Immunohistochemical Markers for Prognosis of Ependymal Neoplasms

Intracranial ependymomas are the third most common primary brain tumor in children. Although clinical and histological criteria for ependymoma prognosis are recognized, studies have reported contradictory results. Prognostic significance based on immunohistochemistry of ependymomas has been reported in a few studies. One-hundred and twelve patients with intracranial ependymomas were examined retrospectively for immuno-expression of various tumor-associated antigens and apoptosis. The results demonstrated significant preponderance of expression of the tenascin, vascular endothelial growth factor protein (VEGF), epidermal growth factor (EGFR) and p53 protein in high-grade tumors. Also high-grade ependymomas revealed more prominent labeling indices (LI) for proliferative marker Ki-S1 and apoptotic index (AI), and lower LI for cyclin-dependent kinase inhibitors p27/Kip1 and p14ARF. For low-grade ependymomas the progression-free survival time (PFS) was found to be significantly shorter for Ki-S1 LI>5%, and for tenascin, VEGF and EGFR positivity. For high-grade ependymomas PFS was found to be significantly reduced for p27 LI<20%, p14ARF LI<10%, for p53 positivity, and for AI<1%. The CART modeling process exhibited five final groups of ependymoma patients (1) low-grade and tenascin-negative; (2) low-grade and tenascin-positive; (3) high-grade and p53-negative with p14 LI>0%; (4) high-grade with combination of either p53 positivity and p14 LI>10% or p53 negativity and p14 LI<10%; (5) high-grade and p53-positive with p14 LI<10%. In summary, some immunohistochemical variables were found to be the strong predictors of ependymoma recurrence and they seem to be useful for assessing individual tumor prognosis in routinely processed biopsy specimens together with tumor grade. For histologically benign ependymomas immunohistochemical study should be focused on Ki-S1, tenascin, EGFR and VEGF evaluation, whereas p53 expression and number of p27, p14 and ISEL-positive nuclei will be of value in determining PFS from high-grade ependymomas.     

Racemose arteriovenous angioma (malformation) of the brain

242 cases of brain arterio-venous malformations (AVM) are analysed clinically and anatomically. Their pathology, histological, ultrastructural and immunohistochemical characteristics, therapeutic pathomorphosis are described. The concept is suggested according to which AVM is a collective term including true developmental defects, dysembryogenetic tumors and outcomes of various pathologic processes (trauma, brain circulation and compensatory-adaptive disturbances, etc.). The necessity of therapeutic methods corrections in agreement with the disease pathogenesis is outlined.     

The histologic grade is a main prognostic factor for patients with intracranial ependymomas treated in the microneurosurgical era: an analysis of 258 patients

BACKGROUND: Ependymomas account for 3-5% of all intracranial malignancies and occur most often in children and young adults. These neoplasms continue to generate considerable controversy with regard to their rational clinical management. It has been shown that the histologic classification of ependymoma is a significant predictor of clinical outcome in patients with ependymoma. METHODS: Ependymomas from 258 patients who underwent microsurgery at a single institution were evaluated histologically to elucidate the prognostic utility of a recently proposed grading scheme. Pathologic and clinical data then were compared using univariate and multivariate analyses. RESULTS: Increasing grade of ependymoma malignancy was found to be associated strongly and independently with worse clinical outcomes in terms of both event-free survival and overall survival. The effect of radiotherapy also was found to be related to histologic grade and was more beneficial for patients who had anaplastic ependymomas and had undergone complete tumor removal. CONCLUSIONS: The application of a uniform diagnostic criteria for grading ependymomas highlighted the key role of tumor histology in clinical outcome in a cohort of patients who were treated in the microsurgical era. The recently proposed grading scheme is likely to be practically useful, reproducible, and clinically applicable.     

Nimesil effectiveness in rheumatoid arthritis

Clinical efficiency and safety of nimesil were studied in the multicenter open clinical trial of 52 patients with verified rheumatoid arthritis. Nimesil was given for 12 weeks in a daily dose 200-400 mg in addition to basic therapy. Clinical and laboratory parameters were assessed after 4 and 8 weeks of the treatment and after its end. The treatment produced a significant positive response of the articular syndrome. Marked improvement was registered in 11 (23.4%) patients, improvement--in 33 (79.2%) patients. Side effects were reversible and occurred in 8 (15.3%) patients. In 5 patients the drug was withdrawn. The conclusion is made on high efficiency and good tolerance of nimesil in rheumatoid arthritis patients.     

Proliferative markers of meningiomas: immunohistochemical analysis and prognostic value

Routine pathological examination cannot precisely predict the clinical course of meningiomas because even histologically benign tumors may recur after total removal. And so, numerous efforts have been made for evaluation of meningioma growth fraction and its prognostic value. In this study the prognostic significance of DNA toposiomerase II alpha (topoII) and cyclin A immunohistochemistry was examined in a series of 263 meningiomas. The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all the three markers were noted among the three grades of meningiomas. The scores for all the three markers were significantly different between recurrent and non-recurrent meningiomas including removed benign tumors. The most important information for an individual clinical outcome of histologically benign meningiomas should be elicited from simultaneous evaluation of all the three proliferative markers.     

Pleomorphic Xanthoastrocytomas: Immunohistochemistry,Grading and Clinico-pathologic Correlations. An Analysis of 34 Cases From a Single Institute

Pleomorphic xanthoastrocytomas (PXAs) are characterized as a well-delineated tumor entity with clear peculiarities in clinico-radiological picture, pathological appearance and biological behavior. Usually the PXAs are associated with relatively good prognosis. Nevertheless, up to 35% of patients die following one and more recurrence with or without tumor malignant transformation. Till now, there is no agreement on what histopathological features constitute to objective and reliable signs of PXAs malignancy and clinical outcome. Thirty-four PXAs were subdivided on three subsets: typical (Grade I) – tumors without mitoses per 20 high power fields, proliferating (Grade II) – tumors with mitoses but without necroses, and malignant (Grade III) – tumors with elevated mitotic index and necrotic foci. Also, immunohistochemical investigation with various tumor-associated antigens was performed. All PXAs subtypes showed differences in clinical outcomes. There were no recurrences and death among the tumors Grade I. Five out of 14 (36%) Grade II PXAs have recurred and one of them died. All 5 patients with PXAs Grade III have rapidly recurred and four of them died. Immunohistochemical variables, such as Ki-S1, p27/Kip1, vascular endothelial growth factor expression, p53 immunoreactivity and apoptotic index also exhibited significant differences among the three PXAs grades. The progression-free survival was significantly reduced for PXAs grade and presence of mitoses, whereas overall survival was reduced for mitotic index 3 and presence of necroses. No one from immunohistochemical variables reached significant value. In summary, the three-tiered PXAs subdivision proposed by us is carrying some element of rationality but, undoubtedly, requires further prospective studies.