bluuebunny/crossref_metadata_2025_split huggingface dataset:
MPC-06 LRG1 HAS MULTIPLE POTENTIAL FOR CLINICOPATHOLOGICAL BIOMARKER OF GLIOBLASTOMA
Authors: Furuta Takuya , Sugita Yasuo , Komaki Satoru , Ohshima Kouichi , Morioka Motohiro , Uchida Yasuo , Tachikawa Masanori , Otsuki Sumio , Terasaki Tetsuya , Nakada Mitsutoshi 
Published: December 2019

Abstract

BACKGROUND AND AIM
Leucine-rich α-2 glycoprotein 1 (LRG1) is one of the candidate proteins as a diagnostic marker for glioblastoma. Although association with angiogenesis has been reported, it has been suggested that the role as a biomarker differs depending on the tumor types. The role of LRG1 as a biomarker in glioblastoma was examined clinicopathologically.

METHODS
Tumor tissues of 156 cases diagnosed as diffuse glioma (27 astrocytomas, 15 oligodendrogliomas, 114 glioblastomas) according to WHO 2016 classification at Kurume University from January 2001 to April 2019 were used. The immunohistochemical intensity of LRG1 was scoring as 4 stages and classified into 2 groups; score 0–1 was defined as low expression and score 2–3 was defined as high expression. Mutations of IDH1/2 and TERT promoter were analyzed by Sanger method. In glioblastoma, the relationship between LRG1 expression and clinical parameters such as age, preoperative Karnofsky Performance Scale, tumor location, extent of resection, MGMT promoter, and prognosis were examined.

RESULTS
LRG1 high expression rate was 41.2% (47/114) in glioblastoma, 3.7% (1/27) in astrocytoma, 20% (3/15) in oligodendroglioma, and glioblastoma showed significant higher expression level of LRG1 compared with lower-grade glioma (p = 0.0003). High expression of LRG1 was an independent favorable prognostic factor (HR 0.41, 95% CI 0.18–0.86, p=0.019) in IDH-wildtype glioblastoma, and correlated with gross total resection (p = 0.002) and the tumor location of the non-subventricular zone (SVZ) (p = 0.00007).

CONCLUSION
LRG1 demonstrated multiple potential as diagnostic, prognostic, and regional biomarker for glioblastoma.
MPC-16 RAPID PROGRESSIVE SPINAL DIFFUSE MIDLINE GLIOMA, A CASE REPORT
Authors: Takezaki Tatsuya , Shinojima Naoki , Kuroda Junichiro , Yamamoto Takahiro , Makino Keishi , Yokoo Hideaki , Mikami Yoshiki , Mukasa Akitake 
Published: December 2019

Abstract
A 17-year-old boy presented with a 2-week history of lower back pain, progressive gait difficulty and sensory deficit of bilateral lower limbs. Magnetic resonance imaging of neuroaxis showed intramedullary tumor with spinal cord expansion from Th12 to L2 and irregular areas of enhancement. Emergent laminoplasty and biopsy was performed. Histopathological examination showed small atypical cells, but most cells had too much degeneration and necrosis to confirm the diagnosis definitively. Leptomeningeal dissemination caused conscious disturbance, nuchal rigidity and epilepsy. 2 weeks after decompression, we performed cordotomy again for advanced diagnosis, to be found diffuse midline glioma, H3K27M mutant by immunohistopathological examination and DAN sequence. He was treated with combination of whole brain and spine radiation therapy and chemotherapy with temozolomide and bevacizumab. He is still alive over 6 months. The clinical significance of H3K27M mutant in spinal gliomas is unclear. Further examinations are needed.
MPC-17 USEFULNESS OF INTRAOPERATIVE MOLECULAR DIAGNOSIS OF GLIOMA USING REAL-TIME PCR
Authors: Koriyama Shunichi , Nitta Masayuki , Masui Kenta , Maruyama Takashi , Saito Taiichi , Komori Takashi , Muragaki Yoshihiro , Kawamata Takakazu 
Published: December 2019

Abstract

BACKGROUNDS
Based on the comprehensive gene association studies in recent years, the revision was issued in 2016 WHO classification, integrating genetic information in glioma diagnosis. Many studies have been reported the correlation between each molecular subtype and prognosis in the new classification. Gliomas surgery is required to maximum tumor resection with functional preservation. Currently, our institute decides a surgical strategy based on the morphological diagnosis and genetic information from the obtained tissue during the operation. We evaluated the IDH 1/2 gene mutations and 1p/19q codeletion by using real-time PCR intraoperatively. We report the usefulness of this method in this presentation.

OBJECTIVE
58 specimens obtained during surgery from March to November 2017, IDH 1/2 gene mutations and 1p/19q codeletion were evaluated intraoperatively by real-time PCR. IDH 1/2 gene mutations were detected using HRM, and SNP genotyping was used for TERT promoter mutations expected as a surrogate marker for 1p/19q codeletion.

RESULT
Each gene mutation was detected in approximately 90 minutes from DNA extraction of obtained surgical tissue to analysis. The accuracy of HRM of IDH 1/2 mutations was 97.3% (72/74 cases) evaluated by the result of IDH1-R132H IHC or Sanger sequencing, and SNP genotyping of TERT promoter mutations was 94.3% (50/53 cases). There was almost no difference from final genetic information.

CONCLUSION
Real-time PCR is feasible as an intraoperative molecular diagnosis. The accuracy of diagnosis is very high and it can be evaluated in a short time, so it’s useful for decision making during operation.
NI-08 TRIAL AND PROBLEM OF USING ASL IN INTRAOPERATIVE MRI
Authors: Nishiyama Jun , Yonemochi Takuya , Yokota Kazuma , Atsumi Hideki , Sorimachi Takatoshi , Chang Han Soo , Matsumae Mitsunori , Shibukawa Shuhei , Takano Susumu , Kajihara Nao 
Published: December 2019

Abstract

INTRODUCTION
Magnetic resonance perfusion imaging is considered to be available as grading of brain tumor and follow-up of brain treatment. One of the methods, arterial spin labeling (ASL), is a test that is useful for patients with renal impairment and contrast agent allergy and has low invasiveness because it does not use a contrast agent. However, there have been no reports of ASL in intraoperative MRI (iMRI).

PURPOSE
In this hospital iMRI (1.5T), it was examined whether ASL could be used to evaluate residual tumor in patients under general anesthesia.

CASE STUDY
A 75-year-old woman with right temporal lobe Glioblastoma. 43-year-old man, left temporal lobe Diffuse astrocytoma. All performed ASL at the time of MRI imaging for navigation before induction of anesthesia just before surgery and iMRI. In all cases, the blood pressure at iMRI was maintained, and Post Label Delay (PLD) calculated the optimal PLD from the carotid artery velocity measured by iMRI, and defined it as 1800–2200 ms, and performed ASL.

RESULTS
Actually, imaging by iMRI was almost difficult to visualize, and reflux was not recognized not only in the tumor but also in the gray matter.

DISCUSSION
The blood flow velocity measurement in the internal carotid artery is performed by the phase contrast method by intraoperative MRI, and the CBF decreases because propofol used during the operation decreases the CBF and also the brain metabolism. However, it has been suggested that it is one of the factors that make evaluation with ASL difficult. Although the iMRI of our hospital is 1.5 T, which is also a subject of investigation, it is thought that there is a limit to ASL imaging in the case of general anesthesia with propofol even from the calculated PLD.

CONCLUSION
ASL in iMRI at our hospital was not useful.
NI-10 AVAILABILITY OF AMIDE PROTON TRANSFER-WEIGHTED MRI METRICS IN GLIOMA
Authors: Yamashita Shinji , Azuma Minako , Saito Kiyotaka , Watanabe Takashi , Yokogami Kiyotaka , Takeshima Hideo 
Published: December 2019

Abstract

OBJECTIVE
Chemical exchange saturation transfer (CEST) is a novel MR imaging contrast technique that relies on the molecular characteristics of the sample. Amide proton transfer (APT) imaging is an emerging CEST-based MR imaging technique that is sensitive to mobile proteins and peptides in the tissue. APT imaging has become increasingly recognized as a promising imaging modality for glioma. Several reports suggest that APT signals are a promising imaging biomarker for glioma grading and prediction of molecular marker status. In this study, we assessed the utility of APT imaging in glioma by evaluating the relationship between APT signals and clinical parameters in glioma.

METHODS
We enrolled 23 glioma patients (25 lesions) who underwent preoperative MRI with APT imaging and surgery at our institution between May 2018 and July 2019. The median age of patients was 64 years old (range, 14–84). 2 patients had Grade 2, 1 patient had Grade 3, and 22 patients had Grade 4. APT signals were measured inside the ROI that was manually placed in the solid portion of tumor that best represented the entire tumor signal on raw APT images.

RESULTS
We could see that the high APT signals seemed to be related to IDH wild status and high glioma grading (IDH status; p=0.171, Grade; p=0.113). Moreover, the high APT signals were significantly strong related to high Mib-1 LI (p=0.0068, cutoff: 3.295%, sensitivity: 83%, specificity: 71%).

CONCLUSIONS
APT imaging might be associated with IDH mutation status and glioma grading. Especially, high APT signal was a great predictor of high MIB-1 LI in glioma.
NI-18 INVASIONS OF WHITE MATTER AS A PROGNOSTIC FACTOR IN LOW GRADE GLIOMAS
Authors: Nakahara Yukiko , Ito Hiroshi , Koguchi Motofumi , Wakamiya Tomihiro , Masuoka Jun , Abe Tatsuya 
Published: December 2019

Abstract

INTRODUCTION
Gliomatosis cerebri (GC), which was characterized by widespread infiltration of the brain involving three lobes, was deleted in the 2016 WHO classification. However, it is known that gliomas with GC growth pattern have a poor prognosis even in low histological grading. In this study, we focused on tumor invasion into white matter fibers. We analyzed the MRI findings focusing on white matter fibers and compared in patients with histologically proven low grade gliomas (LGGs) with GC pattern and localized LGGs.

METHOD
The patients can be classified into four groups according to the range of tumor invasion in T2-weighted image as follows: group 1, more than 3 lobes (n=6); group 2, 1 or 2 lobes infiltrate the basal ganglia (n=5); group 3, multicentric (n=2) and group 4 (n=12), localized. In reference to the human brain white matter atlas, the infiltration to the major white matter fibers (uncinate fasciculus, genu &splenium of corpus callosum, inferior fronto-occipital fasciculus, superior& inferior longitudinal fasciculus) was examined.

RESULTS
Twenty-five patients (median 39.5 years) were included in the study. Of these, 20 patients were histologically diagnosed with diffuse astrocytomas, and 5 patients with oligodendrogliomas. The infiltrations into ifo, slf, and ilf of white matter fibers were a poor prognostic factor. The number of infiltrating white matter fibers correlated significantly with the Kaplan-Meier survival curve.

CONCLUSIONS
The 2016 WHO classification defines diagnostic entities by combining molecular and histological information and remove GC as a distinct glioma entity. LGGs with GC pattern should be considered to be detected in different types of histologically and molecularly defined gliomas. As the patient numbers analyzed here were small, and larger series reproducing these results would be desirable. MRI findings particularly focusing on infiltration of LGGs into white matter fibers might be important to estimate the prognosis of patients.
NQPC-09 PROGNOSIS AND DELAYED COMPLICATIONS OF MEDULLOBLASTOMA IN KOBE CHILDREN’S HOSPITAL
Authors: Kawamura Atsufumi , Koyama Junji , Akutsu Nobuyuki , Yamanishi Shunsuke 
Published: December 2019

Abstract
Medulloblastoma is the most common pediatric malignant tumor and about 84.2% of cases are under 15 years old. With a current combined-modality approach that includes surgical approach, chemotherapy and radiation therapy, 5 year-survival rates have become 70–85% and also the so-called long-term survivors have increased in our country. This report reviews the prognosis and delayed complications of medulloblastoma in our institute. Cases were 14 boys and 11 girls from January,2010 to May 2019. Mean age was 6.1 years old (4 months to 14 years old). 18 cases receiver gross total removal and 12 cases were high risk group. Exclude recent 4 cases, 15 cases have indicated complete reaction though 6 cases had relapsed or new tumor. The results are that 5 year-survival rates in our institute is 86.7%, but 4 cases had neuro-psychological complications. 5 cases suffered from endocrinal disorders which were not confirmed after the end of all treatments. 2 secondary cancer had appeared 5 and 8 years after the first treatments. The more the survivor in medulloblastoma cases increase, neurosurgeons have to consider long term follow up more than 5 years and pay more attention to support activity of daily life of these patients.
ML-08 THE ROLE OF MAINTENANCE HIGH-DOSE METHOTREXATE CHEMOTHERAPY IN ELDERLY PRIMARY CNS LYMPHOMA PATIENTS
Authors: Mishima Kazuhiko , Shirahata Mitsuaki , Adachi Jun-Ichi , Suzuki Tomonari , Fujimaki Takamitsu , Nishikawa Ryo 
Published: December 2019

Abstract

BACKGROUND
The addition of high-dose methotrexate (HD-MTX)-based chemotherapy to whole brain irradiation (WBRT) has improved the prognosis of primary central nervous system lymphoma (PCNSL). However, the high neurotoxicity rates observed, especially in the elderly, raised interest in chemotherapy-only treatments. Withholding radiotherapy substantially decreases the risk of neurotoxicity, however, disease control may be compromised. In the elderly who cannot tolerate WBRT as a consolidation, maintenance treatment may serve as a feasible approach after an initial response. We treated ePCNSL with induction immunochemotherapy, maintenance chemotherapy with HD-MTX and deferred WBRT. Here, we retrospectively investigated the prognosis for ePCNSL that became CR after the induction chemotherapy.

MATERIAL AND METHODS
Newly diagnosed ePCNSL (median age: 74 years) received biweekly rituximab/HD-MTX for 6 cycles (induction) followed by monthly rituximab/HD-MTX for 2 cycles (consolidation) and then were treated differently according to the radiological response. With CR patients, HD-MTX was continued with every 3 months (maintenance) for 2 years. Patients who did not obtain consent for maintenance therapy were followed up. For PD patients, immunochemotherapy was interrupted and WBRT initiated immediately. Patients with PR and SD were treated with alternative chemotherapy with temozolomide and/or stereotactic radiotherapy or WBRT.

RESULTS
The median PFS was 24.6 months and median OS was 27 months for the entire cohort. Of the 42 ePCNSL, 26 had CR after induction and consolidation, of which 18 cases were carried out maintenance (M+) and 8 cases were followed up (M-). Median PFS was 73 months in the M+ group and 24.5 months in the M- group. Median OS is 102.2months versus 27.6 months, respectively. Both mPFS (P= 0.0125) and mOS (P =0.0015) were significantly prolonged by maintenance therapy.

CONCLUSION
It was suggested that maintenance treatment with HD-MTX may improve the prognosis for ePCNSL that reached complete response after induction therapy.
ML-10 PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE CRANIAL VAULT: A CASE REPORT
Authors: Nitta Naoki , Fukami Tadateru , Sasao Akifumi , Nozaki Kazuhiko 
Published: December 2019

Abstract

BACKGROUND
Tumors other than meningiomas, cavernous malformations and metastatic tumors rarely originate in the cranial vault. We report a case of primary diffuse large B-cell lymphoma of the cranial vault.

CASE DESCRIPTION
A 58-year-old woman was referred to our hospital because of a right frontal subcutaneous mass that had rapidly increased in size. The patient had been well until approximately 2 months before this referral, when she had slight difficulty in opening the right eye. Thereafter she had headaches and a swelling of the forehead. She was seen in a neurosurgery clinic and referred to our hospital. She had no past history of serious illnesses, operations or hospitalizations. On examination, there was a fixed firm mass, 13 cm in size, in the right side of the forehead. The skin on the center of the mass was stretched and took on a reddish hue. Neurological examination was negative. Blood chemistry tests showed lactate dehydrogenase four times above normal and a slight increase in alkaline phosphatase, amylase and lipase. Beta-2-microglobulin was normal. Bone windows of computed tomography (CT) of the head showed hyperostosis and permeative lytic changes of the frontal bone. Postcontrast MRI showed a large enhanced subgaleal lesion extending through the bony calvarium with a large subdural component. Histological examination after a biopsy was characteristic for a diffuse large B-cell lymphoma. Postcontrast CT of the abdomen and FDG-PET showed metastatic lesions in the pancreas, kidneys and cervical lymph nodes. The patient has been treated by CHOP chemotherapy and has been well.

CONCLUSIONS
We present a case of primary diffuse large B-cell lymphoma of the cranial vault. We recommend including this tumor variant in the differential diagnosis of rapid growing cranial vault tumors.
ML-13 AN ATTEMPT OF RECHALLENGE OF HD-MTX AND MAINTENANCE THERAPY OF MTX FOR PATIENTS WITH PCNSL
Authors: Yamaguchi Takashi , Nagayama Rie , Gomi Akira , Kawai Kensuke 
Published: December 2019

Abstract

PURPOSE
High dose methotrexate (HD-MTX) followed by radiotherapy (RT) is a standard therapy for primary CNS malignant lymphoma. However, the delayed neuronal toxicity due to RT is a serious problem especially for elderly patients. To avoid RT toxicity, we performed re-challenge of HD-MTX until complete remission (CR). Furthermore, we started maintenance therapy (MT) with MTX for elderly and poor Karnofsky Performance Scale (KPS) patients and reported the interim results.

METHODS
We performed HD-MTX (3.5g/m2) therapy until achieving CR for patients whose ages were older than 70 years old and KPS were less than or equal to 60%. After having CR, 3 courses of MT of MTX (3g/patient) for 3 weeks were introduced every 3–4 months for 2 years. In cases of recurrence, HD-MTX was repeated. But when CR was not achieved by HD-MTX, RT was introduced.

RESULTS
Number of patients was 8. Median age, median KPS, and median follow up periods were 73.5y.o. (71–78), 40% (30–60), and 4.5mo. (1–42), respectively. CR rate was 75% but two patients did not achieve CR. One patient had a complication of acute tubular necrosis just after first use of HD-MTX and another died due to pneumocystis pneumonia after 4th HD-MTX. Two patients without RT maintained CR and good KPS over 2 years. Four patients with RT maintained CR but their KPS gradually deteriorated.

DISCUSSION
Rechallenge of HD-MTX exhibits better results and comparable safety with standard treatment, but RT was unavoidable. In order to avoid RT, we started MTX maintenance therapy for elderly and poor KPS patients before recurrence. Our maintenance therapy is easy and good disease control for patients who had not received RT, however there were two serious adverse events.

CONCLUSION
Rechallenge of HD-MTX and maintenance therapy of MTX might be promising but dangerous for elderly patients. Further careful assessment is needed.
MNG-03 PD-L1 EXPRESSION, PATIENT PROGNOSIS AND INITIAL WHO GRADE IN GRADE II/III MENINGIOMA
Authors: Kamamoto Dai , Sasaki Hikaru , Sasao Ryota , Fujiyama Takumi , Yoshida Kazunari 
Published: December 2019

Abstract
The optimal treatment for grade II/III meningioma is operation with or without radiation therapy. However, their natural course is sometimes aggressive with high recurrent rate. There is no effective treatment other than operation and radiation therapy, therefore, a new therapeutic strategy for grade II/III meningioma is urgently required.PD-1 and PD-L1 play important roles as immune-checkpoint mediators within tumor microenvironment and the antibodies to these molecules are now approved for the treatment of various kinds of cancers. In Japan, anti-PD-1 antibody and anti-CTLA-4 antibody are approved for unresectable melanoma or advanced / recurrent non-small cell lung cancer and their high effectiveness has been reported. We investigated the expression of PD-L1 (clone:28-8) in 51 cases of grade II/III meningioma by immunohistochemistry and analyzed the relationship between the expression with overall survival, progression free survival and initial WHO grade. For now, we have evaluated 25 cases of PD-L1 immunohistochemistry and PD-L1 showed positivity in 15 cases. There is no correlation observed between PD-L1 expression and patients’ prognosis. Although it does not reach a significant difference, the WHO grade at the time of initial operation tends to be high in those with high PD-L1 staining rate.Similar studies that were previously reported did not use antibodies targeting clone 28-8, which was used as a companion diagnosis for nivolumab administration, but “Correlation between PD-L1 expression and WHO grade”, or “PD-L1 expression is an independent prognostic factor” have been reported. In our investigation, which was using antibodies for companion diagnosis, PD-L1 was positive in more than half of Grade II / III meningiomas and it also related to WHO grade. These results suggest the possibility that tumor immune evasion mechanisms are also working in meningiomas. At the conference, we will report it with the specific data from all cases with a literature review.
CS-05 EXTRA-PARENCHYMAL (PERIPHERAL) ATYPICAL TERATOID / RHABDOID TUMORS
Authors: Oka Hidehiro , Kusumi Mari , Kondo Koji , Koremura Masafumi 
Published: December 2019

Abstract
AT/RT is a malignant embryonal tumor reported by Rorke in 1996. Authors reported first AT/RT in Japan in 1998. This tumor entity was included as new malignant embryonal tumor in WHO 2000, and tumors of Japanese patients has been reported more than 60 cases in the past. This AT/RT is a tumor in the brain parenchyma that a medulloblastoma and PNET and the possibility that it has been misdiagnosed have had pointed out. On the other hand, it is reported that there is the type that we should call peripheral AT/RT which rarely occurs in extra-parenchyma. We want to propose that there is such special tumor group. In the results, age: 6 infants were main (2nd - 14 years old after birth). tumor location: 6 sellar region, 3 civuses, 2 petrous bone or cerebellum and 2 conexities. treatment: duration of survival significantly improved all macroscopic tumor resection by the operation, but, in small pontine part AT/RT, an outcome tended to be poor. On the other hand, in AT/RT which occurred in the sellar region, all cases adult woman tended to have good prognosis. It is necessary for AT/RT (central AT/RT) in the brain to recognize that there is extra-parenchymal AT/RT (peripheral AT/RT) tumor which we reported this time which came to be recognized widely.