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Diagnostic challenges, management and outcomes of midline low-grade gliomas

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Abstract

Introduction

Low-grade gliomas (LGGs) are slow-growing and diffusely infiltrating tumours constituting 25–30 % of adult gliomas. Rarely, these tumours may arise in the cerebral midline, including the thalamus, hypothalamus, tectum and brainstem. Here we present a contemporary experience with midline LGGs.

Methods

Midline LGGs were identified from a retrospective database of adult patients who received a histological diagnosis of WHO grade II glioma between 2006 and 2012 at a single institution. Location, radiological data and clinical outcomes were collected. IDH1 status was assessed by immunohistochemistry.

Results

Eighteen patients with midline LGGs were identified, with a median age of 45. Most received biopsy upon diagnosis, though asymptomatic patients with tectal tumours underwent active surveillance. Oligodendroglial tumours were much less common than in a comparable group of lobar tumours (6 vs. 38 %, Fisher’s exact test, p = 0.007). Only one tumour was immunopositive for IDH1 (1/17). Radiological diagnosis correlated with histology in only 71 % of patients. Median survival of midline LGGs was 48 months (3–90 months) and radiological features such as contrast enhancement, size and radiological diagnosis did not predict survival in this cohort. Median overall survival of midline LGGs was less than lobar LGGs (log-rank, p = 0.006), though differences became insignificant when considering only biopsied astrocytomas in both locations (log-rank, p = 0.491).

Conclusions

Diagnosis of midline LGGs is complicated by both limitations of biopsy and imaging. Midline tumours have a poorer prognosis compared to lobar equivalents and survival differences are probably due to the absence of significant surgical intervention in midline locations.

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Authors and Affiliations

  1. School of Medicine, University of Liverpool, Cedar House Ashton Street, Liverpool, L9 7AL, UK

    Mueez Waqar

  2. Institute of Infection and Global Health, University of Liverpool, Liverpool, L9 7AL, UK

    Mueez Waqar & Michael D. Jenkinson

  3. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK

    Shahid Hanif, Rasheed Zakaria, Andrew R. Brodbelt, Carol Walker & Michael D. Jenkinson

  4. Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK

    Nitika Rathi

  5. Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK

    Kumar Das

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  1. Mueez Waqar
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Waqar, M., Hanif, S., Rathi, N. et al. Diagnostic challenges, management and outcomes of midline low-grade gliomas. J Neurooncol 120, 389–398 (2014). https://doi.org/10.1007/s11060-014-1563-6

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