Philippe Dory-Lautrec

Multimodal MR Imaging (Diffusion, Perfusion, and Spectroscopy): Is It Possible To Distinguish Oligodendroglial Tumor Grade and 1p/19q Codeletion in the Pretherapeutic Diagnosis?

These authors combined 3 advanced MRI techniques in an attempt to determine which oligodendrogliomas had 1p/19q deletions and thus a more favorable prognosis. They retrospectively analyzed data obtained in 50 tumors and found that though these 3 techniques were helpful in the grading of oligodendrogliomas, the multimodal approach used showed no significant differences between tumors with and without 1p/19q deletions. BACKGROUND AND PURPOSE: Pretherapeutic determination of tumor grade and genotype in grade II and III oligodendroglial tumors is clinically important but is still challenging. Tumor grade and 1p/19q status are currently the 2 most important factors in therapeutic decision making for patients with these tumors. Histopathology and cMRI studies are still limited in some cases. In the present study, we were interested in determining whether the combination of PWI, DWI, and MR spectroscopy could help distinguish oligodendroglial tumors according to their histopathologic grade and genotype. MATERIALS AND METHODS: We retrospectively reviewed 50 adult patients with grade II and III oligodendrogliomas and oligoastrocytomas who had DWI, PWI, and MR spectroscopy at short and long TE data and known 1p/19q status. Univariate analyses and multivariate random forest models were performed to determine which criteria could differentiate between grades and genotypes. RESULTS: ADC, rCBV, rCBF, and rK2 were significantly different between grade II and III oligodendroglial tumors. DWI, PWI, and MR spectroscopy showed no significant difference between tumors with and without 1p/19q loss. Separation between tumor grades and genotypes with cMRI alone showed 31% and 48% misclassification rates, respectively. Multimodal MR imaging helps to determine tumor grade and 1p/19q genotype more accurately (misclassification rates of 17% and 40%, respectively). CONCLUSIONS: Although multimodal investigation of oligodendroglial tumors has a lower contribution to 1p/19q genotyping compared with cMRI alone, it greatly improves the accuracy of grading of these neoplasms. Use of multimodal MR imaging could thus provide valuable information that may assist clinicians in patient preoperative management and treatment decision making.

Primary neurolymphomatosis diagnosis and treatment: A retrospective study

BACKGROUND To discuss the therapeutic approach for primary neurolymphomatosis. METHODS We report all primary neurolymphomatosis cases referred to our institution, with descriptions of clinical, radiological, electrophysiological, histological features and long-term follow-up. We treated all patients with a combination of high-dose methotrexate and alkylating agents. RESULTS Five patients were diagnosed with histologically confirmed primary neurolymphomatosis. The majority of them presented with painful asymmetric sensory-motor neuropathy. Magnetic resonance imaging was abnormal in 4 of 5 patients, as shown with gadolinium enhancements. Electroneuromyography revealed denervation in all 4 cases with contributive examinations. All our patients received a chemotherapy combination of high-dose methotrexate and alkylating agent. Median progression-free survival was 8 months (2 complete responses and 2 partial responses), and overall survival was 24 months. CONCLUSIONS Primary neurolymphomatosis is rare and polymorphic; it represents a difficult diagnosis of neuropathy. In our cohort, treatment with a chemotherapy combination with high-dose methotrexate showed encouraging results.

Can metronomic maintenance with weekly vinblastine prevent early relapse/progression after bevacizumab-irinotecan in children with low-grade glioma?

The association of bevacizumab and irinotecan has been shown to display a quick efficacy in low‐grade glioma (LGG), but most patients relapse within months after cessation of therapy. From October 2012 to March 2014, four patients have been treated with irinotecan–bevacizumab followed by a metronomic maintenance with weekly vinblastine to try to prevent relapses. After a median follow‐up of 23 months after the end of the bevacizumab–irinotecan induction, no patient relapsed. These observations suggest that maintenance chemotherapy with weekly vinblastine after an induction by irinotecan–bevacizumab can improve progression‐free survival in children with LGG.

Metronomic Four-Drug Regimen Has Anti-tumor Activity in Pediatric Low-Grade Glioma; The Results of a Phase II Clinical Trial

Background: Metronomic chemotherapy (MC) is defined as the frequent administration of chemotherapy at doses below the maximal tolerated dose and with no prolonged drug-free break. MC has shown its efficacy in adult tumor types such as breast and ovarian cancer and has to some extent been studied in pediatrics. Objective: To assess the anti-tumor activity and toxicity of a four-drug metronomic regimen in relapsing/refractory pediatric brain tumors (BT) with progression-free survival (PFS) after two cycles as primary endpoint. Methods: Patients ≥4 to 25 years of age were included with progressing BT. Treatment consisted of an 8-week cycle of celecoxib, vinblastine, and cyclophosphamide alternating with methotrexate. Kepner and Chang two-steps model was used with 10 patients in the first stage. If stabilization was observed in ≥2 patients, 8 additional patients were recruited. Assessment was according WHO criteria with central radiology review. Results: Twenty-nine patients (27 evaluable) were included in two groups: ependymoma (group 1, N = 8), and miscellaneous BT (group 2): 3 medulloblastoma (MB), 5 high grade glioma (HGG), 11 low grade glioma (LGG), 2 other BT. After first stage, recruitment for ependymoma was closed [one patient had stable disease (SD) for 4 months]. Cohort 2 was opened for second stage since 1 HGG and 3 LGG patients had SD after two cycles. Recruitment was limited to LGG for the second stage and 2 partial responses (PR), 6 SD and 2 progressive disease (PD) were observed after two cycles. Of these patients with LGG, median age was 10 years, nine patients received vinblastine previously. Median number of cycles was 6.8 (range: 1–12). Treatment was interrupted in five patients for grade 3/4 toxicity. Conclusion: This regimen is active in patients with LGG, even if patients had previously received vinblastine. Toxicity is acceptable. Trial Registration: This study was registered under clinicaltrials.gov – NCT01285817; EUDRACT nr: 2010-021792-81.

Neurofibromatose avec localisation péricardique

Une patiente de 42 ans, suivie pour une maladie de Recklinghausen, est hospitalisee pour une dyspnee d’aggravation progressive. Le bilan met en evidence un epanchement pericardique qui augmente de maniere importante au cours des quinze derniers jours d’hospitalisation. Un scanner cardiaque est demande pour faire le bilan de cet epanchement pericardique.

Lymphome développé dans l’espace épicardique

Un homme de 65 ans est hospitalise pour le bilan d’une dyspnee rapidement progressive. le bilan echographique revele la presence d’une masse cardiaque droite et de masses surrenaliennes bilaterales. Une IRM est demandee pour completer le bilan.

Bourrelet graisseux de la veine cave

Patiente de 45 ans, obese, chez qui on retrouve, sur un scanner demande pour le bilan d’une douleur abdominale, une masse dans la veine cave inferieure retrohepatique. Une IRM et un scanner sont demandes pour l’exploration de cette masse.

Malformation vasculaire de type veineuse intracardiaque (ancien hémangiome)

Patient de 55 ans qui nous est adresse pour la realisation d’une IRM devant la decouverte d’une masse dans l’oreillette droite. Ce patient est asymptomatique et ne presente pas d’antecedent particulier.

Thrombus au cours des cardiomyopathies dilatées (CMD)

Monsieur F., 80 ans, est hospitalise pour decompensation cardiaque globale. Son echocardiographie montre une dilatation cardiaque globale et une fraction d’ejection diminuee. L’IRM est demandee pour faire le bilan etiologique de cette cardiomyopathie de decouverte recente.

Thrombus et greffe cardiaque

Homme de 68 ans, transplante cardiaque. Decouverte fortuite a l’echographie d’une masse dans l’oreillette droite. L’IRM est demandee pour faire le bilan de cette masse et le diagnostic differentiel entre thrombus et lesion lymphoproliferative.