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Supratentorial gangliogliomas: histopathologic
grading and tumor recurrence in 184 patients with a median follow-up of 8 years
Luyken C, Blumcke I, Fimmers R, Urbach H, Wiestler OD, Schramm J
Department of Neurosurgery, University of Bonn Medical Center,
Bonn, Germany. cordelia.luyken@uni-duesseldorf.de
Background.
Supratentorial gangliogliomas (GGs) are rare tumors of the central nervous
system and are commonly associated with chronic seizures.
To date, only case reports and small series of patients with short-term
follow-up have been available for the assessment of the potential of GGs to
recur and progress.
Methods.
Data from 184
patients who underwent resection of GGs between 1988 and 2001 were available
from the University of Bonn Epilepsy Surgery Center (Bonn, Germany).
Analysis of factors that influenced tumor recurrence and patient survival, such
as preoperative history, age at operation, tumor location, histopathologic
findings (including immunohistochemical findings), extent of tumor resection,
and recurrence evaluated on postoperative magnetic resonance imaging (MRI), was
performed.
Results.
The median
follow-up period was 8 years (range, 1-14 years).
One hundred seventy-eight patients (97%) presented with long-term seizures (>
or = 2 years).
The median age at surgery was 26 years (range, 2-65 years).
Tumor location was temporal in 79% of patients and frontal in 12% of
patients.
Eleven tumors (6%) were classified as World Health Organization (WHO) Grade 2
lesions, and 2 tumors were classified as anaplastic WHO Grade 3 lesions.
For 38 patients (21%), postoperative MRIs revealed residual tumors.
Two years after surgery, 5 patients (3%) experienced tumor recurrence, which
resulted in malignant progression in 3 patients (2%) and death in 2 patients
(1%).
Eighty-four percent of patients with epilepsy had complete and sustained seizure
relief.
The calculated 7.5-year recurrence-free survival rate was 97%.
Lower rates of recurrence were found in patients with tumors classified as WHO
Grade 1 lesions (P < 0.0001), patients with temporal lesions (P < 0.0001),
patients who underwent complete tumor resection (P = 0.0278), and patients with
long-standing epilepsy (P < 0.0001).
Conclusions.
Supratentorial GGs are benign tumors, and the surgical goal for patients with GG
should be complete resection.
Residual tumor masses, frontal tumor location, and WHO Grade 2 or 3 lesions are
associated with a greater risk of recurrence or malignant progression.
Patients with such characteristics should be considered for long-term clinical
follow-up using MRI.
Copyright 2004 American Cancer Society.
PMID: 15222000 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15222000
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