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Journal articles on the topic 'Malignancy; Nervous system'

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Published: 4 June 2021

Last updated: 5 February 2022

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Youle, Richard J. "Immunotoxins for central nervous system malignancy." Seminars in Cancer Biology 7, no. 2 (1996): 65–70. http://dx.doi.org/10.1006/scbi.1996.0010.

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Lister, Andrew, Lauren E. Abrey, and John T. Sandlund. "Central Nervous System Lymphoma." Hematology 2002, no. 1 (2002): 283–96. http://dx.doi.org/10.1182/asheducation-2002.1.283.

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Abstract Central nervous system involvement with malignant lymphoma whether primary or secondary is an uncommon but not rare complication observed in the management of patients with hematological malignancy. Its importance lies in the considerable morbidity and mortality with which it is associated and the inadequacy of therapy. In Section I, Dr. Lauren Abrey addresses the totality of the problem of primary central nervous system lymphoma, with emphasis on strategies increasingly dependent on systemic chemotherapy. In Section II, Dr. John Sandlund reviews the success of sequential clinical trials of overall therapy for acute lymphoblastic leukemia in childhood, identifying those patients at high risk of central nervous system leukemia and the development of a rational therapeutic strategy for prevention. In Section III, Dr. Andrew Lister discusses the issue of secondary central nervous system involvement with lymphoma and the indications for prophylaxis.

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Kaufman, Stuart S., Constance M. Goldgar, Francis Fitzmaurice, Dean L. Antonson, and Jon A. Vanderhoof. "Intestinal Abnormalities with Central Nervous System Malignancy." Journal of Pediatric Gastroenterology and Nutrition 5, no. 4 (1986): 665–70. http://dx.doi.org/10.1097/00005176-198607000-00027.

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Hall, Walter A., and Øystein Fodstad. "Immunotoxins and central nervous system neoplasia." Journal of Neurosurgery 76, no. 1 (1992): 1–12. http://dx.doi.org/10.3171/jns.1992.76.1.0001.

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✓ The poor prognosis associated with central nervous system (CNS) malignancy has led investigators to seek new, innovative treatment modalities. Immunotoxins, carrier molecules linked to toxic agents, combine high specificity for tumor-associated antigens with extreme potency. The rationale for both the development of these compounds and for their application to CNS neoplasia is explained. This report discusses the design and construction of immunoconjugates, using toxins that differ in their mechanism of action bound to ligands directed against various antigens. A comparison is made between the in vitro efficacy of standard chemotherapy and immunotoxins in glioblastoma- and medulloblastoma-derived cell lines. A review is included of the results of experiments in animals with leptomeningeal neoplasia, where prolongation of survival following intrathecal administration of immunotoxins has been reported. The obstacles encountered in clinical trials with other types of cancer are addressed and approaches to optimize the use of these novel agents in the context of treating malignant disease of the CNS are suggested.

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Kurtzman, Drew J. B., Andrew J. Fabiano, Jingxin Qiu, and Nathalie C. Zeitouni. "Muir–Torre Syndrome and Central Nervous System Malignancy." Dermatologic Surgery 41, no. 7 (2015): 856–59. http://dx.doi.org/10.1097/dss.0000000000000376.

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Galli, Jonathan, and John Greenlee. "Paraneoplastic Diseases of the Central Nervous System." F1000Research 9 (March 6, 2020): 167. http://dx.doi.org/10.12688/f1000research.21309.1.

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Paraneoplastic neurological syndromes are nonmetastatic complications of malignancy secondary to immune-mediated neuronal dysfunction or death. Pathogenesis may occur from cell surface binding of antineuronal antibodies leading to dysfunction of the target protein, or from antibodies binding against intracellular antigens which ultimately leads to cell death. There are several classical neurological paraneoplastic phenotypes including subacute cerebellar degeneration, limbic encephalitis, encephalomyelitis, and dorsal sensory neuropathy. The patient’s clinical presentations may be suggestive to the treating clinician as to the specific underlying paraneoplastic antibody. Specific antibodies often correlate with the specific underlying tumor type, and malignancy screening is essential in all patients with paraneoplastic neurological disease. Prompt initiation of immunotherapy is essential in the treatment of patients with paraneoplastic neurological disease, often more effective in cell surface antibodies in comparison to intracellular antibodies, as is removal of the underlying tumor.

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Deangelis, Lisa M. "Primary central nervous system lymphoma as a secondary malignancy." Cancer 67, no. 5 (1991): 1431–35. http://dx.doi.org/10.1002/1097-0142(19910301)67:5<1431::aid-cncr2820670527>3.0.co;2-k.

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Schiff, David. "Quantifying the burden of primary central nervous system malignancy." Neuro-Oncology 18, no. 1 (2015): 5–6. http://dx.doi.org/10.1093/neuonc/nov287.

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Huber, Katrin, Isabelle Janoueix-Lerosey, Wolfgang Kummer, Hermann Rohrer, and Arthur S. Tischler. "The sympathetic nervous system: malignancy, disease, and novel functions." Cell and Tissue Research 372, no. 2 (2018): 163–70. http://dx.doi.org/10.1007/s00441-018-2831-0.

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Saddawi-Konefka, Robert, and John R. Crawford. "Chronic Viral Infection and Primary Central Nervous System Malignancy." Journal of Neuroimmune Pharmacology 5, no. 3 (2010): 387–403. http://dx.doi.org/10.1007/s11481-010-9204-0.

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Kurczynski, Thaddeus W., Amimul A. Choudhury, Samuel J. Horwitz, Uros Roessmann, and Samuel Gross. "Remote Effect of Malignancy on the Nervous System in Children." Developmental Medicine & Child Neurology 22, no. 2 (2008): 205–13. http://dx.doi.org/10.1111/j.1469-8749.1980.tb04329.x.

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Branco, Vasco, José Pimentel, Maria Alexandra Brito, and Cristina Carvalho. "Thioredoxin, Glutathione and Related Molecules in Tumors of the Nervous System." Current Medicinal Chemistry 27, no. 12 (2020): 1878–900. http://dx.doi.org/10.2174/0929867326666190201113004.

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Background: Central Nervous System (CNS) tumors have a poor survival prognosis due to their invasive and heterogeneous nature, in addition to the resistance to multiple treatments. Objective: In this paper, the main aspects of brain tumor biology and pathogenesis are reviewed both for primary tumors of the brain, (i.e., gliomas) and for metastasis from other malignant tumors, namely lung cancer, breast cancer and malignant melanoma which account for a high percentage of overall malignant brain tumors. We review the role of antioxidant systems, namely the thioredoxin and glutathione systems, in the genesis and/or progression of brain tumors. Methods: Although overexpression of Thioredoxin Reductase (TrxR) and Thioredoxin (Trx) is often linked to increased malignancy rate of brain tumors, and higher expression of Glutathione (GSH) and Glutathione S-Transferases (GST) are associated to resistance to therapy, several knowledge gaps still exist regarding for example, the role of Peroxiredoxins (Prx), and Glutaredoxins (Grx). Conclusion: Due to their central role in redox homeostasis and ROS scavenging, redox systems are potential targets for new antitumorals and examples of innovative therapeutics aiming at improving success rates in brain tumor treatment are discussed.

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Au, KLK, S. Latonas, A. Shameli, I. Auer, and C. Hahn. "Cerebrospinal fluid flow cytometry: utility in central nervous system lymphoma diagnosis." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s1 (2021): S2—S3. http://dx.doi.org/10.1017/cjn.2021.89.

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Flow cytometry of the cerebrospinal fluid (CSF) is used in isolation or as an adjunct to cytology to increase the sensitivity of detecting primary central nervous system (CNS) lymphoma. We aim to evaluate the sensitivity of CSF flow cytometry as a diagnostic tool for primary CNS lymphoma in patients presenting with undifferentiated neurologic symptoms. We retrospectively reviewed all CSF samples received by the Calgary Laboratory Services Flow Cytometry Laboratory from 2012- 2015. Clinical data, laboratory investigations, radiologic imaging studies, and pathological data were analyzed. Clinical review extended to 2 years post CSF flow cytometric testing. The number of samples of CSF flow cytometry that were positive for a hematological malignancy was 43/763 (5.6%). The overall sensitivity of the test was 69.4%. A positive result was more likely to occur in patients with a prior history of a hematological malignancy or abnormal enhancement on MRI (p<0.0001). CSF flow cytometry was negative in all patients who did not have a previous hematological malignancy or abnormal enhancement on MRI (n = 247). CSF flow cytometry has a limited role in screening for primary CNS lymphoma, unless a strictly endorsed testing algorithm is applied. It is, however, an invaluable tool in evaluating CNS involvement in patients with a previous diagnosis of hematolymphoid malignancy or abnormal enhancement on MRI.LEARNING OBJECTIVESThis presentation will enable the learner to:Discuss the costs and benefits of using CSF flow cytometry to diagnose CNS lymphoma 1.Identify appropriate clinical indications for using CSF flow cytometry as a first-line test2.Apply a testing algorithm to increase the diagnostic yield of CSF flow cytometry

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Au, Ka Loong Kelvin, Sarah Latonas, Afshin Shameli, Iwona Auer, and Christopher Hahn. "Cerebrospinal Fluid Flow Cytometry: Utility in Central Nervous System Lymphoma Diagnosis." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 47, no. 3 (2020): 382–88. http://dx.doi.org/10.1017/cjn.2020.22.

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ABSTRACT:Background:Flow cytometry of the cerebrospinal fluid (CSF) is used in isolation or as an adjunct to cytology to increase the sensitivity of detecting central nervous system (CNS) lymphoma. We aimed to evaluate the sensitivity of CSF flow cytometry as a diagnostic screening tool for primary CNS lymphoma in patients presenting with undifferentiated neurologic symptoms.Methods:We retrospectively reviewed all CSF samples received by the Calgary Laboratory Services Flow Cytometry Laboratory from 2012 to 2015. Clinical data, laboratory investigations, radiologic imaging studies, and pathological data were analyzed. Clinical review extended to 2 years post-CSF flow cytometric testing.Results:Only 43/763 (5.6%) samples of CSF flow cytometry in 28/573 (4.9%) patients were found to be positive for a hematological malignancy in patients with undifferentiated neurologic symptoms. The overall sensitivity of the test was 13.8% with 25 patients with negative CSF flow cytometry later having a positive biopsy for CNS lymphoma. CSF flow cytometry was negative in all cases when at the time of CSF examination the patient did not have a previous hematological malignancy or findings of abnormal enhancement on MRI (n = 249).Conclusion:CSF flow cytometry has low utility in screening for primary CNS lymphoma in the absence of a previous history of hematologic malignancy or findings of abnormal enhancement on MRI.

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Hopster, D. J., S. F. Robinson, L. Chadwick, and J. F. Geddes. "Widespread neuroendocrine malignancy within the central nervous system: a diagnostic conundrum." Journal of Clinical Pathology 50, no. 5 (1997): 440–42. http://dx.doi.org/10.1136/jcp.50.5.440.

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Strowd, R. E., K. Swett, M. Harmon, et al. "Influenza vaccine immunogenicity in patients with primary central nervous system malignancy." Neuro-Oncology 16, no. 12 (2014): 1639–44. http://dx.doi.org/10.1093/neuonc/nou051.

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Muldoon, Leslie L., Carole Soussain, Kristoph Jahnke, et al. "Chemotherapy Delivery Issues in Central Nervous System Malignancy: A Reality Check." Journal of Clinical Oncology 25, no. 16 (2007): 2295–305. http://dx.doi.org/10.1200/jco.2006.09.9861.

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PurposeThis review assesses the current state of knowledge regarding preclinical and clinical pharmacology for brain tumor chemotherapy and evaluates relevant brain tumor pharmacology studies before October 2006.ResultsChemotherapeutic regimens in brain tumor therapy have often emerged from empirical clinical studies with retrospective pharmacologic explanations, rather than prospective trials of rational chemotherapeutic approaches. Brain tumors are largely composed of CNS metastases of systemic cancers. Primary brain tumors, such as glioblastoma multiforme or primary CNS lymphomas, are less common. Few of these tumors have well-defined optimal treatment. Brain tumors are protected from systemic chemotherapy by the blood-brain barrier (BBB) and by intrinsic properties of the tumors. Pharmacologic studies of delivery of conventional chemotherapeutics and novel therapeutics showing actual tumor concentrations and biologic effect are lacking.ConclusionIn this article, we review drug delivery across the BBB, as well as blood-tumor and –cerebrospinal fluid (CSF) barriers, and mechanisms to increase drug delivery to CNS and CSF tumors. Because of the difficulty in treating CNS tumors, innovative treatments and alternative delivery techniques involving brain/cord capillaries, choroid plexus, and CSF are needed.

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Nagpal, Seema, and Lawrence Recht. "Treatment and Prophylaxis of Hematologic Malignancy in the Central Nervous System." Current Treatment Options in Neurology 13, no. 4 (2011): 400–412. http://dx.doi.org/10.1007/s11940-011-0128-7.

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Gachiani, John, Daniel H. Kim, Adriane Nelson, and David Kline. "Management of metastatic tumors invading the peripheral nervous system." Neurosurgical Focus 22, no. 6 (2007): 1–6. http://dx.doi.org/10.3171/foc.2007.22.6.15.

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Object The authors present the results of a retrospective review of 37 surgically treated metastases to nerve (malignant peripheral non–neural sheath nerve tumors). Tumor frequencies, presentations, management, and prognosis are discussed. Methods Thirty-seven patients who were treated for metastases to nerve between 1969 and 2006 at the Louisiana State University Health Sciences Center were identified in a review of patient records. Notes regarding patient history and physical examination findings were reviewed to provide information on presenting symptoms and signs. Imaging and histopathological examination results were also reviewed. Cases were analyzed depending on the primary tumor and the location of metastasis. Results There included 37 surgically treated lesions, 16 of which originated in the breast and 10 of which originated in the lung. In two cases melanomas had metastasized to nerve, and one tumor each had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus. Conclusions The nervous system is involved in numerous ways by oncological process. Direct involvement of the peripheral nervous system occurs mostly from direct extension, although it occasionally occurs because of distant spread from the primary tumor to nerve. Surgical excision of the metastatic lesion with margins has been useful mostly in the control of pain. Nevertheless, patients eventually succumb to their primary malignancy.

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Englund, E., A. Brun, E. M. Larsson, Z. Györffy-Wagner, and B. Persson. "Tumours of the Central Nervous System." Acta Radiologica. Diagnosis 27, no. 6 (1986): 653–59. http://dx.doi.org/10.1177/028418518602700606.

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Proton MR relaxation times T1 and T2 were determined in vitro in 136 small specimens of astrocytomas grades I—IV, of oligodendrogliomas, metastases of adenocarcinomas, meningiomas and acoustic neuromas. In addition, 7 samples of peritumoural white matter were analysed. The analysed specimens were studied microscopically in their entirety regarding tumour type and occurrence of necrosis and non-tumour tissue admixture, such as fibrosis and haemorrhage. Most of the gliomas had longer relaxation times than normal white matter and T2 was significantly longer than in the other three tumour groups. The metastases had longer T1 than normal white matter, while T2 varied. The astrocytomas tended to show shorter relaxation times with increasing degree of malignancy, and shortening of T1 and T2 correlating with the proportion of tissue necrosis. Similarly, the metastases with tissue necrosis had shorter T1 and T2 than non-necrotic samples. The meningiomas had T1 values comparable with normal cortex, while the T2 values varied. Tumours containing a large proportion of fibrous tissue had shorter relaxation times than the others. Acoustic neuromas had only slightly longer T1 than normal white matter, while T2 was not prolonged. Both T1 and T2 were significantly shorter than in all other tumours studied. Peritumoural white matter had prolonged relaxation times compared with normal white matter, correlating to increased water content. These in vitro differences regarding relaxation times in various types of tumours of the central nervous system, dependent on various types of tissue alterations, should be of interest for the interpretation of in vivo images.

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Liang, Chun-Chieh, Se-Yi Chen, Ting-Yi Chen, and Szu-Ting Chen. "Central Nervous System Melioidosis Mimics Malignancy: A Case Report and Literature Review." World Neurosurgery 89 (May 2016): 732.e19–732.e23. http://dx.doi.org/10.1016/j.wneu.2016.01.093.

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SEEWALDT, V., D. FIGGE, B. GREER, H. TAMIMI, W. BROWN, and J. CAIN. "Primary Central Nervous System Recurrence after Paclitaxel Therapy for Epithelial Ovarian Malignancy." Gynecologic Oncology 55, no. 3 (1994): 456–58. http://dx.doi.org/10.1006/gyno.1994.1322.

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Kasinathan, Ganesh, Ahlam Naila Kori, and Nurhidayah Hassan. "Challenging lymphoid malignancy of primary central nervous system lymphoma: A case report." Annals of Medicine and Surgery 57 (September 2020): 307–10. http://dx.doi.org/10.1016/j.amsu.2020.08.011.

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Au, K., S. Latonas, A. Shameli, I. Auer, and C. Hahn. "P.046 Flow cytometry in cerebrospinal fluid: utility in the diagnosis of central nervous system lymphoma." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (2018): S27. http://dx.doi.org/10.1017/cjn.2018.148.

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Background: Flow cytometry in the cerebrospinal fluid (CSF) is used as an adjunct to cytology to increase the sensitivity of detecting central nervous system (CNS) lymphoma. We aim to evaluate CSF flow cytometry as a diagnostic tool for lymphoma in patients presenting with undifferentiated neurologic symptoms. Methods: We retrospectively reviewed all CSF flow cytometry samples sent in the Calgary region from 2012-2015. Clinical data, laboratory investigations, radiologic imaging studies, and pathological data were analyzed. Clinical review extended to 2 years post CSF flow cytometric testing. Results: The number of samples of CSF flow cytometry that were positive for a hematological malignancy was 43/763 (5.6%). The overall sensitivity of the test was 72.9%. A positive result was more likely to occur in patients with a prior history of a hematological malignancy or abnormal enhancement on MRI (p<0.0001). In fact, CSF flow cytometry was negative in all patients who did not have a previous hematological malignancy or abnormal enhancement on MRI (n = 247). Conclusions: CSF flow cytometry has very limited role in the screening for primary CNS lymphoma, unless a strictly endorsed testing algorithm is applied. It is, however, an invaluable tool in assessing CNS involvement in patients with previous diagnosis of hematolymphoid malignancy.

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Vartholomatos, Evrysthenis, George Vartholomatos, George A. Alexiou, and Georgios S. Markopoulos. "The Past, Present and Future of Flow Cytometry in Central Nervous System Malignancies." Methods and Protocols 4, no. 1 (2021): 11. http://dx.doi.org/10.3390/mps4010011.

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Central nervous system malignancies (CNSMs) are categorized among the most aggressive and deadly types of cancer. The low median survival in patients with CNSMs is partly explained by the objective difficulties of brain surgeries as well as by the acquired chemoresistance of CNSM cells. Flow Cytometry is an analytical technique with the ability to quantify cell phenotype and to categorize cell populations on the basis of their characteristics. In the current review, we summarize the Flow Cytometry methodologies that have been used to study different phenotypic aspects of CNSMs. These include DNA content analysis for the determination of malignancy status and phenotypic characterization, as well as the methodologies used during the development of novel therapeutic agents. We conclude with the historical and current utility of Flow Cytometry in the field, and we propose how we can exploit current and possible future methodologies in the battle against this dreadful type of malignancy.

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Choi, Yong Jun, Jung A. Shin, Yong Hoon Kim, et al. "Neurolymphomatosis of Brachial Plexus in Patients with Non-Hodgkin's Lymphoma." Case Reports in Oncological Medicine 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/492329.

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Neurolymphomatosis (NL) is a rare clinical disease where neoplastic cells invade the cranial nerves and peripheral nerve roots, plexus, or other nerves in patients with hematologic malignancy. Most NL cases are caused by B-cell non-Hodgkin’s lymphoma (NHL). Diagnosis can be made by imaging with positron emission tomography (PET) and magnetic resonance imaging (MRI). We experienced two cases of NL involving the brachial plexus in patients with NHL. One patient, who had NHL with central nervous system (CNS) involvement, experienced complete remission after 8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy but relapsed into NL of the brachial plexus 5 months later. The other patient, who suffered from primary central nervous system lymphoma (PCNSL), had been undergoing chemoradiotherapy but progressed to NL of the brachial plexus.

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Yoshii, Yoshihiko, Yutaka Maki, Koji Tsuboi, Yuji Tomono, Kunio Nakagawa, and Takao Hoshino. "Estimation of growth fraction with bromodeoxyuridine in human central nervous system tumors." Journal of Neurosurgery 65, no. 5 (1986): 659–63. http://dx.doi.org/10.3171/jns.1986.65.5.0659.

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✓ Twenty-five patients with tumors of the central nervous system received bromodeoxyuridine (BUdR), 200 mg/sq m, by intravenous infusion every 8 hours for 3 days before surgery. Excised tumor specimens were fixed in chilled 70% ethanol, embedded in paraffin, and cut into 6-µm sections. Each section was reacted with monoclonal antibodies against BUdR and stained with immunoperoxidase to identify nuclei that had incorporated BUdR. The growth fraction of each tumor was estimated by calculating the ratio of BUdR-positive nuclei to the total number of tumor cells in three to six microscopic fields in viable areas of the tumor. In seven cases, the tumor doubling time was measured from the serial computerized tomography scans and an attempt was made to estimate the cell cycle time. The growth fractions ranged from 9.1% to 46.5% in malignant gliomas, 2.0% to 6.7% in low-grade gliomas, 11.2% to 43.2% in metastatic brain tumors, 0.8% to 1.9% in pituitary adenomas, 3.9% to 4.6% in acoustic neurinomas, and 6.2% to 8.2% in meningiomas and cerebellar hemangioblastomas. The estimated cell cycle time was 5 to 12 days in most malignant gliomas and brain metastases; however, the actual cell cycle time should be substantially shorter because cell loss was not considered in the calculation. Although the growth fraction appeared to correlate with the biological malignancy of each tumor, the tumor doubling time did not reflect growth potential. It is possible that unpredictable cell loss plays an important role in tumor growth at certain sizes. Therefore, the cell cycle times calculated in this study are considerably overestimated and should be interpreted with caution.

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Pjevic, Miroslava, Erzebet Patarica-Huber, Dragana Radovanovic, and Sanja Vickovic. "Neuropathic pain due to malignancy: Mechanisms, clinical manifestations and therapy." Medical review 57, no. 1-2 (2004): 33–40. http://dx.doi.org/10.2298/mpns0402033p.

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Introduction Neuropathic pain in cancer patients requires a focused clinical evaluation based on knowledge of common neuropathic pain syndromes. Definition Neuropathic pain is a non-nociceptive pain or "differentiation" pain, which suggests abnormal production of impulses by neural tissue that is separated from afferent input. Impulses arise from the peripheral nervous system or central nervous system. Causes of neuropathic pain due to malignancy Neuropathic pain is caused directly by cancer-related pathology (compression/infiltration of nerve tissue, combination of compression/infiltration) or by diagnostic and therapeutic procedures (surgical procedures, chemotherapy, radiotherapy). Mechanisms Pathophysiological mechanisms are very complex and still not clear enough. Neuropathic pain is generated by electrical hyperactivity of neurons along the pain pathways. Peripheral mechanisms (primary sensitization of nerve endings, ectopically generated action potentials within damaged nerves, abnormal electrogenesis within sensory ganglia) and central mechanisms (loss of input from peripheral nociceptors into dorsal horn, aberrant sprouting within dorsal horn, central sensitization, loss of inhibitory interneurons, mechanisms at higher centers) are involved. Diagnosis The quality of pain presents as spontaneous pain (continuous and paroxysmal), abnormal pain (allodynia, hyperalgesia, hyperpathia), paroxysmal pain. Clinical manifestations Clinically, neuropathic pain is described as the pain in the peripheral nerve (cranial nerves, other mononeuropathies, radiculopathy, plexopathy, paraneoplastic peripheral neuropathy) and relatively infrequent, central pain syndrome. Therapy Treatment of neuropathic pain remains a challenge for clinicians, because there is no accepted algorithm for analgesic treatment of neuropathic pain. Pharmacotherapy is considered to be the first line therapy. Opioids combined with non-steroidal antiinflammatory drugs are warrented. If patient is relatively unresponsive to an opioid, a trial with adjuvant analgesics might be considered. Tricyclic antidepressants might be selected for patients with continuous dysesthesia, and anticonvulsants might be used if the pain is predominanty lancinating or paroxysmal. The complexity of neuropathic syndromes and underlying etiologic mechanisms warrant clinical trials to determine appropriate treatment.

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Tamhane, Tejas M., Sushil G. Kachewar, and Dilip L. Lakhkar. "A Rare Case Report of Intramedullary Spinal Cord Metastasis (ISCM) from A Known Prostatic Primary." Nepal Journal of Neuroscience 13, no. 2 (2016): 112–15. http://dx.doi.org/10.3126/njn.v13i2.20491.

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Intramedullary Spinal Cord Metastases (ISCM) is rare as they represent 8.5% of all central nervous system metastases and account for 5% of all intramedullary lesions. Lung cancer is the most common primary malignancy which causes spinal mets followed by other malignancies like Breast, Lymphoma, Leukemia, Malignant Melanoma etc. Only two cases of ISCM from Prostatic primary were reported in the literature previously. Our case represents one such rare occurrence, hence, reported here.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 112-115

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Cacho-Díaz, Bernardo, Nydia A. Lorenzana-Mendoza, Rosa M. Michel-Ortega, et al. "Central Nervous System Metastases in Patients With Cervical Carcinoma." International Journal of Gynecologic Cancer 26, no. 9 (2016): 1686–89. http://dx.doi.org/10.1097/igc.0000000000000827.

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IntroductionCervical cancer (CC) is the most common malignancy throughout developing countries, although considered rare, central nervous system metastasis (CNSm) does occur.ObjectiveThis study aimed to describe our experiences and compare them to other published cases.Materials and MethodsFrom May 2009 to August 2015, the files of all patients with CC treated at our referral center were reviewed.ResultsWe found 27 patients with CC and CNSm. Mean age at the time of CNS diagnosis was 50 ± 11 years, mean interval between initial CC and CNSm was 46 months; the most frequent initial International Federation of Gynecology and Obstetrics stage was IIB with 17 patients followed by IB in 4. Fifty-nine percent of patients had lung metastases at the time CNSm were diagnosed. Headache was the most common symptom, followed by weakness, altered mental status, and ataxia/cerebellar. Mean survival was 8.2 months after CNSm was discovered; 3 patients are still alive.ConclusionsThe present study describes the largest series of patients with CNSm from CC; this rare complication should be suspected in patients with CC who present with headache, ataxia, cranial nerve palsy, visual disturbance, altered mental status, focal weakness, or other neurological symptom, without other plausible explanation.

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Guo, Geng, Cheng-liang Zhong, Yang Liu, et al. "Overexpression of FRAT1 Is Associated with Malignant Phenotype and Poor Prognosis in Human Gliomas." Disease Markers 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/289750.

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Glioma is the most common malignancy of the central nervous system. Approximately 40 percent of intracranial tumors are diagnosed as gliomas. Difficulties in treatment are associated closely with the malignant phenotype, which is characterized by excessive proliferation, relentless invasion, and angiogenesis. Although the comprehensive treatment level of brain glioma is continuously progressing, the outcome of this malignancy has not been improved drastically. Therefore, the identification of new biomarkers for diagnosis and therapy of this malignancy is of significant scientific and clinical value. FRAT1 is a positive regulator of the Wnt/β-catenin signaling pathway and is overexpressed in many human tumors. In the present study, we investigated the expression status of FRAT1 in 68 patients with human gliomas and its correlation with the pathologic grade, proliferation, invasion, angiogenesis, and prognostic significance. These findings suggest that FRAT1 may be an important factor in the tumorigenesis and progression of glioma and could be explored as a potential biomarker for pathological diagnosis, an indicator for prognosis, and a target for biological therapy of malignancy.

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Kieslich, Matthias, Andreas Fiedler, Pablo Hernaiz Driever, Roger Weis, Dirk Schwabe, and Gert Jacobi. "Lyme borreliosis mimicking central nervous system malignancy: the diagnostic pitfall of cerebrospinal fluid cytology." Brain and Development 22, no. 6 (2000): 403–6. http://dx.doi.org/10.1016/s0387-7604(00)00165-0.

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Puri, Sachin, Surbhi Puri, Ashok Mahapatra, et al. "A Review of Studies on Targeting Interleukin 4 Receptor for Central Nervous System Malignancy." Current Molecular Medicine 9, no. 6 (2009): 732–39. http://dx.doi.org/10.2174/156652409788970661.

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Strowd, Roy E., Gregory Russell, Fang-Chi Hsu, et al. "Immunogenicity of high-dose influenza vaccination in patients with primary central nervous system malignancy." Neuro-Oncology Practice 5, no. 3 (2018): 176–83. http://dx.doi.org/10.1093/nop/npx035.

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Abstract Background For cancer patients, rates of influenza-associated hospitalization and death are 4 times greater than that of the general population. Previously, we reported reduced immunogenicity to the standard-dose influenza vaccine in patients with central nervous system malignancy. In other poorly responding populations (eg, elderly patients), high-dose vaccination has improved efficacy and immunogenicity. Methods A prospective cohort study was designed to evaluate the immunogenicity of the Fluzone® high-dose influenza vaccine in brain tumor patients. Data on diagnosis, active oncologic treatment, and immunologic status (eg, CD4 count, CD8 count, CD4:CD8 ratio) were collected. All patients received the high-dose vaccine (180 µg). Hemagglutination inhibition titers were measured at baseline, day 28, and 3 months following vaccination to determine seroconversion (≥4-fold rise) and seroprotection (titer ≥1:40), which were compared to our prior results. Results Twenty-seven patients enrolled. Diagnoses included high-grade glioma (85%), CNS lymphoma (11%), and meningioma (4%). Treatment at enrollment included glucocorticoids (n = 8, 30%), radiation (n = 2, 7%), and chemotherapy (n = 9, 33%). Posttreatment lymphopenia (PTL, CD4 ≤ 200) was observed in 4 patients (15%). High-dose vaccination was well tolerated with no grade III-IV toxicity. Overall, seroconversion rates for the A/H1N1, A/H3N2, and B vaccine strains were significantly higher than in our prior study: 65% vs 37%, 69% vs 23%, and 50% vs 23%, respectively (all P < .04). Seroconversion was universally poor in patients with PTL. While seroprotection at 3 months declined in our prior study, no drop was observed following high-dose vaccination in this cohort. Conclusions The immunologic response to HD influenza vaccination was higher in this cohort than standard-dose influenza vaccination in our prior report. These findings mirror those in elderly patients where high-dose vaccination is the standard of care and raise the possibility of an immunosenescence phenotype.

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Suryapraba, A. A. Ayu, Ni Made Susilawathi, and I. Wayan Niryana. "Central Nervous System Tuberculoma Complicated with Spinal Arachnoiditis in Immunocompetent Patient." Open Access Macedonian Journal of Medical Sciences 7, no. 12 (2019): 2002–5. http://dx.doi.org/10.3889/oamjms.2019.272.

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BACKGROUND: Central nervous system (CNS) tuberculosis (TB) can manifest as meningitis, abscess, tuberculoma or other manifestations. CNS TB is a rare TB complication, and its diagnosis remains a challenge since it has clinical and imaging features that resemble other diseases. Antituberculosis treatment has a significant role in determining a patient’s outcome and prevent complications and mortality. CASE PRESENTATION: Here, we report a case of CNS TB manifested as tuberculoma in immunocompetent patient complicated with spinal arachnoiditis. Despite a treatment delay, the patient still showed clinical improvement after proper treatment with a combination of antituberculosis drug and corticosteroid.CONCLUSION: Central Nervous System Tuberculoma Complicated with Spinal Arachnoiditis in Immunocompetent Patient CNS tuberculoma is a rare CNS TB manifestation, and its diagnosis remain a challenge since its clinical symptoms and radiological findings could mimic other cases such as malignancy, pyogenic abscess, toxoplasmosis, sarcoidosis, or neurocysticercosis.

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Nguyen, Thu Yen Thi, Alessandra Camboni, Rossella Masciangelo, Jacques Donnez, and Marie-Madeleine Dolmans. "Is Ovarian Tissue Transplantation Safe in Patients with Central Nervous System Primitive Neuroectodermal Tumors?" Journal of Clinical Medicine 9, no. 12 (2020): 4101. http://dx.doi.org/10.3390/jcm9124101.

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The risk of reseeding malignancy harbored in cryopreserved and transplanted ovarian tissue has been a source of concern. This study aimed to determine the potential relationship between frozen–thawed ovarian tissue transplantation and primary cancer recurrence. Three patients with cerebral primitive neuroectodermal tumors (PNET) were included in this study. One woman gave birth to three healthy babies following reimplantation of her cryopreserved ovarian tissue, but subsequently died due to cancer relapse six years after ovarian tissue transplantation. The second subject died from progressive cancer, while the third is still alive and awaiting reimplantation of her ovarian tissue in due course. Frozen ovarian cortex from all three patients was analyzed and xenotransplanted to immunodeficient mice for five months. Main outcomes were the presence of cancer cells in the thawed and xenografted ovarian tissue at histology, immunostaining (expression of neuron-specific enolase and glial fibrillary acidic protein (GFAP)), and reverse-transcription droplet digital polymerase chain reaction (RT-ddPCR) (levels of enolase 2 and GFAP). In conclusion, no malignant cells were detected in ovarian tissue from patients with PNET, even in those who experienced recurrence of the disease, meaning that the risk of reseeding cancer cells with ovarian tissue transplantation in these patients can be considered low.

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Desai, Pankaj, Mayank Kabrawala, Chintan Patel, et al. "Crush cytology: an expeditious diagnostic tool for gastrointestinal tract malignancy." Endoscopy International Open 09, no. 05 (2021): E735—E740. http://dx.doi.org/10.1055/a-1388-6479.

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Abstract Background and study aims Crush cytology is a simple and rapid method used for diagnosis of central nervous system lesions. We have evaluated the diagnostic accuracy of crush cytology for gastrointestinal tract lesions. Patients and methods This was a prospective, cross-sectional, single center study, conducted on the patients who had suspected malignant lesions between August 2018 and March 2020. The crush cytologic diagnoses were correlated with histology to determine the diagnostic accuracy. Results During the period of interest, a total of 451 patients (26.4 % esophagus & GE junction, 16.6 % stomach, 5.9 % ampulla & duodenum, and 50.9 % colorectal) had a suspected malignant lesion on endoscopic examination. Histology confirmed 92.9 % cases as malignant lesions and 7.1 % as nonmalignant. On crush cytology, 84.5 % were positive for malignancy, 8.9 % were negative for malignancy and 6.6 % were reported as suspicious for malignancy. The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of crush cytology were 97.3 %, 90 %, 99.2 %, 72.5 % and 96.9 %, respectively. Conclusions Crush cytology is a highly sensitive, specific, rapid and cost effective technique to diagnose gastrointestinal malignancies in endoscopically suspected malignant lesions. However, it cannot entirely substitute histopathological examination for definite tumor typing, grading, confirming invasion and in cases in which cytology is suspicious. Crush cytology is an added asset to the histology to maximize diagnostic accuracy and accelerating decision making for the management of lesions.

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Musella, Angela, Innocenza Palaia, Lavinia Domenici, Assunta Casorelli, Angela Martoccia, and Pierluigi Benedetti Panici. "Vulvar Malignancy in Neurofibromatosis Syndrome." Case Reports in Obstetrics and Gynecology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/217924.

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Type 1 neurofibromatosis (NF1) is a dominantly inherited neurologic disorder that affects primarily the skin, bones, and peripheral nervous system. It may be associated with a variety of clinical manifestations including cafe-au-lait spots, skinfold freckling, Lisch nodules, and visceral neurofibromas. Individuals affected by NF1 harbor an increased risk for both benign and malignant tumors. Malignant transformation is usually observed in the form of neurosarcoma. Rarely, NF1 affects the genital tract, and isolated vulvar localization is extremely rare. Here is reported a rare case of a solitary neurosarcoma of the vulva in a 43-year-old woman affected by NF1 syndrome treated with surgical excision. The purpose of this case is to underline the possibility of association between NF1 and genital tract sarcoma and to suggest an accurate evaluation of rapid growth vulvar mass in this setting.

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Beardsley, Justin, Tania C. Sorrell, and Sharon C. A. Chen. "Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients." Journal of Fungi 5, no. 3 (2019): 71. http://dx.doi.org/10.3390/jof5030071.

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Central nervous system (CNS) cryptococcosis in non-HIV infected patients affects solid organ transplant (SOT) recipients, patients with malignancy, rheumatic disorders, other immunosuppressive conditions and immunocompetent hosts. More recently described risks include the use of newer biologicals and recreational intravenous drug use. Disease is caused by Cryptococcus neoformans and Cryptococcus gattii species complex; C. gattii is endemic in several geographic regions and has caused outbreaks in North America. Major virulence determinants are the polysaccharide capsule, melanin and several ‘invasins’. Cryptococcal plb1, laccase and urease are essential for dissemination from lung to CNS and crossing the blood–brain barrier. Meningo-encephalitis is common but intracerebral infection or hydrocephalus also occur, and are relatively frequent in C. gattii infection. Complications include neurologic deficits, raised intracranial pressure (ICP) and disseminated disease. Diagnosis relies on culture, phenotypic identification methods, and cryptococcal antigen detection. Molecular methods can assist. Preferred induction antifungal therapy is a lipid amphotericin B formulation (amphotericin B deoxycholate may be used in non-transplant patients) plus 5-flucytosine for 2–6 weeks depending on host type followed by consolidation/maintenance therapy with fluconazole for 12 months or longer. Control of raised ICP is essential. Clinicians should be vigilant for immune reconstitution inflammatory syndrome.

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Rodden, Frank A., Herbert Wiegandt, and Bernard L. Bauer. "Gangliosides: the relevance of current research to neurosurgery." Journal of Neurosurgery 74, no. 4 (1991): 606–19. http://dx.doi.org/10.3171/jns.1991.74.4.0606.

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✓ Gangliosides are complex glycolipids found on the outer surface of most cell membranes: they are particularly concentrated in tissues of the nervous system. Gangliosides form part of the immunological identity of mammalian cells and are involved in a variety of cell-surface phenomena such as cell-substrate binding and receptor functions. In tumorous tissue, the ganglioside composition is altered, sometimes in direct proportion to the degree of malignancy. The literature on the glycosphingolipid composition and immunology of intracranial tumors is reviewed. Some gangliosides induce neuritogenesis and exhibit a trophic effect on nerve cells grown in vitro. In vivo, a particular ganglioside, GM1, reduces cerebral edema and accelerates recovery from injury (traumatic and ischemic) to the peripheral and central nervous systems of laboratory animals. Preliminary clinical studies have shown that treatment with gangliosides may have corresponding effects on lesions of the human peripheral nervous system. Gangliosides have not been tested in human subjects with brain injury.

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Marks, Asher M., and Roger J. Packer. "A Review of Secondary Central Nervous System Tumors After Treatment of a Primary Pediatric Malignancy." Seminars in Pediatric Neurology 19, no. 1 (2012): 43–48. http://dx.doi.org/10.1016/j.spen.2012.02.015.

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Carlsson, Emilia, Kai Krohn, Kristian Ovaska, et al. "Neuron navigator 3 alterations in nervous system tumors associate with tumor malignancy grade and prognosis." Genes, Chromosomes and Cancer 52, no. 2 (2012): 191–201. http://dx.doi.org/10.1002/gcc.22019.

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Madej, Janusz A. "Neoplastic cannibalism and a suggestion for changes in terminology of selected epithelial tumors." Medycyna Weterynaryjna 74, no. 1 (2018): 6040–2018. http://dx.doi.org/10.21521/mw.6040.

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The types of cell cannibalism (entosis) are described (Fig. 1 and 2), including heterocannibalism and homocannibalism (autocannibalism), in which neoplastic cells can undergo incomplete heterophagocytosis, complete heterophagocytosis, pseudocannibalism, degradation to granular bodies, transformation of benign neoplastic cells into malignant ones, reduction in clonogenic potential or the progression of malignancy of tumour cells. The author also suggests changes in the nomenclature of some epithelial neoplasms, (Fig. 3) including tumours originating from blood vessel and lymphatic endothelium (from haemangioendothelioma to carcinoma haemangioendotheliae vel carcinoma lymphangiotheliale), tumours originating from the peritoneum and pleura (from mesothelioma to carcinoma mesotheliale), malignant melanoma (from melanoma malignum to melanocarcinoma, carcinoma melanogenes), thymoma (from thymomata to carcinoma thymi) and nervous system ependymoma (from ependymoma to carcinoma ependymale). .

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Marx, Sascha, Yong Xiao, Marcel Baschin, et al. "The Role of Platelets in Cancer Pathophysiology: Focus on Malignant Glioma." Cancers 11, no. 4 (2019): 569. http://dx.doi.org/10.3390/cancers11040569.

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The link between thrombocytosis and malignancy has been well known for many years and its associations with worse outcomes have been reported mainly for solid tumors. Besides measuring platelet count, it has become popular to assess platelet function in the context of malignant diseases during the last decade. Malignant gliomas differ tremendously from malignancies outside the central nervous system because they virtually never form distant metastases. This review summarizes the current understanding of the platelet–immune cell communication and its potential role in glioma resistance and progression. Particularly, we focus on platelet-derived proinflammatory modulators, such as sphingosine-1-phosphate (S1P). The multifaceted interaction with immune cells puts the platelet into an interesting perspective regarding the recent advances in immunotherapeutic approaches in malignant glioma.

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Liang, Yuanxin, Robert S. Heller, Julian K. Wu, Carl B. Heilman, Arthur S. Tischler, and Knarik Arkun. "High p16 Expression Is Associated with Malignancy and Shorter Disease-Free Survival Time in Solitary Fibrous Tumor/Hemangiopericytoma." Journal of Neurological Surgery Part B: Skull Base 80, no. 03 (2018): 232–38. http://dx.doi.org/10.1055/s-0038-1669419.

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Objective Solitary fibrous tumors (SFT) and hemangiopericytomas (HPC) are now classified along a single spectrum of fibroblastic mesenchymal tumors with NAB2–STAT6 fusion. This fusion acts as a driver mutation that constitutively activates EGR1, which is known to be involved in the p16 pathway. Overexpression of p16 is associated with malignancy and worse prognosis in multiple mesenchymal tumors. The authors sought to investigate p16 immunoexpression in association with malignancy and prognosis of SFT/HPC tumors. Design Twenty-three SFT/HPC tumors (central nervous system [CNS]: 12, non CNS: 11) diagnosed at our institution from 2002 to 2016 were assigned into 3 grades. Data from microarray immunohistochemistry for STAT6, synaptophysin, CD56, chromogranin, SST2A, EGR1, Ki67, and p16, grade and survival were analyzed. Results CNS SFT/HPCs tend to be malignant (grade 3; 67 vs. 18%, p = 0.036) and more likely to express synaptophysin (33 vs. 0%, p = 0.035) than non CNS tumors. Overexpression of p16 (immunopositivity ≥ 50% tumor cells) was associated with malignant (grade 3) tumors, and has a sensitivity of 70% (7/10), and a specificity of 77% (10/13), as a predictive marker for malignancy. SFT/HPC patients with low p16 expression demonstrated significantly longer disease-free survival time (median survival > 113 months) than those with high p16 expression (median survival = 30 months, p = 0.045). Conclusions SFT/HPCs in the CNS are more likely to be malignant than the tumors in other sites. High p16 expression is also associated with malignancy and shorter disease-free survival time in SFT/HPC tumors in our study cohort. Clinically, p16 overexpression can be used as predictive marker for malignancy and prognosis and a possible therapeutic target.

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Koshy, A. N., R. J. Briggs, and M. Dally. "Primary melanoma of the cochlea with cerebellopontine extension and leptomeningeal spread." Journal of Laryngology & Otology 128, S2 (2014): S59—S62. http://dx.doi.org/10.1017/s002221511400019x.

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AbstractBackground:Less than 1 per cent of tumours occurring in the region encompassing the internal auditory canal and the cerebellopontine angle are malignant. Primary central nervous system melanomas arising from this region are exceptionally rare and are often initially misdiagnosed as acoustic neuromas.Methods:We present a 71-year-old man with acute vestibular disturbance and unilateral hearing loss. Magnetic resonance imaging demonstrated a mass, thought to be a cochlear nerve schwannoma, involving the cochlea and the internal auditory canal. At surgery, a pigmented mass adherent to the facial nerve was visualised, and the observed histopathology was consistent with a malignant melanoma. No extracranial site for the primary tumour was found, suggestive of a primary central nervous system melanoma.Results:Despite surgical resection and adjuvant radiotherapy, the patient re-presented with extensive leptomeningeal disease 16 months later.Conclusion:Malignant tumours in the internal auditory canal and cerebellopontine angle region are rare. Early diagnosis and management are aided by recognition of characteristic factors such as a history of prior malignancy, atypical magnetic resonance imaging findings and accelerated audiovestibular symptoms. Despite the presented patient's outcome, total surgical resection with post-operative radiotherapy remains the recommended treatment.

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Glick, Roberta P., Terry G. Unterman, Mary Van der Woude, and Lisa Zollner Blaydes. "Insulin and insulin-like growth factors in central nervous system tumors." Journal of Neurosurgery 77, no. 3 (1992): 445–50. http://dx.doi.org/10.3171/jns.1992.77.3.0445.

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✓ The authors have previously reported the presence of insulin-like growth factor (IGF) receptors in central nervous system (CNS) tumors and the production of IGF's and their binding proteins by CNS tumors in situ. This study was designed to investigate whether CNS tumor cells are capable of autocrine secretion of IGF-I and IGF-II in vitro. Production of IGF's was studied by specific radioimmunoassay of tumor-cell-conditioned serum-free media from 34 CNS tumors: 12 gliomas, 12 meningiomas, and 10 miscellaneous tumors. Normal human serum and cerebrospinal fluid served as controls. Insulin-like growth factor I was detected in five of 12 meningiomas but in none of the gliomas studied. In contrast, IGF-II was detected in four of 12 gliomas and in six of 11 meningiomas studied. Four miscellaneous tumors produced IGF-I and/or IGF-II. These results suggest that CNS tumors differentially produce IGF-I and IGF-II in vitro. Preferential production of IGF's may be an important marker of the tumor-cell differentiation or malignancy and may be useful as a clinical diagnostic tool. These results add further support to the concept that IGF's may play a role in the regulation of the behavior of CNS tumors.

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Yang, J., Z. Liu, Y. Yang, H. Chen, and J. Xu. "Lateral intraventricular primary central nervous system lymphoma (LIPCNSL): a review." QJM: An International Journal of Medicine 113, no. 7 (2020): 457–64. http://dx.doi.org/10.1093/qjmed/hcz330.

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Abstract Background Lateral intraventricular primary central nervous system lymphoma (LIPCNSL) is an extremely rare intraventricular tumor with high malignancy and has never been systematically described. Aim To analyze the clinical characteristics and therapeutic strategy of LIPCNSL. Design Single-center retrospective study. Methods The clinical manifestation, imaging, treatment and outcomes of 13 patients with LIPCNSL who underwent craniotomy in West China Hospital between December 2008 and April 2018 were retrospectively analyzed. Results Eleven male and two female patients were enrolled. The mean age was 49.7 years (14–65 years). The frequent manifestations include symptoms of raised intracranial pressure and limb weakness. The mean duration was 1.8 months (1 week to 1 year). The average maximal diameter of tumors was 4.1 cm (1.8–6.1 cm). Gross total resection was achieved in 84.6% of patients. Symptoms improved in 69.2% of patients but developed in 30.8% of patients after surgery. The median recurrence-free survival (RFS) and overall survival (OS) were 2.0 months (1–86 months) and 3.0 months (1–124 months). High-dose methotrexate or/and radiotherapy significantly prolonged the RFS and OS (P &lt; 0.05). Eight patients (72.7%) experienced relapse and progression. Salvage treatment significantly prolonged survival after relapse (P &lt; 0.05). Conclusions LIPCNSL should be considered as a differential diagnosis of intraventricular tumors. High-dose methotrexate-based chemotherapy with or without radiotherapy should be the first-line treatment, and surgery is only for biopsy and improving symptoms. Long-term intensive follow-up is necessary and active salvage treatment should be performed after relapse.

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Neuwelt, Edward A., Csanád G. Várallyay, Sándor Manninger, et al. "THE POTENTIAL OF FERUMOXYTOL NANOPARTICLE MAGNETIC RESONANCE IMAGING, PERFUSION, AND ANGIOGRAPHY IN CENTRAL NERVOUS SYSTEM MALIGNANCY." Neurosurgery 60, no. 4 (2007): 601–12. http://dx.doi.org/10.1227/01.neu.0000255350.71700.37.

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Strowd, Roy E., Gregory Russell, Michele Harmon, et al. "Immunologic response to high-dose influenza vaccination in patients with primary central nervous system malignancy (PCNSM)." Journal of Clinical Oncology 33, no. 15_suppl (2015): e20669-e20669. http://dx.doi.org/10.1200/jco.2015.33.15_suppl.e20669.

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