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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Acta+Neuropathol
2014 ; 128
(1
): 39-54
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A neuropathology-based approach to epilepsy surgery in brain tumors and proposal
for a new terminology use for long-term epilepsy-associated brain tumors
#MMPMID24858213
Blumcke I
; Aronica E
; Urbach H
; Alexopoulos A
; Gonzalez-Martinez JA
Acta Neuropathol
2014[Jul]; 128
(1
): 39-54
PMID24858213
show ga
Every fourth patient submitted to epilepsy surgery suffers from a brain tumor.
Microscopically, these neoplasms present with a wide-ranging spectrum of glial or
glio-neuronal tumor subtypes. Gangliogliomas (GG) and dysembryoplastic
neuroepithelial tumors (DNTs) are the most frequently recognized entities
accounting for 65 % of 1,551 tumors collected at the European Epilepsy Brain Bank
(n = 5,842 epilepsy surgery samples). These tumors often present with early
seizure onset at a mean age of 16.5 years, with 77 % of neoplasms affecting the
temporal lobe. Relapse and malignant progression are rare events in this
particular group of brain tumors. Surgical resection should be regarded,
therefore, also as important treatment strategy to prevent epilepsy progression
as well as seizure- and medication-related comorbidities. The characteristic
clinical presentation and broad histopathological spectrum of these highly
epileptogenic brain tumors will herein be classified as "long-term epilepsy
associated tumors-LEATs". LEATs differ from most other brain tumors by early
onset of spontaneous seizures, and conceptually are regarded as developmental
tumors to explain their pleomorphic microscopic appearance and frequent
association with Focal Cortical Dysplasia Type IIIb. However, the broad
neuropathologic spectrum and lack of reliable histopathological signatures make
these tumors difficult to classify using the WHO system of brain tumors. As
another consequence from poor agreement in published LEAT series, molecular
diagnostic data remain ambiguous. Availability of surgical tissue specimens from
patients which have been well characterized during their presurgical evaluation
should open the possibility to systematically address the origin and
epileptogenicity of LEATs, and will be further discussed herein. As a conclusion,
the authors propose a novel A-B-C terminology of epileptogenic brain tumors
("epileptomas") which hopefully promote the discussion between neuropathologists,
neurooncologists and epileptologists. It must be our future mission to achieve
international consensus for the clinico-pathological classification of LEATs that
would also involve World Health Organization (WHO) and the International League
against Epilepsy (ILAE).