Histological and Immunohistological Features of Reccurences in Patients with High Grade Diffuse Astrocytic Tumors
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Abstract
The objective: to study recurrences of high grade diffuse astrocytic tumors and to attempt to create some recommendations for their following treatment.
Materials and methods. 25 relapsed cases were investigated. 15 of them were early recurrences and 10 were late recurrences. The primary tumor specimens from patients with early recurrences were additionally examined to value tumor transformation. Case histories of patients were studied retrospectively. The histological investigation and immunohistochemistry were performed. Immunohistochemical analysis included expression of 12 markers: GFAP, Anti-IDH1R132H, vimentin, EGFR, Ki-67, MMP-9, VEGF,CD34, CD3,CD4, CD8, CD68. Mutation IDH1105GGTSNP was detected through molecular analysis. Statistical analysis was used to value quantitative and qualitative data. Tumor transformation in paired samples was valued with the McNemar test.
Results. The one case of pseudoprogression was found among all studied recurrences. Post-treatment effects were more common in early recurrences rather than for late recurrences. In early relapsed tumors, a significant increase of CD8-cell infiltration was observed (McNemar test p-value=0,01343; p <0,05). The index of vascularisation was significantly higher in early recurrences (Mann-Whitney U test, р exect=0,016, р<0,05). There was a strong direct correlation between the index of vascularisation and the percentage of tumor cells expressed MMP-9 (rs=0,893, р<0,05). The mutation IDH1105GGTSNP related to cases of late recurrences (Mann-Whitney U test; p=0,043 p<0,05).
Conclusion. It is important to distinguish pseudoprogression from true progression because it leads to a different treatment strategy. The knowledge of proliferative, vascular and invasive features of the relapsed tumor, the study of their immune response will make possible to create and to put into practice the effective personalized treatment for patients with high grade astrocytomas.##plugins.themes.bootstrap3.article.details##
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