Immunotherapy of pediatric brain tumor patients should include an immunoprevention strategy: a medical hypothesis paper

Adults diagnosed with Glioblastoma multiforme (GBM) are frequently faced with a 7% chance of surviving 2 years compared with pediatric patients with GBM who have a 26% survival rate. Our recent screen of possible glioma-associated antigen precursor protein (TAPP) profiles displayed from different types of pediatric brain tumors showed that pediatric patients contained a subset of the tumor antigens displayed by adult GBM patients. Adult GBM possess at least 27 tumor antigens that can potentially stimulate T cell immune responses, suggesting that these tumors are quite antigenic. In contrast, pediatric brain tumors only expressed nine tumor antigens with mRNA levels that were equivalent to those displayed by adult GBM. These tumor-associated antigens could be used as possible targets of therapeutic immunization for pediatric brain cancer patients. Children have developing immune systems that peak at puberty. An immune response mounted by these pediatric patients might account for their extended life spans, even though the pediatric brain tumors express far fewer total tumor-associated antigens. Here we present a hypothesis that pediatric brain tumor patients might be the best patients to show that immunotherapy can be used to successfully treat established cancers. We speculate that immunotherapy should include a panel of tumor antigens that might prevent the out-growth of more malignant tumor cells and thereby prevent the brain tumor relapse. Thus, pediatric brain tumor patients might provide an opportunity to prove the concept of immunoprevention

Cavernoma gigante: relato de dois casos Giant cavernous angioma: report of two cases

Angiomas cavernosos ou hemangiomas ou ainda cavernomas são malformações do sistema nervoso central, classificadas como lesões cerebrais vasculares ocultas, frequentemente assintomáticas, sendo relativamente raras. Definidas histologicamente como massas compactas cavernosas ou canais sinusoidais de vários tamanhos, com paredes finas no interior do parênquima cerebral e sem intervenção do tecido glial. Podem ocorrer em qualquer faixa etária inclusive em neonatos. Na maioria das vezes são lesões de tamanho reduzido, localizadas no interior do parênquima encefálico. Angiograficamente não mostram alterações com circulação patológica, podendo mesmo não ser diagnosticados pela tomografia, sendo o exame ideal para o seu diagnóstico a ressonância magnética de crânio. Os cavernomas são lesões histologicamente benignas mas, dependendo de sua localização, podem trazer grandes transtornos neurológicos e ser irressecáveis. A exérese cirúrgica da lesão é o tratamento de escolha se a lesão for única e em localização favorável e estiver desencadeando sintomatologia neurológica prejudicial ao paciente. Apresentamos dois casos de cavernomas gigantes que apresentaram boa evolução após ressecção cirúrgica completa. Descritos como gigantes, foram encontrados apenas três casos individuais na literatura .<br>Cavernous angiomas or haemangiomas or yet cavernomas are malformations of the central nervous system classified as occult vascular brain lesions. These rare lesions are clinically silent. They are defined by the presence of abnormally large vascular cavities or sinusoids channels of variable size, with sharp walls, located inside but not invading the brain parenchyma. They can occur at any age, including the neonatal period. Most of the small lesions are located inside the brain parenchyma. No abnormal circulation can be demonstrated in angiography and CT scan can be helpful for diagnosis only in rare occasions. Magnetic resonance is the best exam to demonstrate the lesion. Despite the benign character some lesions may cause neurologic dysfunction when their removal may be difficult. Complete extirpation is the best treatment if the lesion is favorable located and is causing neurological dysfunction. Two cases of giant cavernomas with good outcome after total removal are present. Only three cases of giant cavernomas were reported in the literature