A multinodular and vacuolating neuronal tumor (MVNT) is a rare non-malign central nervous system tumor. The cerebral cortex of young to middle-aged adults is affected and seizures and focal neurological deficits could reveal it. Despite being considered a low-grade tumor, MVNT can be challenging to diagnose and manage due to its histopathological similarities to other neuronal tumors. The limited number of reported cases makes it difficult to establish definitive guidelines for treatment and follow-up. Given the relatively recent discovery of MVNT, there is a need for further research to better understand its pathogenesis, optimal treatment and long-term strategies. Furthermore, studying MVNT can contribute to the broader understanding of brain tumor biology and the intricacies of tumor heterogeneity. This paper explores the challenges and perspectives surrounding MVNT to improve clinical decision-making and patient outcomes. Based on the present narrative review, advancements in diagnostic technologies have shown promise in addressing the challenges associated with diagnosing MVNTs. Liquid biopsy is an innovative and non-invasive diagnostic tool that analyzes biomarkers to provide information about tumors, and radiomics is a method that extracts quantitative data from medical images to provide detailed insights into tumor characteristics. Such innovative diagnostic technologies are important because they have the potential to significantly improve the current diagnostic landscape for MVNTs, allowing for earlier detection, accurate classification, and personalized treatment strategies.
The primary objective of this narrative review is to evaluate the most frequently recommended structural and functional imaging methods in managing epilepsy cases as effectively as possible from a neurologist’s perspective. This review examines the background of current practice, from the beginnings of neuroimaging by computer tomography to the newly introduced methods and their combination, which helps diagnose and monitor these patients. The neuroimaging investigations required for the presurgical evaluation of patients with epilepsy are presented, and recommendations for specific MRI protocols are provided. The clinical use of functional imaging methods is also considered, and correlations between clinical aspects and specific imaging methods are explored, based on the retrieved data in the literature. In conclusion, this review emphasizes using functional and structural imaging methods, guided by clinical evidence, for better therapeutic management in patients with epilepsy.
Gliosarcoma is a rare and aggressive variant of glioblastoma, characterized by both a malignant glial component and a mesenchymal sarcomatous component. Gliosarcomas have genetic alterations with glioblastomas, including TP53, PTEN mutations, and EGFR amplification, but may also exhibit additional changes related to epithelial-mesenchymal transition pathways. Management is similar to glioblastoma, involving safe, maximal surgical resection followed by radiotherapy and chemotherapy with temozolomide, but the prognosis remains poor, with a median survival of 6-14 months. Both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play crucial roles in the detection, characterization, and treatment planning of gliosarcoma. While MRI is the gold standard, CT remains valuable in certain situations. Light microscopy is essential for definitive diagnosis, allowing pathologists to examine cellular morphology and tissue architecture. It is essential for distinguishing gliosarcoma from other high- grade gliomas and for guiding treatment decisions. In addition, two-photon excited fluorescence (TPEF) microscopy is an advanced optical imaging technique that enables real-time, high-resolution visualization of tumor tissue without the need for staining or contrast agents and enhances visualization of collagen structure and vascularization, key factors in gliosarcoma assessment. The study of radiological and histopathological (light microscopy) features in primary gliosarcomas of the brain is a priority to achieve an early diagnosis that can be translated into better outcomes. Here, we describe the radiological and histopathological features observed in multiple cases of gliosarcoma in current practice.
