Dysembryoplastic Neuroepithelial Tumor Outcome [Neurosurgery Wiki]

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====== Dysembryoplastic Neuroepithelial Tumor Outcome ======


[[Seizure]] control: usually improves after surgery of [[dysembryoplastic neuroepithelial tumor]]. The degree of control seems to correlate with the completeness of removal. Improvement in seizures correlates inversely with the duration of intractable seizures
((Nolan MA, Sakuta R, Chuang N, Otsubo H, Rutka JT, Snead OC 3rd, Hawkins CE, Weiss SK. Dysembryoplastic neuroepithelial tumors in childhood: long-term outcome and prognostic features. Neurology. 2004 Jun 22;62(12):2270-6. doi: 10.1212/01.wnl.0000130495.69512.6f. PMID: 15210893.)).



Elder [[seizure]] onset age, longer duration of seizures prior to surgical [[resection]], and a [[temporal]] location may be risk factors of poor [[prognosis]] for DNTs patients after surgical resection
((Cai Y, Liu D, Yang Z, Chen X, Liu J, Zhang J, Li S, Li J, Yang Z. Factors associated with prognosis of dysembryoplastic neuroepithelial tumors patients after surgical resection: a retrospective observational study. Br J Neurosurg. 2021 Feb 2:1-6. doi: 10.1080/02688697.2021.1878107. Epub ahead of print. PMID: 33527856.)).
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see [[Dysembryoplastic neuroepithelial tumor recurrence]]
===== Malignant transformation =====

Mitoses or [[endothelial proliferation]], seen on occasion, do not affect the outcome. Malignant transformation is very rare.

There have been isolated case reports of astrocytic (malignant) transformation of a histologically proven DNET. 

Perhaps one with gemistocytic differentiation. The mechanism of development of a [[gemistocytic astrocytoma]] in a proven DNET remains a matter of debate. Its proposed mechanism is either a [[collision tumor]] or the neoplastic change within DNET. 

These reports of malignant transformation lend credence to the theory that there is at least a subgroup of lesions amongst DNETs, which have a malignant behavior and require adjunct treatment strategies. The issue is to identify this specific subset. How to do this? Whether some special characteristics on histopathologic examination or the genetic analysis hold the key remains unanswered. Till then, the need for lifelong surveillance in the case of DNET cannot be overemphasized
((Aggarwal A, Salunke P, Sodhi HB, Vasishta RK, Gowda KK. Dysembryoplastic
neuroepithelial tumor transforming into malignancy: a case report. Neurol India. 
2014 May-Jun;62(3):323-5. doi: 10.4103/0028-3886.137011. PubMed PMID: 25033864.
)).