Recurrent PNET with MGMT Methylation Responds to Temozolomide
Bibliographic record
Abstract
Primitive neuro-ectodermal tumours (PNET) are neuroepithelial neoplasms arising from the germinal matrix of the primitive neural tube.Primitive neuro-ectodermal tumours are predominately a tumour of childhood, accounting for about 20% of primary central nervous system (CNS) malignancies in children 1 .Typically PNETs occur in the posterior fossa, but supratentorial PNETs in children still account for about 2.8% of all primary tumours of childhood and adolescence 2 .Much is known about the management of PNETs in children.In adults, on the other hand, supratentorial PNETs are exceedingly rare, with only a handful of cases reported in the current literature.Thus, optimal medical management of supratentorial PNETs in adults remains unclear.Chemotherapy options that have been utilized in previous reports include conventional agents such as vincristine, cisplatinum, cyclophosphamide, procarbazine, and CCNU 2,3 , in addition to recent reports of successful treatment with temozolomide 1,4 .Here, we present the case of a patient with a supratentorial PNET diagnosed in adulthood, with tumour recurrence on carboplatin and etoposide, which responded to subsequent treatment with temozolomide. CASE REPORTA 42-year-old man presented to the ED with a few weeks history of headache, confusion, nausea, vomiting, and progressive left-sided hemiparesis.An magnetic resonance image (MRI)-head showed a 6.3 x 5.2 x 5.0 cm partially cystic enhancing mass in the right basal ganglia, with mild surrounding edema and mass effect causing a midline shift of seven mm and right lateral ventricle effacement.He subsequently underwent craniotomy and gross total excision of the tumour.Clinically, he improved significantly after the surgery and had minimal residual deficits.Pathology showed a highly cellular tumour composed of poorly differentiated small round blue cells forming pseudorosettes around vessels.The nuclei were pleomorphic with numerous mitoses and apoptotic bodies, with no necrosis (Figure 1).Immunohistochemistry was positive for synaptophysin and negative for CD45, LMWK, HMWK and GFAP, NF, SMI31 and NeuN.These results were deemed consistent with PNET, but a metastatic neuro-endocrine tumour could not be excluded.He went on to have further imaging, including a computed tompogram (CT) of the chest, abdomen, and pelvis, which did not reveal any findings suggestive of a primary malignancy.Routine staging investigations for radiotherapy included further imaging of his spine and cerebrospinal fluid (CSF) studies to Recurrent PNET with MGMT Methylation Responds to Temozolomide
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".