Background: Glioblastoma multiforme (GBM) poses a significant health challenge as the most common primary malignancy of the adult central nervous system. Gender and age-related differences in GBM influence prognosis and treatment complexities. This multicenter retrospective study explores gender and age disparities in GBM patients, investigating their impact on occurrence and survival outcomes. Methods: This STROBE-compliant retrospective study involved GBM patients who received medical care in Guilan Province, Iran. Patients’ data, including age, gender, tumor location, and histopathological diagnosis date, was collected from medical records. Results: In a cohort of 164 GBM patients, the average age was 54 years, with higher prevalence in men (59.8%) as well as patients ≤60 years (64.6%). The tumor sites exhibited overlapping features in 68% of cases, with the frontal and temporal lobes being the most prevalent specific locations. The mean survival was 12.88 ± 14.14 months, one-year survival of 45%, with women showing higher one-year survival (60% vs. 40%) and longer mean survival (16.14 ± 17.35 vs. 10.75 ± 11.15 months). Patients ≤60 years had higher one-year survival (75% vs. 35%). In subgroup analysis, women had significantly higher survival rates in patients ≤60 years. However, among patients over 60, women exhibited a more significant reduction in survival rates, and no statistically significant difference was observed between males and females in this age group. Discussion: While the biological mechanisms behind gender disparities in GBM remain unclear, studies suggest the potential involvement of sex hormones. Age-related differences, in line with the prior research, highlight the complexity of managing older GBM patients. Conclusion: This study underscores age and gender disparities in GBM occurrence and prognosis, emphasizing the necessity for further investigations and innovative approaches to address the potential pathogenesis.

Introduction Chorioangioma is a benign vascular tumor of the placenta that occurs in approximately 1% of pregnancies1. The majority of cases are small and asymptomatic, with symptoms appearing in only 0.01%–0.03% of instances2. Giant chorioangiomas, defined as tumors larger than 4 cm, are remarkably rare, with a prevalence ranging from 1:9,000 to 1:50,000 3. While many chorioangiomas are detected during postnatal examination of placental histology, large chorioangiomas are associated with significant maternal and fetal complications. These include preterm labor, intrauterine growth restriction (IUGR), pre-eclampsia, polyhydramnios as well as hydrops fetalis, disseminated intravascular coagulation (DIC), and mortality 4–6.Despite significant advancements in therapeutic approaches, perinatal mortality rates remain high, estimated to be more than 30%7. Therefore, it is essential to highlight the importance of timely identification, comprehensive prenatal monitoring, and appropriate interventions to prevent fetal morbidity and mortality8. In this report, we present a case involving multiple giant chorioangiomas in a 23-year-old woman, which were associated with fetal complications and ultimately resulted in the neonate’s death due to hydrops fetalis. This case emphasizes the complexity of this condition and underscores the necessity for a multidisciplinary approach in evaluating and counseling patients with intricate fetal anomalies. This study has been reported in line with the CARE criteria9.

Letter To the EditorWe read the article ”Retroperitoneal Schwannoma: Uncommon Location of a Benign Tumor” by Debaibi et al. 1 in the Journal of Clinical Case Reports in 2022 with great interest. While this research is undoubtedly valuable in contributing to our understanding of retroperitoneal schwannomas, it has come to our attention that certain aspects of the study merit further discussion and consideration.In the opening paragraph of the discussion section, the authors allude to the rarity of malignant transformation within schwannomas, except in cases of type 2 neurofibromatosis, citing Harhar et al. 20212. However, this statement is inaccurate, as Harhar et al. reported that up to 60% of individuals with Von Recklinghausen’s disease, specifically referring to neurofibromatosis type one, may undergo malignant transformation. Therefore, the assertion concerning type 2 neurofibromatosis lacks support from their reference. For the sake of clarity, farschtchi et al.3, in their article, also stated that “schwannomas in neurofibromatosis type 2 hardly ever undergo malignant transformation.”In the second paragraph of the discussion section, the authors refer to abdominal Magnetic Resonance Imaging (MRI) as the ”gold standard” for diagnosis, citing Radojkovic et al. 4 and Harhar et al. While Radojkovic et al. do emphasize the role of MRI in diagnosing soft-tissue tumors, it is crucial to clarify that MRI is not universally the gold standard for differentiating between benign and malignant lesions. Moreover, Harhar et al. acknowledge the lack of distinct imaging characteristics for retroperitoneal schwannomas on computed tomography (CT) and MRI scans. Since there is no gold standard diagnostic method for RSs5, establishing a definitive preoperative diagnosis of RSs remains challenging. However, the importance of contrast-enhanced CT as a primary imaging investigation, especially in differentiating various pathologies in the retroperitoneum, should be highlighted, as suggested by Messiou et al.6 in 2018. Despite the availability of numerous advanced imaging techniques, such as ultrasound (US), CT, and MRI, the absence of distinct imaging features limits our ability to diagnose RSs accurately, with less than 20% of all cases receiving a precise preoperative identification. 7Lastly, in the introduction section, the authors state that retroperitoneal schwannomas represent only 4% of all retroperitoneal tumors, citing Radojkovic et al. 2018. 4 However, I would like to point out that this specific reference is not mentioned anywhere in the manuscript. The accurate source for this information is Harhar et al. 2021. This discrepancy in referencing should be addressed and corrected, as the integrity of scientific literature relies on accurate and well-referenced information, especially in clinical case reports.Retroperitoneal schwannomas (RSs) are unusual tumors, accounting for only 1 to 3% of all schwannomas. They often go unnoticed due to the expansive and flexible nature of the retroperitoneal space, leading to delayed diagnosis and significant lesion growth. Definitive diagnosis of schwannomas is based on histopathological and immunohistochemical findings8. Characteristic histopathological changes are marked by elongated spindle cells forming hypercellular Antoni A areas with twisted nuclei and Verocay bodies, as well as hypocellular Antoni B regions exhibiting inflammatory cells, collagen bundles, and xanthomatous changes8,9. The primary treatment approach involves surgical removal, which can be accomplished through traditional open procedures or minimally invasive laparoscopy, often yielding positive therapeutic results5,10. However, this necessitates thorough preoperative planning and a multidisciplinary approach, given the complex nature of both diagnosis and treatment.