Diffuse Spinal Leptomeningeal Spread of a Pilocytic Astrocytoma in a 3-Year-Old Child

Abstract

Pilocytic astrocytomas correspond to low-grade gliomas and therefore metastasize exceedingly rare. However, pilocytic astrocytomas are able to and leptomeningeal dissemination may be seen. What are the treatment options of these cases? We present a case report of a 3-year-old child with a pilocytic astrocytoma of the optic chiasm with leptomeningeal dissemination of the spinal meninges. Partial resection of the cerebral tumor has been performed. Since the leptomeningeal dissemination was seen all over the spinal meninges, the child did not undergo further surgical treatment. A wait and watch strategy were followed. Chemotherapy was initiated, if a 25% tumor growth was seen. Leptomeningeal dissemination of a pilocytic astrocytoma is seen so infrequently that no standard therapy is established. Since these metastases may occur even up to 2 decades after primary tumor resection, long-term follow-up is indicated. In case of spinal metastases, surgical treatment should be performed if feasible. Otherwise observation should be possessed and/or chemotherapy should be initiated.

Suprasellar pilocytic astrocytoma with leptomeningeal dissemination

“…Hydrocephalus occurs in suprasellar tumours secondary to extension into the anterior portion of the third ventricle and obstruction at the foramen of Monro, which was seen in the presented case. 16 Almost similar findings were also reported by Alyeldien et al 7 and Chang et al 17 Two other paediatric cases documented spinal dissemination in patients with optic chiasm astrocytomas. 13,15 The possible mechanism could be due to contact of the tumour with the ventricular system which leads to tumour cell invasion of the perivascular and subarachnoid spaces, increasing the possibility of leptomeningeal dissemination.…”

“…Hydrocephalus occurs in suprasellar tumours secondary to extension into the anterior portion of the third ventricle and obstruction at the foramen of Monro, which was seen in the presented case. 16 Almost similar findings were also reported by Alyeldien et al 7 and Chang et al 17 …”

“…As mentioned, the prognosis is mostly good. 7 The tumour usually occurs near the midline, commonly arising in the cerebellum, at the optic nerve and chiasm, or in the hypothalamus-thalamus region. Less common locations include the cerebral hemispheres, the cerebral ventricles, velum interpositum, and spinal cord.…”

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

“…Leptomeningeal dissemination of the cerebellar tumours into the spinal cord might occur many years after primary surgery [45,66,78]; less commonly the meningeal seeding appears at the initial presentation [67]. Spread into the spinal meninges can be observed in PAs of the spinal cord [1,9] and optic chiasm [4,48]. Extremely rarely, spinal cord PA can spread via the cerebrospinal fluid pathway (CSF) to the cerebral meninges [69].…”

Posterior Fossa Tumors

“…However, PAs are able to and leptomeningeal dissemination may be seen. 12 Differential diagnosis of PA in children mainly includes EP and medulloblastoma. However, other mass lesions should be included in differential diagnosis.…”