Endoscopic diagnosis of an MRI-occult, low-grade glioma with ependymal dissemination

Abstract

<jats:p>A 21-year-old man presented with triventricular hydrocephalus due to a tectal mass. He underwent an endoscopic third ventriculostomy, and multiple nodules were identified at the floor of the third ventricle intraoperatively. Surgical pathology of one of these lesions demonstrated that the tissue represented a low-grade astrocytoma. The case highlights the existing potential of neuroendoscopy to reveal neuroimaging-occult lesions, in spite of the significant advances of MRI. Furthermore, the combination of the age of the patient, the nonenhancing MRI appearance, and the multifocality of the lesions constitutes a rare and interesting neoplastic presentation within the brain. The constellation of findings likely represents dissemination of a low-grade tectal glioma via the CSF compartment.</jats:p>

Multiple cerebral gliomas mimicking central nervous system inflammatory demyelinating diseases

“…In addition, anaplastic astrocytoma, anaplastic oligoastrocytoma, gliosarcoma, oligoastrocytoma, and ependymoma have also been reported in MCGs. [26–29] MCGs have a worse prognosis than do solitary tumors and the survival time ranges from 2 to 10 months under treatment, including radio-, chemo-, and immunotherapies.…”

Cerebrospinal Fluid Dissemination and Neoplastic Meningitis in Primary Brain Tumors

“…Lack of standardized diagnostic methods, difficulties determining treatment response, and lack of large, randomized controlled trials complicate the evaluation and management of neoplastic meningitis. [167][168][169][170][171][172][173][174][175][176][177][178] Those issues notwithstanding, evidence suggests that palliative therapies for neoplastic meningitis are effective and, in certain patients, can prolong survival. Typically, treatment is multimodal and involves a combination of surgery, radiotherapy, and chemotherapy.…”

“…The Figure outlines a treatment algorithm for neoplastic meningitis. [167][168][169][170][171][172][173][174][175][176][177][178] In general, the only neurological manifestations of neoplastic meningitis that improve with treatment are related to pain. Neurological signs and symptoms (eg, ataxia, confusion, cranial nerve deficits, segmental weakness) only stabilize or minimally improve following treatment.…”

“…Neurological signs and symptoms (eg, ataxia, confusion, cranial nerve deficits, segmental weakness) only stabilize or minimally improve following treatment. [179][180][181][182][183][184][185][186][187][188][189][190]…”

“…Other agents, such as diaziquone, gemcitabine, interferon a, mafosfamide, temozolomide, and topotecan, have been evaluated in an attempt to improve therapeutic efficacy. [179][180][181][182][183][184][185][186][187][188][189][190] Immunotherapy utilizing interleukin 2 and interferon a, gene therapy, and iodine I 131-radiolabeled monoclonal antibodies are among several other therapeutic options being explored in clinical trials. [179][180][181][182][183][184][185][186][187][188][189][190] Supportive Care Aggressive treatment is not appropriate for every patient with neoplastic meningitis.…”