Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm

Wright, Erin; Amankwah, Ernest K.; Winesett, S. Parrish; Tuite, Gerald F.; Jallo, George I.; Carey, Carolyn M.; Rodríguez, L. F.; Stapleton, Stacie

doi:10.1007/s11060-018-03039-1

Cited by 20 publications

(13 citation statements)

References 24 publications

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“…All these features are presumed to be characteristics of low-grade brain tumors. 16,17 In a previous study, we showed that incidental lesions of the infratentorial compartment that displayed contrast enhancement and restriction diffusion were more likely to require surgery at any point in time, either immediately after diagnosis or during the follow-up period. 12 In the current study we were not able to find any correlation between radiological features of incidentally found thalamic lesions and their likelihood of receiving surgery.…”

Section: Radiological Features Of Incidental Lesionsmentioning

confidence: 89%

Pediatric thalamic incidentalomas: an international retrospective multicenter study

Kozyrev

Soleman

Tsering

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Widespread use of modern neuroimaging has led to a surge in diagnosing pediatric brain incidentalomas. Thalamic lesions have unique characteristics such as deep location, surgical complexity, and proximity to eloquent neuronal structures. Currently, the natural course of incidental thalamic lesions is unknown. Therefore, the authors present their experience in treating such lesions. METHODS A retrospective, international multicenter study was carried out in 8 tertiary pediatric centers from 5 countries. Patients were included if they had an incidental thalamic lesion suspected of being a tumor and were diagnosed before the age of 20 years. Treatment strategy, imaging characteristics, pathology, and the outcome of operated and unoperated cases were analyzed. RESULTS Overall, 58 children (23 females and 35 males) with a mean age of 10.8 ± 4.0 years were included. The two most common indications for imaging were nonspecific reasons (n = 19; e.g., research and developmental delay) and headache unrelated to small thalamic lesions (n = 14). Eleven patients (19%) underwent early surgery and 47 were followed, of whom 10 underwent surgery due to radiological changes at a mean of 11.4 ± 9.5 months after diagnosis. Of the 21 patients who underwent surgery, 9 patients underwent resection and 12 underwent biopsy. The two most frequent pathologies were pilocytic astrocytoma and WHO grade II astrocytoma (n = 6 and n = 5, respectively). Three lesions were high-grade gliomas. CONCLUSIONS The results of this study indicate that pediatric incidental thalamic lesions include both low- and high-grade tumors. Close and long-term radiological follow-up is warranted in patients who do not undergo immediate surgery, as tumor progression may occur.

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Section: Radiological Features Of Incidental Lesionsmentioning

confidence: 89%

Pediatric thalamic incidentalomas: an international retrospective multicenter study

Kozyrev

Soleman

Tsering

et al. 2022

Journal of Neurosurgery: Pediatrics

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“…Previous studies of IDG included tumors that came to attention during workup for headache 18,[25][26][27] . We elected to exclude such cases as there was no instance in our series of a tumor detected in persons with a long-standing headache disorder during a purely 'routine' imaging study.…”

Section: Discussionmentioning

confidence: 99%

“…Although current recommendations support early surgical resection for low-grade gliomas [9][10][11][12][13] , management of asymptomatic incidentally diagnosed gliomas remains a matter of debate. There are multiple studies supporting moving away from the "watchful waiting" approach to earlier therapeutic strategies [14][15][16][17][18] . Pallud et al reported that incidental grade II gliomas were progressive in all cases and transformed to symptomatic grade II gliomas at a median interval of 48 months after radiological discovery and had malignant transformation at a median interval of 5.7 years after radiological diagnosis 4,19 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of asymptomatic glioma and implications for survival

Lobbous

et al. 2020

Preprint

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Background: Brain tumors can present as focal neurologic deficits (reflecting the tumor location) or generalized symptoms due to increased intracranial pressure. Occasionally, brain tumors can be found incidentally in asymptomatic patients or in patients with unrelated symptoms who undergo brain imaging. The term incidentaloma is used to refer to these imaging abnormalities. Objective: The object of this study was to examine the prevalence and correlates of asymptomatic glioma in a large epidemiological study of brain tumors. Methods: The analysis was based on a large series of patients with glioma (N = 1989) enrolled in a multicenter clinic-based epidemiologic study between 2005 and 2017. Patients were considered asymptomatic from the tumor, and thus as having an incidentally detected glioma (IDG), if the tumor was diagnosed during workup of injury or unrelated medical condition. Results: A total of 32 of 1989 (1.6%) patients were asymptomatic at diagnosis. The leading indication for brain imaging in IDG was non-workplace injuries followed by medical workup for unrelated conditions. IDG was more prevalent in patients younger than 50 years of age (2.6% vs 1.0%). IDG was also more common in patients with low grade gliomas (4.7% for WHO grade II and 1.5% for WHO grade III) vs glioblastomas (0.6% in WHO grade IV). Conclusion: The present data suggest that gliomas may be found incidentally, especially among low grade gliomas. Studies of IDG may be useful as a proxy for early detection of tumor as a means to improve patient survival.

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“…For example, rates of hepatoblastoma and central nervous system (CNS) tumors increased substantially from 1992-2004. 3 The increase in CNS tumor incidence is partially attributable to incidental detection of indolent tumors with the expanded use of medical imaging; 5 however, factors underlying increases in hepatoblastoma incidence remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Assisted reproductive technology and association with childhood cancer subtypes

Gulrajani

Montes

McGough

et al. 2021

Preprint

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Objectives: Use of assisted reproductive technology (ART) may alter the typical course of fetal development. We sought to investigate the association between ART use and childhood cancer subtype. Study design: We surveyed 1701 parents of children with cancer about ART use, demographics, and gestational and perinatal factors. Multivariable logistic regression modeled the association between ART use and childhood cancer subtypes, birthweight and multiple gestation status. Results: Among childhood cancer patients, ART use was highest among children with osteosarcoma (OR=2.81; 95% CI=1.2-6.4; P=0.01). ART use was also elevated among children with hepatoblastoma, and this relationship appeared mediated by low birthweight. No specific type of ART appeared to drive these associations. Low birthweight was itself strongly associated with increased hepatoblastoma risk, even after adjustment for ART use, multiple gestation status, sex, and parental income (P<0.001). Birthweight was higher in patients with germ cell tumors (P=0.02) and with neuroblastoma (P=0.06). Multiple gestation status was associated with neuroblastoma among females (OR=3.6, 95% CI=1.2-10.5, P=0.02), but not among males (OR=0.97, 95% CI=0.27-3.4, P=0.96) (Pinteraction=0.02). Conclusions: Associations between ART use and hepatoblastoma risk may be mediated by birthweight, a strong hepatoblastoma risk factor that was replicated in our study. ART use may also be associated with osteosarcoma independent of birthweight, an association not previously observed in studies limited to cancers diagnosed before adolescence. Evaluating long-term health outcomes in children conceived by ART, throughout adolescence and potentially into adulthood, appears warranted.

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Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm

Cited by 20 publications

References 24 publications

Pediatric thalamic incidentalomas: an international retrospective multicenter study

Pediatric thalamic incidentalomas: an international retrospective multicenter study

Prevalence of asymptomatic glioma and implications for survival

Assisted reproductive technology and association with childhood cancer subtypes

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