Intracranial Metastases of Cervical Intramedullary Low-Grade Astrocytoma without Malignant Transformation in Adult

Abstract

The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report. Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord. Two years later, posterior fusion was necessary for progressive kyphosis in the cervical spine. He was well for approximately 7 years after the primary surgery. Two months ago, he presented with partial weakness and incoordination with gait difficulty. MRI Scan demonstrated multiple small lesions in the cerebellar vermis and left hemisphere. After suboccipital craniectomy and posterior cervical exposure, the small masses in the cerebellar vermis and hemispheres were excised to a large extent by guidance of an intraoperative navigation system. The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II). When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.

Intracranial Metastases of Intramedullary Spinal Cord Low-Grade Astrocytoma

“…Most cases of intracranial metastasis of spinal cord astrocytoma are related to high-grade tumors and intracranial metastasis of spinal cord LG astrocytoma is a rare phenomenon. [4,10,12] The mechanism of intracranial metastasis of intramedullary spinal cord LG astrocytoma is not well known. [10,13] Some previous researchers have hypothesized that metastasis of LG astrocytoma can develop due to resection and manipulation.…”

“…Spinal cord astrocytoma is a rare neoplasm in the pediatric population. [1] The previous literature has reported that its prevalence is <1% of all primary neoplasms of the central nervous system [2][3][4] and that it comprises 6%-8% of all primary spinal cord tumors. [5][6][7] Brain metastasis of a primary spinal cord astrocytoma has rarely been reported, and most of the reported cases have been caused by high-grade astrocytoma.…”

“…This study concluded that the LG spinal cord astrocytoma might spread to intracranial structures without malignant transformation. [4] Ryu et al reported two malignant transformations of LG spinal cord astrocytoma among 12 patients. [2] Yamagami et al reported a case of a 44-year-old patient with LG…”

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

“…One reported case even reveals a patient with a cervical low-grade astrocytoma with a cerebral metastasis, indicating the possibility of such history and also emphasizing that - to prevent further metastases - metastases should be rejected if possible. 2 …”

“… 1 Up to now, only nine cases of pilocytic astrocytoma with dissemination in the spinal meninges have been published. Interestingly, only three of these nine cases have been described in children; 2-4 the other six cases concerned adult patients. 1 , 5-9 This may be due to the fact that intradural extramedullary spinal dissemination occurred even 10-20 years after the primary surgery of the cerebral tumor.…”