Regression after subtotal resection of an optic pathway glioma in an adult without adjuvant therapy: case report

Abstract

Optic pathway gliomas (OPGs) are relatively common and benign lesions in children; however, in adults these lesions are nearly always malignant and hold a very poor prognosis. In this report the authors present the case of an adult patient with a benign OPG who underwent subtotal resection without adjuvant therapy and has had no tumor progression for more than 20 years. A 50-year-old woman presented with a 2-year history of personality changes, weight gain, and a few months of visual disturbances. Ophthalmological evaluation showed incomplete right homonymous hemianopsia. MRI demonstrated a 2.5 × 2.5 × 2.5-cm enhancing left-sided lesion involving the hypothalamus with extension into the suprasellar cistern, extending along the left optic tract and anterior to the level of the optic chiasm. A biopsy procedure revealed a juvenile pilocytic astrocytoma. A subtotal resection of approximately 80% of the tumor was performed. Postoperatively, the patient experienced complete resolution of her personality changes, and her weight decreased back to baseline. Ophthalmological examination showed increased right homonymous hemianopsia. In the years following her surgery, there was a spontaneous decrease in tumor size without adjuvant therapy. The patient continues to have an excellent quality of life despite a visual field defect, and no further tumor growth has been observed.

Pilocytic Astrocytoma: A Review of General, Clinical, and Molecular Characteristics

“…9,28 The best treatment in adult patients also remains uncertain, as there is evidence that its presence in older individuals can lead to a worse prognosis. 33…”

“…The best course of treatment in adult patients remains unclear, but it is usually approached differently than in children, given the malignant characteristic that these tumors usually present in this age group. 33 Wabbels et al 34 report in their study that loss of unilateral visual acuity is the presenting symptom in 70% of adult cases and bilateral in 30%. Headaches, ophthalmoplegia, and neurologic deficits, including hemiparesis, are other signs and symptoms associated with tumor presence.…”

The role of radiotherapy and chemotherapy in adult optic nerve gliomas: a SEER-based analysis

“…To our knowledge, there have been only nine documented cases of low-grade optic pathway gliomas in adults in the past few years. [17,16] The recent case study by Hidalgo et al demonstrated that an adult patient with low-grade optic pathway glioma who received no adjuvant therapy after STR could survive more than 20 years without tumor progression. [16] In another study that included limited 14 children with optic chiasmatic-hypothalamic gliomas, no signi cant differences were observed regarding the volume change of tumors treated or not treated with chemotherapy.…”

“…[17,16] The recent case study by Hidalgo et al demonstrated that an adult patient with low-grade optic pathway glioma who received no adjuvant therapy after STR could survive more than 20 years without tumor progression. [16] In another study that included limited 14 children with optic chiasmatic-hypothalamic gliomas, no signi cant differences were observed regarding the volume change of tumors treated or not treated with chemotherapy. [32] The critical nding in our study shows that both adjuvant RT and chemotherapy may have potentially adverse effects on survival in adult patients with low-grade ONGs.…”

“…[14,15,4] While in adults, ONGs are rare, and the treatment for which has historically been approached in a different manner than children. [16][17][18] However, the de nitive e cacy of adjuvant RT or chemotherapy is still inconclusive due to the paucity of research data. Also, because ONGs are relatively uncommon in adults, it is still challenging to perform prospective studies now or soon.…”