Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity

Kapoor, Ankur; Savardekar, Amey; Tewari, Manoj Kumar; Chatterjee, Debjyoti; Radotra, Bishan Dass

doi:10.1007/s00381-015-2749-8

Cited by 20 publications

(8 citation statements)

References 15 publications

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“…Although vascular necrosis and tumor invasion are the primary causes of bleeding in high-grade gliomas, the mechanisms underlying low-grade gliomas remain unclear. [ 2 ] Previous studies have demonstrated that spontaneous bleeding in PAs is due to interaction of different factors, which can be attributed to the specific pathological changes in vascular structures of tumor, such as interstitial degeneration, hyaline degeneration and proliferation of vascular endothelial cells. For instance, the vascular histology of bleeding tumor indicated a poorly developed capillary bed and thin vessel walls.…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, patients with pilocytic astrocytomas (PAs) may present with a spontaneous intratumoral hemorrhage. [ 2 ] Although there have been few reported cases of spontaneous intracerebral hemorrhage in pediatric cerebellar PAs, such occurrence is extremely rare among elderly patients (Table 1 ). Here, we report a case of an elderly male who presented with cerebellar PAs and spontaneous intratumoral hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

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Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly

et al. 2018

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Rationale:Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial tumor. Adult occurrence is rare, especially in elderly adults. How to manage the pilocytic astrocytoma with spontaneous intratumoral hemorrhage in the elderly is still unfamiliar with clinician.Patient concerns:Reports of tumors with intratumoral hemorrhage in elderly adults are extremely rare. We report a case of a 62-year-old male diagnosed with cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage. Informed consent was obtained from the patient.Diagnoses:Histological examination of the specimens revealed pilocytic astrocytomas, including a hemorrhagic portion.Interventions:The patient underwent the radical resections of tumour and was given the regular follow-up.Outcomes:12 months later, he recovered without evidence of disease.Lessons:Cerebellar pilocytic astrocytomas associated with hemorrhages occur over the age of 60 is extremely rare. Removing the tumor and hematoma completely is the best treatment options. Long term follow-up is very necessary for this tumor.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly

et al. 2018

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“…[56] Only 6 previous cases of spontaneous hemorrhage into a suprasellar PA have been reported in the pediatric age group. [2] The initial presentation of tumors with hemorrhage is similar to subarachnoid hemorrhage or spontaneous intracranial bleeding and is usually catastrophic. Our patient on the contrary presented with subacute visual decline, memory impairment, and headache over a 1-month period with no history of acute deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Low-grade gliomas rarely present with hemorrhage, with only 6 cases of spontaneous hemorrhage in pediatric supratentorial PAs having been reported. [2] Radiation therapy (RT)-induced vascular injury is well-documented in these tumors and often occurs within the first decade of the treatment. [3] An immature central nervous system vasculature in the pediatric population may predispose these patients to cerebrovascular morbidity.…”

Section: Introductionmentioning

confidence: 99%

Delayed hemorrhage after surgery and radiation in suprasellar pilocytic astrocytomas

2016

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Delayed intracranial hemorrhage is a rare complication of treatment for central nervous system tumors. This may be secondary to malignant transformation of the tumor or vasculopathy related to radiation therapy (RT). While most reports on radiation-induced vasculopathy in children with optic pathway gliomas are associated with ischemic complications, there are only two reports of hemorrhagic complications in these patients. In both cases, the hemorrhage was asymptomatic and remote from the site of the original tumor but within the field of irradiation. We describe a female patient who underwent surgery for an optico-chiasmatic pilocytic astrocytoma (PA) at the age of 12 followed by RT at the age of 17 for tumor progression. The patient was followed with serial magnetic resonance imaging (MRI) scans showing marginal regression and no subsequent evidence of tumor recurrence, including the most recent MRI done only 6 months before the latest presentation. She then developed a symptomatic intratumoral hemorrhage at the age of 32 for which she underwent emergent surgery. To our knowledge, this is the first report of a nonaneurysmal-delayed hemorrhage within the site of previous surgery, several years after RT for a suprasellar PA. We review literature on delayed vasculopathy following the treatment of pediatric optic pathway gliomas and discuss the possible mechanisms of hemorrhage in our case. These long-term follow-up outcomes add significant insight and have implications in patient management.

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“…It accounts for up to 6–10% of all intracranial hemorrhage. [ 4 ] Large sized tumors in the posterior fossa have a tendency to prolapse into supratentorial cavity following the CSF diversion. The sudden decompression of ventricles precipitates hemorrhage within the tumor that extends through the capsule into fourth ventricle and then to supratentorial ventricles.…”

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confidence: 99%

Diagnosing early upward cerebellar herniation by computed tomography: A diagnostic boom, a savior

2016

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Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity

Abstract: The presence of calcifications in the peri-hemorrhagic areas and the presence of mass effect disproportionate to the size of the bleeding are harbingers of the presence of a benign neoplasm that may have bled.

Cited by 20 publications

References 15 publications

Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly

Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly

Delayed hemorrhage after surgery and radiation in suprasellar pilocytic astrocytomas

Diagnosing early upward cerebellar herniation by computed tomography: A diagnostic boom, a savior

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