Unusual dissemination patterns of low-grade astrocytomas in childhood

Rondinelli, Patricia Imperatriz Porto; Osório, Carlos Alberto Martinez; Cohen, Marcela Pecora; Novaes, Priscila

doi:10.1590/s0004-282x2008000100011

Cited by 8 publications

(12 citation statements)

References 13 publications

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“…Although CSF dissemination has occasionally been reported in children with malignant gliomas 8 and more rarely in children with low-grade gliomas 18 (especially in brainstem gliomas), 12 LMSS is an exceptional complication in supratentorial DLGGs in adults.…”

Section: Discussionmentioning

confidence: 98%

Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults

Eulate-Beramendi

Rigau²,

Taillandier³

et al. 2014

JNS

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Object Diffuse WHO Grade II glioma (diffuse low-grade glioma [DLGG]) is an infiltrative brain tumor that usually migrates along the white matter fibers. The delayed CSF dissemination of supratentorial DLGGs is an exceptional complication and is rarely described in adults. Here, the authors report outcomes in a surgical series of 9 patients with DLGGs with subsequent leptomeningeal and/or subependymal seeding (LMSS) following multiple incomplete resections. Methods The authors performed a retrospective review of patients who underwent surgery for histopathologically confirmed WHO Grade II gliomas between 1998 and 2012 and experienced a secondary CSF spread. Information regarding clinical features, surgical procedures, histopathological results, adjuvant treatment, and clinical outcomes was collected and analyzed. Results Nine consecutive patients were included in this study. There were 6 men and 3 women whose mean age was 35.5 years (range 22–59 years) at the time of initial symptom onset. All patients underwent surgery with the aid of intraoperative mapping, with incomplete tumor removal because of invasion of eloquent structures. The neuropathological examination diagnosed a DLGG in all cases (7 oligodendrogliomas, 1 astrocytoma, and 1 oligoastrocytoma). Five patients had a 1p19q codeletion. Because of tumor regrowth, the 9 patients underwent reoperation (2 surgeries in 6 cases and 3 surgeries in 3 cases), again with incomplete resection. There were no surgical complications. Adjuvant therapy (radiotherapy and chemotherapy) was administered in all patients because of progression to a higher grade of malignancy that was histopathologically confirmed in all tumors. The patients suddenly worsened, and the diagnosis of LMSS was made with a mean delay of 77 months (range 27–140 months) after the initial symptom onset. Six patients benefited from salvage chemotherapy while palliative care was chosen in 3 cases. The median survival in the 6 patients who underwent LMSS treatment was significantly longer than that in the 3 patients who did not receive salvage chemotherapy (p = 0.03). Indeed, all patients died, with a mean delay between the diagnosis of LMSS and death of 11 months (range 2–38 months) and with a mean delay between the initial symptom onset and death of 88 months (range 34–144 months). Conclusions Cerebrospinal fluid dissemination of DLGG is a rare but possible event. It can occur throughout the progression of WHO Grade II oligodendrogliomas, oligoastrocytomas, and astrocytomas, regardless of 1p19q status. This complication seems to appear in patients who have undergone multiple incomplete resections. Salvage therapy can be considered in patients with good neurological status. However, LMSS is associated with a decreased overall survival. Therefore, this rare entity deserves further multicenter studies to better understand its pathophysiology and to adapt therapeutic strategies.

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Section: Discussionmentioning

confidence: 98%

Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults

Eulate-Beramendi

Rigau²,

Taillandier³

et al. 2014

JNS

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“…leptomeningeal dissemination of low-grade astrocytoma, particularly those diagnosed at presentation, has rarely been reported in the medical literature with fewer than 60 cases (3,6). The exact incidence still remains unclear (6,12). Previous studies have demonstrated that leptomeningeal dissemination occurs in approximately 4 to up to 12% of patients with low grade gliomas or low grade astrocytomas (9,11).…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism and risk factors of leptomeningeal dissemination of low-grade PA is unknown (6,12). Recent studies cite intracranial surgical intervention (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies cite intracranial surgical intervention (i.e. shunt insertion and/or partial tumor excision), and anatomical proximity of the primary tumor to subarachnoid spaces, CSF cisterns or ventricles as the most common risk factors (5,12). This phenomenon could also be part of the natural course of tumor progression if left untreated or could originate from unknown biological factors such as degree of adhesiveness, capacity to invade the leptomeninges, and metabolic or antigenic factors (5,6).…”

Section: Discussionmentioning

confidence: 99%

“…Since leptomeningeal dissemination of PA is a very rare entity, the most ideal treatment of the disease is still debated (5,12). Recent studies have shown that total resection of the primitive tumor, if possible, is the treatment of choice (5).…”

Section: Discussionmentioning

confidence: 99%

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Leptomeningeal dissemination of pilocytic astrocytoma in a 17-year-old boy

Jandaghi

Bidabadi²,

Saadat³

et al. 2014

Turkish Neurosurgery

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Pilocytic astrocytoma with leptomeningeal dissemination is a rare phenomenon and can be associated with obstructive hydrocephalus and an unfavorable prognosis. Herein, we report a seventeen-year-old boy with a history of ventriculo-peritoneal shunt insertion due to severe hydrocephalus who presented with progressive headache and vomiting together with ocular and cerebellar signs and symptoms. Neuroimaging confirmed the presence of multiple intracranial masses in the cerebellum and thalamus. Intracranial dissemination of tumor to the the leptomeninges was seen during neuroendoscopy. Simultaneous biopsy and endoscopic third ventriculostomy were performed and the diagnosis of low-grade pilocytic astrocytoma with leptomeningeal dissemination was made by histological examination. The patient underwent chemotherapy in combination with radiotherapy to reduce the risk of reoccurrence of the primary tumor and was followed for one year. KEywoRds: Pilocytic astrocytoma, Leptomeningeal dissemination, Hydrocephalus, Neuroendoscopy ÖZLeptomeningeal yayılımlı pilositik astrositom nadir bir olaydır ve obstrüktif hidrosefali ve kötü prognozla ilişkili olabilir. Burada şiddetli hidrosefali nedeniyle ventriküloperitoneal şant uygulama öyküsü olan ve oküler ve serebellar bulgu ve belirtilerle birlikte ilerleyici başağrısı ve kusmayla gelen 17 yaşında bir erkek olgu bildiriyoruz. Nörogörüntüleme, serebellum ve talamusta çok sayıda intrakraniyal kitle varlığını doğruladı. Nöroendoskopi sırasında tümörün leptomeninkslere intrakraniyal olarak yayıldığı görüldü. Aynı anda biyopsi ve endoskopik üçüncü ventrikülostomi yapıldı ve histolojik incelemeyle leptomeningeal yayılımlı düşük dereceli pilositik astrositom tanısı kondu. Hastaya primer tümörün tekrar oluşması riskini azaltmak üzere radyoterapiyle kombinasyon halinde kemoterapi verildi ve bir yıl takip yapıldı.

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Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital

Chamdine

Broniscer

et al. 2015

Pediatric Blood & Cancer

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Background Patients with low-grade gliomas (LGG), which are the most common childhood brain tumors, have excellent long-term survival. Dissemination of LGG is rare. Robust data on the incidence, presentation, patterns of dissemination, disease behavior, outcome, and best-management approaches do not exist. We describe 20 years of follow-up of children with metastatic LGG. Procedure Data collected during the period 1990–2010 were retrospectively reviewed for the following inclusion criteria: diagnosis of metastatic LGG, age younger than 21 years at initial diagnosis, and magnetic resonance imaging of the brain and/or spine at diagnosis and/or follow-up. Patient demographics, pathology, treatment modalities, and outcome were reviewed. Results Of 599 patients with LGG, 38 (6%) had metastatic disease at either diagnosis or follow-up. Most tumors (87%) were located in the brain, and half of the patients had metastatic disease at presentation. The most common diagnosis was pilocytic astrocytoma (55%). Chemotherapy was the most common initial treatment modality. Median survival of the group was 6.2 years (range, 0.1–16.9 years). Fifteen (40%) patients died at a median of 6 years from diagnosis (range, 0.8–15 years). Overall survival at 5, 10, and 15 years was 80.7 ± 6.6%, 63.0 ± 10.2%, and 50.9 ±16.0%, respectively. Conclusion This study describes the longest follow-up of children with metastatic LGG. LGG is underestimated and entails major morbidity and mortality. Prospective studies are needed to learn the true incidence, study the biology, and determine the best approaches to diagnosis, treatment, and follow-up.

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Unusual dissemination patterns of low-grade astrocytomas in childhood

Cited by 8 publications

References 13 publications

Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults

Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults

Leptomeningeal dissemination of pilocytic astrocytoma in a 17-year-old boy

Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital

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