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Das AK, Mani SK, Singh SK, Kumar S. Management and outcome of unusual pediatric brain tumors: challenges experienced at a tertiary care center of a developing country. Childs Nerv Syst 2023; 39:169-183. [PMID: 36198891 DOI: 10.1007/s00381-022-05694-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Primary brain tumors are the most frequent solid pediatric tumors, accounting for 40-50% of all cancers in children. Eighty to ninety percent of the 250,000 new cases of pediatric cancer each year are discovered in low and middle-income nations, where nearly 88 percent of the world's children reside. This article aims to emphasize the unusual presentation, management, and surgical outcome of complex pediatric brain tumors. METHODS We performed a retrospective study of patients who were admitted to the neurosurgery department with unusual pediatric brain tumors between March 1, 2019, and March 1, 2022. The study included pediatric patients up to age 18 years. We included those pediatric brain tumors whose (i) location was uncommon, or (ii) presented with unusual clinical presentation, or (iii) histopathology suggested to be a rare tumor, or (iv) radiological features were atypical. RESULTS We included 9 cases of rare unusual pediatric brain tumors. Three out of 9 cases required preoperative embolization due to its hypervascular nature on digital subtraction angiography (DSA). All patients underwent surgical excision within 24-48 h of tumor devascularization. One out of 9 cases died in follow-up period due to pleural effusion and distant metastasis to lungs. CONCLUSION Treatment considerations for unusual pediatric brain tumors include a comprehensive multidisciplinary approach, including community-based screening and proper referral system for early treatment, a variety of treatment modalities, and sophisticated follow-up strategy. Government shall work in coherence with tertiary centers to spread social awareness and provide various financial scheme to prevent treatment dropouts.
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Affiliation(s)
- Anand Kumar Das
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Suraj Kant Mani
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Saraj Kumar Singh
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India.
| | - Subhash Kumar
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
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Kim SH, Hwang K, Lee KS, Choe G, Kim CY. Cerebellar Pleomorphic Xanthoastrocytoma with BRAF V600E Mutation. World Neurosurg 2020; 139:577-581. [PMID: 32348888 DOI: 10.1016/j.wneu.2020.04.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pleomorphic xanthoastrocytoma (PXA) is a rare type of astrocytoma with a peak incidence from 10 to 19 years of age. PXA is found most commonly in the supratentorium. When it is present in atypical areas such as the infratentorium, it is often overlooked as a potential differential diagnosis. CASE DESCRIPTION This report discusses the case of an 18-year-old woman with a pure PXA in the left cerebellum. The case consists of interesting pathologic and molecular features which do not align with the literature about PXA: a positive finding for BRAF V600E mutation and a negative finding for cluster of differentiation 34 expression. A review of pure PXA cases in the infratentorium has also been completed. CONCLUSIONS To our knowledge, this is the first case of PXA in the infratentorium with BRAF V600E mutation. The case also highlights the clinical relevance of including PXA as a differential diagnosis for lesions of the infratentorium.
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Affiliation(s)
- Sang Ho Kim
- School of Medicine, The University of Auckland, Auckland, New Zealand; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
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Luna LP, da Ponte IM, Oliveira IB, Ramos F, Gerson G. Pleomorphic xanthoastrocytoma in the posterior fossa: a case report with advanced neuroimaging findings. Clin Imaging 2020; 63:30-34. [PMID: 32120310 DOI: 10.1016/j.clinimag.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare glioma usually occurring in children and young adults. It is a benign World Health Organization (WHO) grade II tumor that accounts for <1% of all astrocytomas. Its occurrence in the infratentorial compartment is rare, and the cerebellum is the most common of the unusual locations. Few case reports have described conventional imaging features of these tumors, but none has reported the advanced magnetic resonance (MR) neuroimaging features in dynamic susceptibility perfusion-weighted imaging (DSC-PWI), diffusion weighted-imaging (DWI) and MR spectroscopy. Therefore, the purpose of this study is to report a case of PXA in the cerebellum of a 28-year-old patient and discuss the MR advanced imaging characteristics compared to the more common PXA supratentorial type.
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Affiliation(s)
- Licia Pacheco Luna
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, 21287 Baltimore, USA; Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil.
| | - Isabelle Meneses da Ponte
- Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil
| | - Isabella Bezerra Oliveira
- Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil
| | - Francisco Ramos
- Department of Neurosurgery, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Fortaleza, Brazil
| | - Gunter Gerson
- Department of Pathology, Hospital Universitário Walter Cantídio, 1290 Pastor Samuel Munguba St, Rodolfo Teófilo, 60430-372 Fortaleza, Brazil
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Mallick S, Giridhar P, Benson R, Melgandi W, Rath GK. Demography, Pattern of Care, and Survival in Patients with Xanthoastrocytoma: A Systematic Review and Individual Patient Data Analysis of 325 Cases. J Neurosci Rural Pract 2019; 10:430-437. [PMID: 31595115 PMCID: PMC6779544 DOI: 10.1055/s-0039-1697873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives Xanthoastrocytoma (XA) is a low-grade glial tumor seen in young adults and there is lack of robust data on treatment of this rare tumor. In this systematic review and individual patient's data analysis, we aimed to look into the demography, pattern of care, survival outcomes, and prognostic factors in patients with both Grade II and III XA. Methods A comprehensive search was conducted with the Medical Subject Heading terms: "Xanthoastrocytoma; Pleomorphic Xanthoastrocytoma; Anaplastic Xanthoastrocytoma; Xanthoastrocytoma AND treatment; and Anaplastic Xanthoastrocytoma AND survival" to find all possible publications. Results A total of 325 individual patients from a total of 138 publications pertaining to XA were retrieved. Median age of the entire cohort was 19 years. About 56.1% of the patients underwent a gross total resection (GTR) and 31.4% underwent a subtotal resection. Nearly, 76.6% of the patients had a Grade II tumor and adjuvant radiation was delivered in 27.4% of the patients. Estimated 2- and 5-year progression-free survival (PFS) were 68.5 and 51.2%, respectively. Age, grade, and extent of surgery were significant factors affecting PFS. Estimated 2- and 5-year overall survival (OS) was 88.8 and 78%, respectively. The median OS for Grade II and Grade III tumors were 209 and 49 months, respectively. Age and extent of surgery were significant factors affecting OS. Conclusion XA is a disease of young adults with favorable prognosis. Younger patients (<20 years), patients who undergo a GTR, and patients with a lower grade tumor have a better treatment outcome.
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Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prashanth Giridhar
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rony Benson
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Wineeta Melgandi
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Mallick S, Benson R, Melgandi W, Giridhar P, Rath GK. Grade II Pleomorphic Xanthoastrocytoma; a meta-analysis of data from previously reported 167 cases. J Clin Neurosci 2018; 54:57-62. [PMID: 29803334 DOI: 10.1016/j.jocn.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/10/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
Pleomorphic Xanthoastrocytoma [PXA] is a rare low grade glial tumor commonly affecting young adults. We did this systematic review and meta-analysis to identify prognostic factors and optimal treatment in these patients. A thorough search of the PubMed, Google scholar was made to find all possible publications related to grade II PXA. A total of 167 patients from 89 articles were included in the analysis. Median age of the entire cohort was 20 years. Headache was the most common presentation in 49.1% of the patients followed by seizure in 27.9%. Temporal lobe was the most common location of the tumor. 63% patents underwent a gross total resection [GTR] and 26.7% underwent a sub total excision [STR]. Adjuvant radiation was given to 17.6% of patients. Median follow-up for the entire cohort was 33 months. Estimated median overall survival [OS] for the entire cohort was 209.0 months [96% CI: 149.7-268.3]. Estimated median progression free survival [PFS] was 48 months [95% CI: 31.9-64.0]. In univariate and multivariate analysis younger patients and patients who underwent a GTR had a significantly better survival outcome. Use of adjuvant therapy was not found to be a significant factor affecting PFS or OS. Radiotherapy was used in salvage treatment in 76.1% of the patients. Younger patients and patients who undergo a GTR, have better survival outcomes. There is inadequate evidence to recommend routine adjuvant radiation or chemotherapy in all patients with grade II PXA.
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Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rony Benson
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Wineeta Melgandi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - G K Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Mehrotra A, Pal L, Bhaisora KS, Jaiswal AK, Kumar R. An Infratentorial Pure Pleomorphic Xanthoastrocytoma Arising from Middle Cerebellar Peduncle: A Rare Location of an Uncommon Tumor. World Neurosurg 2017; 111:335-340. [PMID: 29288852 DOI: 10.1016/j.wneu.2017.12.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pleomorphic xanthoastrocytomas are rare tumors of glial origin comprising <1% of all astrocytic tumors of brain. These tumors are rare in the infratentorial compartment and were not known to arise from the middle cerebellar peduncle. CASE DESCRIPTION We discuss the case of a 16-year-boy who presented with altered sensorium and features of increased intracranial pressure and was found to have a 4 × 4 × 3 cm mass arising from the middle cerebellar peduncle. CONCLUSION We also discuss the histopathologic features of these tumors suggesting their resemblance to other maldevelopmental tumors, the rarity of pure World Health Organization grade II pleomorphic xanthoastrocytoma in the infratentorial compartment, as well as the appropriate management.
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Affiliation(s)
- Shruti Gupta
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Lily Pal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Simultaneous Presentation of Cerebellopontine Angle Pleomorphic Xanthoastrocytoma and Malignant Melanoma in a Known Case of Neurofibromatosis 1; Probable Role of BRAF Gene: A Case Report and Review of Literature. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Praver M, D'Amico R, Arraez C, Zacharia BE, Varma H, Goldman JE, Bruce JN, Canoll P. Atypical pleomorphic neoplasms of the pineal gland: Case report and review of the literature. Surg Neurol Int 2015; 6:129. [PMID: 26257987 PMCID: PMC4524004 DOI: 10.4103/2152-7806.161790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Pineal region tumors are rare and diverse. Among them exist reports of pleomorphic xanthroastrocytoma (PXA) and pleomorphic granular cell astrocytoma (PGCA) of the pineal gland. These related tumors are remarkably similar sharing pleomorphic histologic features with only minor immunohistochemical and ultrastructural differences. Case Description: We present a case of a 42-year old right-handed woman presented with a longstanding history of migraine headaches which had worsened over the two months leading up to her hospitalization. MRI revealed a 1.7 × 1.3 × 1.6 cm intensely enhancing lesion originating in the pineal gland. The tumor closely resembled PGCA but did not strictly fit the diagnostic requirements of either PGCA or PXA. Conclusion: The present case highlights the exotic nature of pineal region tumors with pleomorphic cell histology. Given the diverse range of tumors encountered in the pineal region, pathological confirmation is mandatory. Favorable clinical outcomes demonstrate that surgical resection alone can yield excellent long-term results for tumors falling within the spectrum of pleomorphic lesions of the pineal gland.
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Affiliation(s)
- M Praver
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - R D'Amico
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - C Arraez
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - B E Zacharia
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - H Varma
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - J E Goldman
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - J N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - P Canoll
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
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Perkins SM, Mitra N, Fei W, Shinohara ET. Patterns of care and outcomes of patients with pleomorphic xanthoastrocytoma: a SEER analysis. J Neurooncol 2012; 110:99-104. [PMID: 22843450 DOI: 10.1007/s11060-012-0939-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/09/2012] [Indexed: 11/30/2022]
Abstract
To study the clinical characteristics, treatment approach and outcome of pleomorphic xanthoastrocytoma (PXA), patients were identified using the National Cancer Intitute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 214 patients were identified with PXA using the November 2010 submission. Patient demographics, tumor characteristics, extent of surgical resection, the use of radiotherapy, and overall survival were evaluated. Overall survival for PXA was then compared to that of pilocytic astrocytoma, oligodendroglioma, ependymom and glioblastoma also using the SEER database. Kaplan-Meier, univariate and multivariate analyses were performed. The majority of patients were found to be young adults with the most common tumor location being temporal lobe. Surgery was performed on most (95 %) patients, while 25 % of patients received radiation therapy. Five and 10 year overall survival rates were 75 and 67 %, respectively. Grade was only available for a limited number of patients but appeared to affect prognosis. Patients with grade IV tumors had a median overall survival of 45 months, whereas median survival was not reached for grade I-III patients. On multivariate analysis, male gender and increasing age were associated with worse overall survival (p values 0.05 and <0.006, respectively). Extent of resection trended towards significance in favor of gross total resection. PXA is a rare diagnosis that affects young adults. Surgical resection is the primary modality of treatment with an overall good prognosis. Elderly patients, those with higher grade disease and patients with incomplete resections may have a worse prognosis. The role of radiation therapy for PXA remains unclear but is more often used for patients with high grade tumors. Compared to other common brain tumors, PXA's appear to fare worse than pilocytic astrocytoma and oligodendroglioma, especially in younger patients. However, even high grade PXA patients have significantly better overall survival compared to glioblastoma.
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Affiliation(s)
- Stephanie M Perkins
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Okazaki T, Kageji T, Matsuzaki K, Horiguchi H, Hirose T, Watanabe H, Ohnishi T, Nagahiro S. Primary anaplastic pleomorphic xanthoastrocytoma with widespread neuroaxis dissemination at diagnosis--a pediatric case report and review of the literature. J Neurooncol 2009; 94:431-7. [PMID: 19326050 DOI: 10.1007/s11060-009-9876-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/16/2009] [Indexed: 11/30/2022]
Abstract
We report a 5 year-old boy with primary anaplastic pleomorphic xanthoastrocytoma (PXA) with whole neuroaxis dissemination at diagnosis who experienced the sudden onset of generalized convulsion. Head- and spinal magnetic resonance imaging (MRI) showed widespread gadolinium (Gd)-enhanced lesions extending to the bilateral frontal- and medial temporal lobes and the spinal cord. Subsequent MRI study demonstrated that the lesion size increased without any neurological deterioration. Under a histopathologic diagnosis of anaplastic PXA he underwent adjuvant chemotherapy consisting of 12 cycles of carboplatin and vincristine. The patient is alive without any neurological deficits; follow-up MRI showed that the lesions remained stable during 18 months of chemotherapy. We report a very rare pediatric case of primary anaplastic PXA with dissemination involving the entire neuroaxis at the time of diagnosis.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, School of Medicine, The University of Tokushima, Tokushima, Japan.
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