1
|
La Spina M, Caruso M, Gulizia C, Comella M, Soma R, Meli M, Samperi P, Bertuna G, Di Cataldo A, Russo G. Diencephalic Syndrome: Misleading Clinical Onset of Low-Grade Glioma. Curr Oncol 2023; 30:8401-8410. [PMID: 37754525 PMCID: PMC10529672 DOI: 10.3390/curroncol30090610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Diencephalic Syndrome is an atypical early manifestation of low-grade gliomas; so, it is important to detect it in patients that experience a failure to thrive despite adequate length growth and food intake. The purpose of this article is to focus attention on this rare but potentially dangerous cause of poor weight gain or stunting in childhood. MATERIALS AND METHODS We describe four patients with Diencephalic Syndrome and low-grade gliomas who were evaluated in our institution from January 2017 to December 2021. CASE DESCRIPTION AND RESULTS two patients presented with suspected malabsorption, and two presented with a suspected eating disorder. In all cases, neurological symptoms appeared late, explaining the reason for the diagnostic delay, which impacts negatively on prognosis and on quality of life. Currently, patients 1 and 2 have stable disease in second-line therapy, patient 3 has stable disease post end of second-line therapy, and patient 4 has stable disease in first-line therapy. Everyone is in psychophysical rehabilitation. CONCLUSIONS A multidisciplinary evaluation is essential in order to make an early diagnosis and improve prognosis and quality of life.
Collapse
Affiliation(s)
- Milena La Spina
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Manuela Caruso
- Pediatric Endocrinology and Diabetology Center, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Carmela Gulizia
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Mattia Comella
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Rachele Soma
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Mariaclaudia Meli
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Piera Samperi
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Gregoria Bertuna
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| |
Collapse
|
2
|
Trapani S, Bortone B, Bianconi M, Rubino C, Sardi I, Lionetti P, Indolfi G. Diencephalic syndrome in childhood, a challenging cause of failure to thrive: miniseries and literature review. Ital J Pediatr 2022; 48:147. [PMID: 35978327 PMCID: PMC9387003 DOI: 10.1186/s13052-022-01316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
The aim of our study was to better define the clinical pattern of diencephalic syndrome, a rare but potentially lethal cause of failure to thrive in infancy. Poor weight gain or weight loss, the characteristic presenting feature, often firstly attributed to gastrointestinal or endocrinological or genetic diseases, is secondary to a malfunctioning hypothalamus, caused by a diencephalic tumor. Due to its unexpected clinical onset, diagnostic delay and misdiagnosis are common. We described a case series of 3 children with diencephalic syndrome admitted at our Hospital, over a 5-year period. Furthermore, a narrative review on all pediatric cases published in the last seventy years was performed. Clinical pattern, timing to diagnosis, neuroimaging, management, and outcome were analyzed. Our three cases are singularly described in all clinical and diagnostic findings. Overall, 100 children were selected; all these cases as well as our children presented with failure to thrive: 96% had body mass index or weight-length/height ratio lower than 5th percentile. Vomiting and hyperactivity are reported in 35 and 26% of cases, respectively. The neurological features, mainly nystagmus reported in 43%, may occur late in the disease course. In conclusion, the diagnostic delay is the hallmark of diencephalic syndrome, confirming the lack of knowledge by clinicians. The poor weight gain/loss despite adequate length growth and food intake, especially in children with hyperactivity and good psychomotor development, should alert pediatricians towards this condition, before neurological signs/symptoms occurrence.
Collapse
Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, Pediatric Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Barbara Bortone
- Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Martina Bianconi
- Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Chiara Rubino
- Pediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Medicine, Meyer Children's Hospital, Florence, Italy
| | - Paolo Lionetti
- NEUROFARBA Department, Gastroenterology and Nutrition Unit, University of Florence, Meyer Children's Hospital, Viale Pieraccini, 24, 50139, Florence, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Pediatric Unit, Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy
| |
Collapse
|
3
|
Marec-Berard P, Szathmari A, Conter C, Mottolese C, Berlier P, Frappaz D. Improvement of diencephalic syndrome after partial surgery of optic chiasm glioma. Pediatr Blood Cancer 2009; 53:502-4. [PMID: 19489055 DOI: 10.1002/pbc.22085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 10-month-old male presented with sudden growth failure and cachexia. MRI showed a chiasma of the hypothalamic mass. Biopsy was avoided due to operative risks. Three cycles of chemotherapy were given, resulting in stable disease on MRI, but growth failure despite attempts at enteral feeding. Surgical biopsy was then performed. A 30% tumor reduction was observed on post-operative imaging. Pathological examination revealed a pilocytic astrocytoma. After surgery, the child gained weight and his growth curve returned to normal. Enteral feeding was discontinued. After 4-year of follow-up, neurological development remains normal, with no residual or endocrine abnormalities.
Collapse
|
4
|
Aguilar Moliner I, Costa Orvay JA, Juma K, Costa Clara JM, Cruz Martínez O, Pou Fernández J. Astrocitoma de vías ópticas: una causa infrecuente de retraso ponderal en el lactante. An Pediatr (Barc) 2007; 66:622-4. [PMID: 17583627 DOI: 10.1157/13107400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Failure to thrive is a frequent cause of consultation in pediatric services. The main objective in these patients is the early detection of an organic cause, if present. We report a case of low-grade astrocytoma of the optic pathway in a 2-month-old child whose main symptoms at diagnosis were failure to thrive and anorexia. Unfortunately, despite therapeutic efforts, the tumor showed local and metastatic progression refractory to chemotherapy. The patient died 3 months after diagnosis. We conclude that diencephalic tumors must be considered in the differential diagnosis of failure to thrive during the first year of life, especially when, after initial investigations, a cause is not found.
Collapse
Affiliation(s)
- I Aguilar Moliner
- Servicios de Pediatría, Unidad Integrada Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, España
| | | | | | | | | | | |
Collapse
|
5
|
Ahn Y, Cho BK, Kim SK, Chung YN, Lee CS, Kim IH, Yang SW, Kim HS, Kim HJ, Jung HW, Wang KC. Optic pathway glioma: outcome and prognostic factors in a surgical series. Childs Nerv Syst 2006; 22:1136-42. [PMID: 16628460 DOI: 10.1007/s00381-006-0086-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Indexed: 10/24/2022]
Abstract
OBJECTS The goals of this study were to evaluate the surgical outcomes of optic pathway glioma (OPG) and to analyze the prognostic factors related to the progression-free survival. MATERIALS AND METHODS A retrospective review was conducted on 33 patients who underwent surgery for OPG; these included 15 male and 18 female patients with a mean age of 8.3 years. The mean duration of follow-up was 52 months. RESULTS AND CONCLUSIONS The preservation rate of ipsilateral vision was 25%, while that of contralateral vision was 83% (P<0.001). There was no remarkable endocrine improvement after surgery. The overall and progression-free survival rates at 5 years were 93.6 and 52.4%, respectively. In our study, the predictors for tumor progression were children younger than 5 years of age (p=0.023) and of female gender (p=0.022). Because of the variable course of OPG, treatment policy should be optimized individually according to patient's status.
Collapse
Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Brauner R, Trivin C, Zerah M, Souberbielle JC, Doz F, Kalifa C, Sainte-Rose C. Diencephalic syndrome due to hypothalamic tumor: a model of the relationship between weight and puberty onset. J Clin Endocrinol Metab 2006; 91:2467-73. [PMID: 16621905 DOI: 10.1210/jc.2006-0322] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Changes in body weight, statural growth rate, and puberty may be the presenting symptoms of hypothalamic-pituitary tumors. OBJECTIVE The objective of the study was to assess the relationship between the tumor and its treatment and the weight, growth rate, and onset of puberty, using the diencephalic syndrome of emaciation as model. PATIENTS Eleven patients seen before 1 yr of age, except one aged 9 yr, for diencephalic syndrome of emaciation due to hypothalamic pilocytic astrocytoma, were treated by surgical resection (n = 9), cranial irradiation (n = 7), and/or chemotherapy (n = 10). RESULTS At diagnosis, growth rate was normal, despite the emaciation, and there was no hypothalamic-pituitary deficiency, except in the oldest patient. After tumor treatment, all had GH and thyroid-stimulating hormone deficiencies, but only three, who underwent major surgical resection, also had ACTH deficiency and diabetes insipidus. Eight became obese, and all but the oldest had transient precocious puberty. Plasma leptin concentrations were very low at diagnosis, increased after tumor treatment, and decreased transiently in one boy when the testosterone increased. The plasma soluble leptin receptor concentrations changed in the opposite direction, leading to an increase in the free leptin index, including in the three patients whose tumor was reduced without surgery. The body mass index was correlated positively with plasma leptin (rho = 0.73, P = 0.0004) and free leptin index (rho = 0.63, P < 0.004) and negatively with ghrelin (rho = -0.49, P < 0.03) concentrations. CONCLUSIONS The obesity that occurs after treatment of hypothalamic tumors is not due to dysregulation of leptin secretion because it and plasma soluble leptin receptor remain regulated by factors like testosterone. This study also shows the influence of weight, possibly via leptin secretion, on the transient hypothalamic-pituitary-gonadal activation that occurs during the first year of life.
Collapse
Affiliation(s)
- Raja Brauner
- Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité d'Endocrinologie Pédiatrique, 94270 Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | |
Collapse
|
7
|
Arita K, Kurisu K, Sugiyama K, Itoh Y, Hotta T, Sogabe T, Uozumi T. Long-term results of conventional treatment of diencephalic pilocytic astrocytoma in infants. Childs Nerv Syst 2003; 19:145-51. [PMID: 12644865 DOI: 10.1007/s00381-002-0705-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2002] [Indexed: 11/24/2022]
Abstract
BACKGROUND To develop an effective therapeutic strategy for patients with diencephalic pilocytic astrocytomas (PA), we must understand the long-term effects and problems of conventional treatments. METHODS We performed a retrospective follow-up of four infants with PA in the diencephalon. CONCLUSION The initial treatment consisted of partial tumor removal and/or external radiation. The mean progression-free duration after the initial treatment was 108.5 months. All patients received a second course of radiation to treat recurrent tumors. These conventional treatments produced relatively long survival. Three patients died 105, 202, and 379 months after the initial treatment. One patient is still alive at 249 months after the initial treatment. However, mental retardation was obvious in all four patients 6 to 12 years after the first irradiation and within 2 years of the second course of irradiation. Therefore, new therapeutic strategies must focus on delaying the timing of radiation until the patients are at least 5 years old and avoiding a second course of radiation to treat recurrence.
Collapse
Affiliation(s)
- Kazunori Arita
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, 734-8551 Hiroshima, Japan.
| | | | | | | | | | | | | |
Collapse
|
8
|
Miyoshi Y, Yunoki M, Yano A, Nishimoto K. Diencephalic Syndrome of Emaciation in an Adult Associated with a Third Ventricle Intrinsic Craniopharyngioma: Case Report. Neurosurgery 2003. [DOI: 10.1227/00006123-200301000-00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
9
|
Miyoshi Y, Yunoki M, Yano A, Nishimoto K. Diencephalic syndrome of emaciation in an adult associated with a third ventricle intrinsic craniopharyngioma: case report. Neurosurgery 2003; 52:224-7; discussion 227. [PMID: 12493122 DOI: 10.1097/00006123-200301000-00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Accepted: 09/06/2002] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Diencephalic syndrome of emaciation (DS) is seen almost exclusively in infants and young children, and only two cases of DS in adults have been reported previously. We describe a case of DS associated with a third ventricle intrinsic craniopharyngioma in an adult patient. CLINICAL PRESENTATION A 54-year-old man presented with profound emaciation, disorientation, memory loss, and psychological disorders. Computed tomographic scanning and magnetic resonance imaging of his brain disclosed a tumor within the third ventricle. The preoperative endocrinological examination indicated an elevated growth hormone level and a decreased somatomedin C level. INTERVENTION The patient underwent partial resection of the tumor, which was adherent to the floor of the third ventricle but not to the ventricle wall, by an interhemispheric-transcallosal approach. The histological examination revealed a squamous papillary-type craniopharyngioma. The patient received 50 Gy of radiotherapy, which resulted in 90 to 95% reduction of the tumor size within 6 months, as indicated by the magnetic resonance images presented. The psychological disorders, memory disturbance, and severe emaciation improved gradually thereafter. CONCLUSION Although extremely rare, DS can occur in an adult harboring a tumor in the anterior hypothalamus.
Collapse
Affiliation(s)
- Yasuyuki Miyoshi
- Department of Neurological Surgery, Sumitomo Besshi Hospital, Niihama, Japan.
| | | | | | | |
Collapse
|
10
|
Moreno Villares J, Fernández Carrión F, Gallego Fernández M, Muñoz González A, Manzanares López-Manzanares J, Rodrigo Alfageme M. Síndrome diencefàlico: una causa poco común de malnutrición. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77847-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
11
|
Squires LA, Thomas S, Betz BW, Cottingham S. Vein of Galen malformation with diencephalic syndrome: a clinical pathologic report. J Child Neurol 1998; 13:575-7. [PMID: 9853653 DOI: 10.1177/088307389801301110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A vein of Galen malformation is a dural extracranial vascular anomaly resulting in direct arteriovenous fistulae between the choroid or quadrigeminal arteries and an overlying single venous sac. The disorder can be identified on prenatal ultrasound examination and presents with macrocrania, with or without congestive heart failure, or cranial bruit. Therapeutic measures have included surgical clipping of feeding arteries and transarterial placement of wire, coils, or "bird cages. "2 Recently, newer endovascular techniques involving both a transarterial and transvenous approach have been promising. Prognosis for infants with the disorder remains poor, although improved with new endovascular techniques. Morbidity and mortality have improved to approximately 40% with mild to severe neurologic deficits.3 One cause of significant pre- and posttreatment morbidity might be the presence of vascular steal leading to visual deterioration, seizures, and signs of parenchymal loss, at times with striking progression. 4 The diencephalic syndrome of emaciation or failure to gain weight in an infant with extreme irritability or euphoria has not been reported previously with the vein of Galen malformation and is usually associated with a hypothalamic or chiasmatic glioma.
Collapse
Affiliation(s)
- L A Squires
- DeVos Children's Hospital at Butterworth, Grand Rapids, MI, USA
| | | | | | | |
Collapse
|
12
|
Gropman AL, Packer RJ, Nicholson HS, Vezina LG, Jakacki R, Geyer R, Olson JM, Phillips P, Needle M, Broxson EH, Reaman G, Finlay J. Treatment of diencephalic syndrome with chemotherapy: growth, tumor response, and long term control. Cancer 1998; 83:166-72. [PMID: 9655307 DOI: 10.1002/(sici)1097-0142(19980701)83:1<166::aid-cncr22>3.0.co;2-u] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The diencephalic syndrome (DS), which is manifested by progressive emaciation and failure to thrive in an apparently alert, cheerful infant, usually is due to a low grade hypothalamic glioma. Treatment with aggressive surgery and/or radiotherapy is variably successful in controlling disease and may result in severe neurologic sequelae. Chemotherapy recently has been shown to be effective in patients with low grade gliomas of childhood, but it is used infrequently in those with DS. METHODS The authors evaluated the efficacy of a regimen of carboplatin and vincristine on improving weight, causing tumor shrinkage, and delaying the need for alternative therapies in seven children (ages 9-20 months; median age, 11 months) with DS. Five patients weighed less than the 5th percentile for their age at the start of the study, one weighed within the 10th percentile, and one weighed within the 25th percentile. RESULTS At follow-up (range, 6-54 months; median, 28 months), the patients' weights had increased by 66-95% (median, 80%). On magnetic resonance imaging, four patients had a >50% reduction in tumor mass, one had a 25-50% reduction, and two had stable disease. In those patients with radiographic response to treatment, weight gain was accomplished with oral feedings in four of five patients, whereas those with stable disease required nasogastric, nasojejunal, or gastrostomy tube supplementation to maintain weight. Disease progression occurred at a median of 24 months after initiation of chemotherapy, and two patients remained free of progressive disease at last follow-up. Five patients were alive a median of 59 months from diagnosis. The need for radiation or other therapies was delayed in six of seven children. Therapy was tolerated without significant toxicities. CONCLUSION The authors conclude that treatment of DS with a carboplatin and vincristine regimen results in demonstrable weight gain, may result in tumor shrinkage, and in some cases, significantly delays the need for alternative therapies.
Collapse
Affiliation(s)
- A L Gropman
- Department of Neurology, Children's National Medical Center and George Washington University, Washington, DC 20010, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Perilongo G, Carollo C, Salviati L, Murgia A, Pillon M, Basso G, Gardiman M, Laverda A. Diencephalic syndrome and disseminated juvenile pilocytic astrocytomas of the hypothalamic-optic chiasm region. Cancer 1997; 80:142-6. [PMID: 9210720 DOI: 10.1002/(sici)1097-0142(19970701)80:1<142::aid-cncr19>3.0.co;2-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diencephalic syndrome (DS) is a complex of signs and symptoms related to hypothalamic dysfunction; its main features are emaciation, despite a normal or slightly diminished caloric intake, and an alert appearance. DS has been almost exclusively described in association with space-occupying lesions of the hypothalamic-optic chiasm region, mainly juvenile pilocytic astrocytoma (JPA). A systematic diagnostic approach, including contrast-enhanced magnetic resonance imaging (MRI) of the child's head, is rapidly expanding our knowledge of this syndrome. METHODS The MRI findings for three children affected by DS associated with biopsy-proven JPA, consecutively referred to the Pediatric Neuro-Oncology Program of the Department of Pediatrics at the University of Padua between September 1991 and January 1996, are presented in this article. The children were boys, ages 6, 7, and 18 months, respectively. RESULTS In all three patients, the initial contrast-enhancing MRIs of the head showed evidence of tumor dissemination. This finding prompted a study of the spine, which in turn showed tumor deposits in all three subjects. Among the 43 patients younger than 16 years with low grade astroctyoma who consecutively entered the Neuro-Oncology Program during the study period, these 3 patients were the only ones who had disseminated tumors. CONCLUSIONS In this study, the hypothesis was formulated that DS and disseminated hypothalamic-optic chiasm JPA tend to be more commonly associated than previously stated. This study suggests that the initial contrast-enhanced MRI of the head of a child affected by DS and hypothalamic JPA must be looked at carefully for evidence of tumor dissemination, and that the spine must also be examined if the findings are positive.
Collapse
Affiliation(s)
- G Perilongo
- Department of Pediatrics of the University of Padua, Italy
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Tumors of the hypothalamus present with a variety of clinical syndromes. Such syndromes appear to be both age and histology dependent. The diencephalic syndrome, an entity classically seen in infancy, presents as failure to thrive. In essentially all cases the pathologic substrate is a tumor with a predominance of gliomas. The traditional approach to treatment of the diencephalic syndrome has been surgery both for decompression and pathologic diagnosis followed by irradiation. Because of the tumor location, surgery is often confined to biopsy rather than radical extirpation. Furthermore, in infancy focal brain irradiation is not without significant morbidity. Within this context, we would like to present a case discussion regarding a 27-month-old boy with a hypothalamic-midbrain protoplasmic glioma treated with primary chemotherapy after surgical biopsy and pathologic documentation. The schedule of drugs utilized was based on the hypothesis of biochemical modulation of nitrosourea chemotherapy. Successful response to therapy was documented by sequential computed tomography (CT) studies and serial neurologic examinations beginning at age 5 months and every 2 months thereafter. The response of a single patient with the diencephalic syndrome treated primarily with chemotherapy makes extrapolation premature. Rather, the authors suggest chemotherapy as an alternative to focal brain irradiation. Such therapy could be utilized either in the event of recurrent tumor or as late consolidation after primary treatment with chemotherapy. The latter approach would allow a patient to have radiation therapy deferred until a later age at which time morbidity attending brain irradiation may be minimized.
Collapse
Affiliation(s)
- M C Chamberlain
- Department of Neurosciences, University of California, San Diego 92103
| | | |
Collapse
|
15
|
Alvord EC, Lofton S. Gliomas of the optic nerve or chiasm. Outcome by patients' age, tumor site, and treatment. J Neurosurg 1988; 68:85-98. [PMID: 3275755 DOI: 10.3171/jns.1988.68.1.0085] [Citation(s) in RCA: 243] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A review of the literature revealed 623 cases of optic gliomas with sufficient information to permit actuarial (life-table) analysis concerning the prognosis of this disease by the patients' age, tumor site, treatment, and presence of concomitant neurofibromatosis or extension into the hypothalamus or ventricle. All of these factors are important. The development of mathematical models led to the conclusion that these tumors, generally regarded histologically as low-grade astrocytomas, actually have a very wide but continuous range of growth rates. Some grow rapidly enough to be explained by simple exponential doubling at a constant rate, but most behave as though their growth decelerates. Decelerating growth rates make comparisons of various groups of patients difficult. No support is found for the classical hypothesis that some may be hamartomas. Inadequately treated gliomas of the optic nerve or chiasm bear about the same poor prognosis. However, tumors of the optic nerve (intracranial as well as intraorbital) have an excellent prognosis following complete surgical excision and only a slightly poorer prognosis following irradiation. About 5% of optic nerve gliomas recur in the chiasm following "complete" intraorbital excision. Patients with neurofibromatosis have about twice the recurrence rate following complete excision of an intraorbital glioma. Optic chiasmal gliomas appear to respond to irradiation with doses above 4500 rads. Patients with neurofibromatosis have about the same prognosis as patients without neurofibromatosis following irradiation of a chiasmal glioma.
Collapse
Affiliation(s)
- E C Alvord
- Department of Pathology, University of Washington School of Medicine, Seattle
| | | |
Collapse
|