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Costanzo R, Rosetti V, Tomassini A, Fuschillo D, Lofrese G, Iacopino DG, Tosatto L, D’Andrea M. Hypothalamic Hemangioma-like Pilocytic Astrocytoma in an Adult Patient: A Systematic Review with a Focus on Differential Diagnosis and Neurological Presentation. J Clin Med 2024; 13:3536. [PMID: 38930064 PMCID: PMC11204496 DOI: 10.3390/jcm13123536] [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: 04/02/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Pilocytic astrocytoma (PCA) are commonly observed as slow-growing noncancerous brain tumors in pediatric populations, but they can also occur in adults, albeit rarely. When located in diencephalic regions, particularly in the hypothalamus, they present unique diagnostic and management challenges due to their rarity and overlapping clinical and radiological features with other intracranial pathologies. This systematic review aims to provide a comprehensive understanding of hypothalamic PCA in adults, focusing on their differential diagnosis, neurological presentation, diagnostic modalities, treatment strategies. A case illustration is also described in order to better underline all the difficulties related to the diagnostic process. Material and methods: A systematic literature search was conducted in the PubMed/MEDLINE, Embase, and Scopus databases up to November 2023 to identify studies. Results: The systematic literature search identified a total of 214 articles. Following screening by title and abstract and full-text review, 12 studies were deemed eligible and are included here. Conclusions: Adult-onset PCA in diencephalic regions pose diagnostic challenges due to their rarity and overlapping features with other intracranial lesions. Advanced imaging techniques play a crucial role in diagnosis, while surgery remains the cornerstone of treatment. Multidisciplinary collaboration is essential for the optimal management and long-term follow-up of these patients.
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Affiliation(s)
- Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurology Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy;
| | - Vittoria Rosetti
- Department of Neurosurgery, Institute of Neurological Sciences of Bologna, 40124 Bologna, Italy;
| | - Alessia Tomassini
- Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy; (A.T.); (D.F.); (G.L.); (L.T.); (M.D.)
| | - Dalila Fuschillo
- Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy; (A.T.); (D.F.); (G.L.); (L.T.); (M.D.)
| | - Giorgio Lofrese
- Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy; (A.T.); (D.F.); (G.L.); (L.T.); (M.D.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurology Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy;
| | - Luigino Tosatto
- Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy; (A.T.); (D.F.); (G.L.); (L.T.); (M.D.)
| | - Marcello D’Andrea
- Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy; (A.T.); (D.F.); (G.L.); (L.T.); (M.D.)
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Teshigawara A, Kimura T, Ichi S. Critical cerebellar hemorrhage due to pilocytic astrocytoma in a child: A case report. Surg Neurol Int 2021; 12:448. [PMID: 34621563 PMCID: PMC8492438 DOI: 10.25259/sni_430_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cerebellar hemorrhage is rare in children, and its cause is usually vascular disorders such as arteriovenous malformations or hematological disorders. CASE DESCRIPTION A previously healthy 10-year-old girl presented with a loss of consciousness following sudden headache and vomiting. A non-contrast brain computed tomography (CT) scan revealed a massive cerebellar hemorrhage with obstructive hydrocephalus; however, subsequent CT angiography (CTA) showed no vascular abnormalities. An emergency craniotomy was performed to evacuate the hematoma, and histological analysis of the specimen obtained from the tissue surrounding the hematoma revealed a pilocytic astrocytoma (PA). Six months after the ictus, her recovery was scored at 2 on the modified Rankin Scale. CONCLUSION PA can be a cause of critical cerebellar hemorrhage. In this case of life-threatening massive hematoma, CTA was useful to exclude a major vascular pathology and to save time.
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Affiliation(s)
| | - Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Boukobza M, Goutagny S, Cazals-Hatem D, Laissy JP. Hemorrhagic presentation of frontal partially calcified pilocytic astrocytoma in an 18-year-old woman: A case report and literature review as "clinical case". Neurochirurgie 2019; 65:32-35. [PMID: 30711258 DOI: 10.1016/j.neuchi.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/09/2018] [Accepted: 12/08/2018] [Indexed: 11/16/2022]
Abstract
We report an unusual case of a frontal partially calcified pilocytic astrocytoma (PA) (WHO grade 1) in an 18-year-old woman who presented with acute, spontaneous intracerebral hemorrhage. Histopathology revealed the PA was mixed with psammoma bodies and areas of vascular proliferation responsible for a hypervascular pattern. The patient underwent a total gross resection. MRI showed no residual tumor at the 18-month follow-up and her neurological deficits improved after rehabilitation. Only 20 cases, including ours, of hemorrhagic presentation of PA in adults have been reported to date with enough radiological data. Furthermore, hemorrhagic presentation of a calcified PA is extremely rare. To date only two other cases of calcified PA with hemorrhagic presentation have been reported, one in an adult and one in an infant as described by Shibao et al. (2012) and Kapoor et al. (2015) respectively. Endothelial proliferation may be the main cause of bleeding in these lesions. In our case, a hypervascular pattern was exhibited by histopathological findings. A diagnosis of PA should be considered, especially when calcifications are present within a hemorrhagic tumor lesion.
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Affiliation(s)
- M Boukobza
- Department of radiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, 46, rue Henri-Huchard, 75018, Paris, France.
| | - S Goutagny
- Department of neurosurgery, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 92100 Clichy, France.
| | - D Cazals-Hatem
- Pathology department, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 92100 Clichy, France.
| | - J-P Laissy
- Department of radiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, 46, rue Henri-Huchard, 75018, Paris, France; INSERM U1148, 75018 Paris, France; University Paris 7, Faculté de Médecine Xavier-Bichat, 75018 Paris, France.
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