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Kobayashi K, Tanaka K, Iwai A, Taki J, Kitagawa M, Hayashi T, Tsuzuki S, Yamamoto T, Yoshioka T, Hirato J, Maihara T, Yamada K, Usami I, Heike T. Primary Diffuse Leptomeningeal Atypical Teratoid/Rhabdoid Tumor Initially Masquerading as Guillain–Barré Syndrome: A Case Report and Literature Review. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0041-1742251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractA 10-year-old male child patient was admitted with a chief complaint of progression of lower limb weakness lasting for 5 weeks. An initial clinical picture was reminiscent of Guillain–Barré syndrome. Repeated cerebrospinal fluid (CSF) cytological examinations were negative for neoplastic cells, but leptomeningeal biopsy targeting positron emission tomography (PET) avid lesion confirmed the invasion of tumor cells which were negatively stained with Brahma-related gene 1. An extensive literature review identified five cases of primary diffuse leptomeningeal atypical teratoid/rhabdoid tumors, and the clinical characteristics, including ours, were characterized as follows: (1) there was a bimodal age distribution in young children and adolescents with a male predominance, (2) roughly half of the patients fulfilled the diagnostic criteria of albuminocytologic dissociation and CSF cytology was neither sensitive nor specific to establish a definitive diagnosis, and (3) cerebrospinal magnetic resonance imaging findings were mostly indistinguishable from those of infectious or inflammatory diseases. We would like to suggest that primary leptomeningeal tumor should be included in the differential diagnosis of progressive polyneuropathy even in the absence of CSF cytological findings and implementation of preoperative PET may enhance the diagnostic accuracy of such a miscellaneous central nervous system tumor.
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Affiliation(s)
- Kenichiro Kobayashi
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Japan
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Kuniaki Tanaka
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Japan
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Atsushi Iwai
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Japan
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Junya Taki
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Masashi Kitagawa
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Tomoko Hayashi
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Sadatoshi Tsuzuki
- Department of Pathology, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Tetsuro Yamamoto
- Department of Pathology, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Takako Yoshioka
- Department of Pathology, National Research Institute for Child Health and Development, Japan
| | - Junko Hirato
- Department of Pathology, Public Tomioka General Hospital, Japan
| | - Toshiro Maihara
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Keisuke Yamada
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Ikuya Usami
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Japan
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Toshio Heike
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Japan
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Primary Diffuse Leptomeningeal Gliomatosis: Radiological/Pathological Features. Case Rep Neurol Med 2016; 2016:5016840. [PMID: 27891270 PMCID: PMC5116496 DOI: 10.1155/2016/5016840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022] Open
Abstract
We present the case of a 43-year-old lady who presented with headaches, visual impairment, and seizures, progressing rapidly over the course of a few weeks. Extensive workup excluded an inflammatory or infectious cause. Imaging studies revealed diffuse thickening of the leptomeninges and serial CSF analysis showed raised opening pressures and increased protein levels. A diagnostic biopsy of the lower thoracic dura confirmed the diagnosis of primary diffuse leptomeningeal gliomatosis (PDGL). She was managed supportively for her symptoms and unfortunately she passed away a few weeks later.
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Kosker M, Sener D, Kilic O, Hasiloglu ZI, Islak C, Kafadar A, Batur S, Oz B, Cokugras H, Akcakaya N, Camcioglu Y. Primary diffuse leptomeningeal gliomatosis mimicking tuberculous meningitis. J Child Neurol 2014; 29:NP171-5. [PMID: 24284232 DOI: 10.1177/0883073813509121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary diffuse leptomeningeal gliomatosis is a disease with an aggressive course that can result in death. To date, 82 cases have been reported. Here, the case of a 3-year-old male patient presenting with strabismus, headache, and restlessness is reported. Physical examination revealed paralysis of the left abducens nerve, neck stiffness, and bilateral papilledema. Tuberculous meningitis was tentatively diagnosed, and antituberculosis treatment was initiated when cranial imaging revealed contrast enhancement around the basal cistern. Craniocervical magnetic resonance imaging (MRI) was performed when there was no response to treatment, and it revealed diffuse leptomeningeal contrast enhancement around the basilar cistern, in the supratentorial and infratentorial compartments, and in the spinal region. Primary diffuse leptomeningeal gliomatosis was diagnosed by a meningeal biopsy.
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Affiliation(s)
- Muhammet Kosker
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Dicle Sener
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Omer Kilic
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zehra Isik Hasiloglu
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ali Kafadar
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sebnem Batur
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Neuropathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Necla Akcakaya
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yildiz Camcioglu
- Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Chadarévian JPD, Legido A, Halligan GE, Faerber EN, Piatt JH, Morrissette JD, Ara J, Grant ML, Katsetos CD. Cerebellar gliomatosis in a toddler: case report of a challenging condition and review of the literature. J Child Neurol 2012; 27:511-20. [PMID: 21940698 DOI: 10.1177/0883073811419315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gliomatosis confined to the cerebellum is most unusual. We report such a case in a 20-month-old male who presented with unsteadiness. Magnetic resonance imaging revealed a diffuse area of abnormal signal intensity within both cerebellar hemispheres, which did not enhance after contrast administration. The patient underwent a biopsy, which revealed a diffuse glioma infiltrating the cerebellum. Overall, the tumor cells had oligodendroglioma-like features and exhibited only focal vimentin immunoreactivity. They were negative for glial fibrillary acidic protein, synaptophysin, βIII-tubulin, and neurofilament protein. Immunofluorescence, performed on primary biopsy explants maintained in cell culture without exposure to growth factors or differentiation-promoting agents, revealed widespread nestin immunoreactivity and immunolabeling of occasional cells with antibodies to platelet-derived growth factor-α and O1/O4, markers of oligodendrocyte precursor-cells and immature oligodendrocytes, respectively. Fluorescent in situ hybridization performed on explants, touch preparations, and paraffin sections failed to reveal loss of heterozygosity for either 1p36 or 19q13. The patient was treated with temozolomide and remains stable, albeit with residual quiescent tumor, more than 3 years after surgery. This report calls attention to an unusual presentation of gliomatosis confined to the cerebellum of a toddler and addresses salient aspects of clinical and radiological differential diagnosis, as well as therapeutic challenges encountered.
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Affiliation(s)
- Jean-Pierre de Chadarévian
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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Manley S, Crooks D, Artingstall L, Buxton N, Appleton R, Riordan A, Cleary G, Pizer B. Diffuse central nervous system protoplasmic astrocytoma. Pediatr Blood Cancer 2010; 54:768-9. [PMID: 20049933 DOI: 10.1002/pbc.22402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Protoplasmic astrocytoma is an extremely rare form of grade II low grade glioma which usually presents as a discrete mass lesion. We describe a 3-year-old female with diffuse protoplasmic astrocytoma with parenchymal involvement and leptomeningeal spread. This tumour proved extremely difficult to diagnose and followed a progressive course. Three superficial biopsies did not give the diagnosis and this was only confirmed 8 months from presentation from a larger fourth biopsy taken deeper from the cerebellum. To our knowledge this case represents the distinct presentation of protoplasmic astrocytoma presenting as extensive diffuse meningeal disease.
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Affiliation(s)
- Sue Manley
- Department of Paediatric Oncology, Alder Hey Childrens' NHS Foundation Trust, Liverpool, UK.
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