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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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2
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Vasquez L, Tejada V, Maza I, Mendoza R. Primary osteosarcoma of the skull in teenager. BMJ Case Rep 2019; 12:12/9/e229585. [PMID: 31527199 DOI: 10.1136/bcr-2019-229585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteosarcoma of the skull is a rare primary malignant bone tumour in children, representing 1-2% of all cranial tumours. We describe a case of a 17-year-old adolescent with chondroblastic osteosarcoma of the parietal-occipital bone and no distant metastases at presentation treated with neoadjuvant chemotherapy, surgery and, later, concurrent chemoradiotherapy. The patient suffered progressive disease and died 15 months after diagnosis. There are at least 15 paediatric cases of osteosarcoma of the skull described in the literature. Due to its rarity, there are no broad prospective studies on this entity, which has distinctive features when compared to other craniofacial tumours, carrying a worse prognosis. Complete surgical resection is needed for long-term survival, whereas chemotherapy and radiotherapy have still questionable indications.
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Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology, Rebagliati Hospital, Lima, Peru.,Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres Facultad de Medicina Humana, La Molina, Lima, Peru
| | - Victor Tejada
- Department of Head and Neck Surgery, Rebagliati Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Ronald Mendoza
- Department of Pathology, Rebagliati Hospital, Lima, Peru
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3
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Aziah AR, Suresh Narayanan M, Periyathamby S, Irfan M. Osteosarcoma of right frontal sinus masquerading as a recurrent right large frontal mucocele. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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4
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Osteogenic sarcoma of the skull: long-term outcome of a rare tumor. Childs Nerv Syst 2018; 34:2149-2153. [PMID: 30120533 DOI: 10.1007/s00381-018-3937-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteogenic sarcoma of the skull is uncommon and long-term outcome is not well defined. We review the literature and present a pediatric case of calvarial osteogenic sarcoma with good long-term oncological and cosmetic outcome and excellent quality of life. This case presented major surgical challenges, which are detailed. CASE DESCRIPTION A 6-year-old boy presented with a painless 5 cm × 5 cm lump over the vertex region. He was neurologically normal. Imaging showed an extensive bony lesion with intradural extension. After incisional biopsy showed probable low grade osteosarcoma, a complete en bloc resection with margins was attempted via a concentric craniotomy around the lesion after embolization to reduce blood loss. Invasion of the brain by the tumor precluded the complete en bloc resection, but gross total resection was achieved. The final pathology was consistent with a low-grade osteosarcoma and adjuvant chemotherapy was provided. Follow-up for 8 years has shown no recurrence with good cosmetic and functional outcome.
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Abstract
RATIONALE Primary osteosarcomas of the skull and skull base are rare, comprising <2% of all skull tumors. Primary osteosarcomas of the skull are aggressive neoplasms composed of spindle cells producing osteoid which have poor outcome. PATIENT CONCERNS A 33-year-old woman was admitted to our hospital with a major complaint of a growing mass on her left frontal region of the skull for 10 months. Prior to the accurate diagnosis, the mass on her skull was considered to be eosinophilic granuloma. DIAGNOSES Computerized tomogram (CT) scan of skull revealed a lytic lesion causing destruction of left frontal bone with surrounding soft tissue mass. The histological examination of the lesion showed typical features of osteosarcoma. INTERVENTIONS The patient received 3 surgeries and adjuvant chemotherapy and radiotherapy for the frontal bone lesion. OUTCOMES At the last follow-up, after 4 years, the patient was free of disease both clinically and on imaging by magnetic resonance imaging (MRI) scan after 4 years. LESSONS Because osteosarcoma of skull is a rare disease, the early recognition and correct diagnosis are very important for a better prognosis. It is therefore imperative that clinicians recognize osteosarcoma early to make an accurate diagnosis and complete surgical resection followed by combined chemo-radiation is proved to be one of the most optimal treatment regimens.
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Affiliation(s)
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yu Liu
- Department of Neurosurgery
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He X, Yuan T, Yan Y, Yu J, Tong D. Unique Image Characteristics of an Occipital Primary Chondroblastic Osteosarcoma: A Rare Case Report and a Brief Literature Review. J Neurol Surg Rep 2017; 78:e77-e80. [PMID: 28413767 PMCID: PMC5391261 DOI: 10.1055/s-0037-1601876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/04/2017] [Indexed: 12/02/2022] Open
Abstract
Primary osteosarcomas of the skull and skull base are rare and comprise < 2% of all skull tumors. In head and neck osteosarcomas, the chondroblastic subtype occurs most frequently, which has an exceedingly poor outcome, but its image characteristic remains unknown. Herein, we report a case in the right occipital bone of the skull base and the unique characteristics of image. Pathologic examination of the surgical specimens led to the diagnosis of chondroblastic osteosarcomas. We believe those image characteristics can improve the understanding of skull chondroblastic osteosarcoma and the preoperative diagnosis.
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Affiliation(s)
- Xin He
- Department of Radiology, the First Affiliated Hospital of Jilin University, Changchun, China
| | - Tingting Yuan
- Department of Radiology, the First Affiliated Hospital of Jilin University, Changchun, China
| | - Yuzhu Yan
- Department of Radiology, the First Affiliated Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, the First Affiliated Hospital of Jilin University, Changchun, China
| | - Dan Tong
- Department of Radiology, the First Affiliated Hospital of Jilin University, Changchun, China
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7
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Mitra I, Duraiswamy M, Benning J, Joy HM. Imaging of focal calvarial lesions. Clin Radiol 2016; 71:389-98. [PMID: 26873626 DOI: 10.1016/j.crad.2015.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/08/2015] [Accepted: 12/15/2015] [Indexed: 12/14/2022]
Abstract
Focal calvarial lesions may present as a visible, palpable, or symptomatic lump; however, with increasing use of cross-sectional imaging they are often encountered as an incidental finding. Knowledge of the possible disease entities along with a structured approach to imaging is required to suggest an appropriate diagnosis and assist in management planning. Abnormalities range from common neoplastic lesions to rarer congenital conditions, benign pathologies, and calvarial defects that can mimic lesions. The aim of this article is to demonstrate the salient imaging features that may help to limit the differential diagnosis of a focal calvarial lesion.
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Affiliation(s)
- I Mitra
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton S016 6YD, UK.
| | - M Duraiswamy
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton S016 6YD, UK
| | - J Benning
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton S016 6YD, UK
| | - H M Joy
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton S016 6YD, UK
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Agarwal S, Gahlot GPS, Bhalla A, Bakhshi S. Small cell osteosarcoma of the parietal region: a unique case at an unusual site. BMJ Case Rep 2015; 2015:bcr-2015-210086. [PMID: 26628304 DOI: 10.1136/bcr-2015-210086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Small cell osteosarcoma is a rare tumour that histologically mimics Ewing sarcoma, mesenchymal chondrosarcoma and lymphoma, the presence of osteoid being diagnostic. This variant needs different management protocol, being non-radiosensitive and behaving more aggressively than conventional osteosarcoma. The aim of this article is to highlight such an entity at an unusual site--the parietal region--with unique diagnostic, treatment and prognostic considerations in a 16-year-old girl.
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Affiliation(s)
- Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav P S Gahlot
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Hadley C, Gressot LV, Patel AJ, Wang LL, Flores RJ, Whitehead WE, Luerssen TG, Jea A, Bollo RJ. Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 2014; 13:380-7. [PMID: 24483254 DOI: 10.3171/2013.12.peds13359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cranial osteosarcoma is very rare in children, rendering the development of optimal treatment algorithms challenging. The authors present 3 cases of pediatric cranial osteosarcoma: a primary calvarial tumor, a cranial metastasis, and a primary osteosarcoma of the cranial base. A review of the literature demonstrates significant variation in the management of cranial osteosarcomas and the outcome for patients with these tumors. This series and literature review is presented to improve the understanding of pediatric cranial osteosarcoma and to reinforce the importance of maximal resection in optimizing outcome.
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Affiliation(s)
- Caroline Hadley
- Department of Neurosurgery, Baylor College of Medicine and Division of Pediatric Neurosurgery, Texas Children's Hospital
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Shah JM, Wong A, Lim TC, Lim J, Mun LK, Ning C, Petersson BF, Sundar G. Autoclaved autologous bone graft for orbital reconstruction for recurrent temporal bone orbital osteosarcoma. J Craniofac Surg 2013; 24:e59-62. [PMID: 23348340 DOI: 10.1097/scs.0b013e31827003ba] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post-tumor excision and reconstruction of the craniofacial region is a complex and technically demanding process due to its proximity to numerous vital structures and irregularly shaped bony tissue. As such, novel methods are needed when reconstruction of irregularly shaped structures is necessary. Autoclaving of autologous bone grafts is an established practice in orthopedic and neurosurgical practice, but has only been described twice previously for orbital reconstruction. We performed grafting of an autoclaved autologous bone segment as part of surgery on a 30-year-old man to treat his recurrent temporal osteosarcoma with orbital involvement, which is rare. In addition, we went on to highlight key differences between bone autoclaving and pasteurization, an alternative heat treatment technique, for orbital reconstruction post-tumor excision. Although he suffered a second recurrence 8 months later, there was no evidence of recurrence in the autoclaved bone. To treat his second recurrence, he subsequently underwent a modified eyelid-conjunctiva sparing orbital exenteration, also an uncommonly performed procedure. Also, we subsequently examined the novel technique of a lid-sparing and conjunctiva-sparing orbital exenteration and its benefits. He continues to remain under follow-up.
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Affiliation(s)
- Jinesh M Shah
- Department of Ophthalmology, National University Cancer Institute, Singapore, Singapore
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Chang CS, Bergeron L, Liao CC, Liao HT, Chang CN, Kuo-Ting Chen P, Chen YR. Craniofacial reconstruction of primary osteogenic sarcoma of the skull. J Plast Reconstr Aesthet Surg 2010; 63:1265-8. [DOI: 10.1016/j.bjps.2009.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 07/16/2009] [Accepted: 07/23/2009] [Indexed: 11/29/2022]
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12
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SATO H, HAYASHI N, YAMAMOTO H, NAGAI S, OHMORI K, KANAMORI M, ENDO S. Synchronous Multifocal Osteosarcoma Involving the Skull Presenting With Intracranial Hemorrhage -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:407-9. [DOI: 10.2176/nmc.50.407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hikari SATO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | | | - Shoichi NAGAI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Kazuo OHMORI
- Department of Orthopedics, Faculty of Medicine, University of Toyama
| | - Masahiko KANAMORI
- Department of Orthopedics, Faculty of Medicine, University of Toyama
| | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
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14
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Dagcinar A, Bayrakli F, Yapicier O, Ozek M. Primary meningeal osteosarcoma of the brain during childhood. Case report. J Neurosurg Pediatr 2008; 1:325-9. [PMID: 18377310 DOI: 10.3171/ped/2008/1/4/325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary meningeal osteosarcomas are rare tumors, with only 19 reported cases in the literature; only 4 of these, including the present case, are in pediatric patients. In this report, the authors present the case of an 8-year-old boy with a history of generalized tonic-clonic seizures who was found to harbor a meningeal osteosarcoma within the sylvian fissure. Initial working diagnoses included meningioma and glioma. After tumor enlargement and progressive symptoms, the patient underwent a large frontotemporal craniotomy and complete resection of the lesion, which recurred 6 and 12 months after the initial surgery and was surgically treated after each recurrence. The rarity of primary meningeal osteosarcomas can make their diagnosis difficult, and histopathological evaluation is mandatory for diagnosis. Because of their fast progression, they must be treated aggressively by means of surgery, chemotherapy, and radiotherapy.
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Affiliation(s)
- Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
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Haddad H, Benchakroun N, Sahraoui S, Benider A. [Osteosarcoma of the skull base: a case report]. Neurochirurgie 2007; 53:483-5. [PMID: 18061213 DOI: 10.1016/j.neuchi.2007.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 08/04/2007] [Indexed: 10/22/2022]
Abstract
Osteosarcoma, usually observed in long bones, is the second most frequent primitive malignant bone tumor after myeloma. The skull base is an exceptional localization. We report a case of skull base osteosarcoma managed in our department. A 23-year-old female was admitted for bilateral epistaxis, headache, decreasing visual acuity then blindness. Physical examination revealed bilateral blindness and exophthalmia. Cranial magnetic resonance imaging showed a voluminous mass in the skull base extending to the nasosinusal area. A rhinoseptal surgical approach was used but the tumor was so huge that excision was impossible. The biopsy identified at an osteoblastic osteosarcoma. Search for extension (chest computed tomography and abdominal ultrasonography) was negative. Chemotherapy was to be delivered before combination chemoradiotherapy but the patient died before any treatment could be started. Osteosarcoma of the skull base is very rare. The treatment is based on surgery which should be as complete as possible followed by chemoradiotherapy. Prognosis is poor. Median survival is around six months.
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Affiliation(s)
- H Haddad
- Centre d'oncologie Ibn-Rochd, CHU d'Ibn-Rochd, Casablanca, Maroc.
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Abe K, Kosuda S, Kusano S, Shima K. Detection of Recurrent Skull Osteosarcoma by Skull Single Photon Emission Computed Tomography Using Tc-99m Methylene Diphosphonate. Clin Nucl Med 2004; 29:72-3. [PMID: 14688610 DOI: 10.1097/01.rlu.0000102766.99886.e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Katsumi Abe
- Department of Radiology, National Defense Medical College, Tokorozawa, Japan
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