Adult hippocampal ganglioneuroblastoma: Case report and literature review

Intracranial leptomeningeal CNS ganglioneuroblastoma. First report and review of the literature

BACKGROUND

CNS ganglioneuroblastoma in an extremely rare embryonal tumour, specifically in the pediatric population. Bad prognosis is documented due to aggressiveness and absence of protocolized treatment at the moment.

CLINICAL DESCRIPTION

We present the case of a 5-year-old boy who presented with sudden loss of consciousness. CT scan was performed showing a large posterior fossa lesion with several intraventricular focal lesions, suggesting metastases, the largest one located inside the III ventricle. The patient underwent a posterior fossa resection of the lesion and a subtotal resection of the III ventricle lesion, with adjuvant chemotherapy. The evolution was poor and the patient finally died 3 months after diagnosis.

CONCLUSION

Ganglioneuroblastoma is extremely likely to recur quickly and extensively. There is little knowledge about treatment options but is documented that gross total resection followed by adjuvant radiotherapy and chemotherapy is the best management in these patients.

Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature

Ganglioneuroblastoma (GNB) is a condition belonging to the neuroblastoma family. It is a transitional tumor consisting of a mixture of mature ganglioneuromas and malignant neuroblastomas. Its biological behavior is intermediate between benign and malignant, with a risk of recurrence and metastasis. It usually occurs in pediatric patients aged <10 years, particularly between the ages of 1 and 2 years, but may also occur in adolescents or adults. The present study reported on the clinical management of a case of postoperative stress ulcer with perforation in a 17-year-old female patient with retroperitoneal GNB and provided a review of the literature on retroperitoneal GNB in adolescents and adults.

Suprasellar central nervous system ganglioneuroblastoma: a case in a 9-year-old child and review of the literature

PURPOSE

Intracranial ganglioneuroblastomas are incredibly rare neuroectodermal tumors with only 8 described cases total, 5 of those having imaging findings METHODS: Here we present a 9-year-old female patient with 4 months progressive headaches, personality changes, and vomiting. We also present a review of the current literature of intracranial ganglioneuroblastomas.

RESULTS

Imaging demonstrated a partially calcified suprasellar mass measuring 4.6 × 6.3 × 5 cm composed of both solid and cystic components, diagnosed to be a ganglioneuroblastoma, with mass effect on the lateral and 3rd ventricles, with a midline shift of right to left of 6-7 mm. She was treated with subtotal surgical resection, an intensive chemotherapeutic regimen, and radiation and has no residual disease on imaging 1 year and 4 months status post-surgery.

CONCLUSION

To our knowledge, this is the first case of a ganglioneuroblastoma to mimic a craniopharyngioma based upon imaging findings and suprasellar location. As these cases are extremely rare, an optimal therapeutic regimen has not been defined. However, a combination of surgical resection, chemotherapy, and radiation therapy can be effective, as shown here with successful treatment and no evidence of residual disease.

Metastatic adult neuroblastoma with spontaneous tumor lysis syndrome

Neuroblastoma (NB) is a solid tumor of the sympathetic nervous system, most commonly found in childhood, standing for 7% of all pediatric malignancies. The incidence in adults is markedly smaller: 1 case per 10 million adults per year. We report the case of a previously healthy 27-year-old woman who started with lumbar pain, asthenia, and abdominal distension over the last month. A chest and abdomen tomography scan showed a huge mass in the upper left hemithorax and marked hepatomegaly. The diagnosis was confirmed by hepatic and lung biopsies. On day 4, after admission, the patient started chemotherapy. On the following days, she had severe vaginal bleeding, epistaxis, worsening of the hepatic function markers, refractory shock, and multiple organ dysfunction. She died on the twelfth day of admission. We also present a review of adult cases of NB reported in the past 5 years.

Central nervous system ganglioneuroblastoma harboring MYO5A-NTRK3 fusion

Central nervous system (CNS) ganglioneuroblastoma is a rare neuroectodermal neoplasm and little is known about its clinical and biological features. Herein, we report a pediatric case of CNS ganglioneuroblastoma harboring MYO5A-NTRK3 fusion. The patient, a 4-year-old boy, underwent a partial resection of a supratentorial tumor that was histopathologically diagnosed as a CNS ganglioneuroblastoma. Treatment with radiotherapy was started per the St Jude Medulloblastoma 03 (SJMB03) protocol; however, the tumor progressed rapidly and radiotherapy was temporally discontinued. Meanwhile, the patient underwent a second surgery, in which a gross total resection was successfully performed, following which he completed the remaining protocol-based therapy. Although an early focal recurrence was detected for which he received additional radiotherapy and oral temozolomide, the patient remained in complete remission for 14 months after the completion of the treatment. A central pathological review and molecular analysis were performed that revealed a MYO5A-NTRK3 fusion. Interestingly, the MYO5A-NTRK3 fusion has been recurrently detected in melanocytic tumors but not in other types of tumors. Therefore, it can be speculated that our case might partly share tumorigenesis mechanisms with MYO5A-NTRK3-positive melanocytic tumors. In addition, our case may enable an improved understanding of the pathogenesis and clinical features of CNS ganglioneuroblastomas.

Incidence, Treatment, and Survival in Primary Central Nervous System Neuroblastoma

BACKGROUND

Primary central nervous system neuroblastoma (PCNSN) is a rare disease, and its incidence, treatment modalities, and survival remain poorly understood.

METHODS

The SEER (Surveillance Epidemiology and End Results) database was used to identify patients diagnosed with PCNSN from 1973 to 2013. The incidence and survival rates were examined. Clinical features, treatment modalities, and prognosis were also assessed.

RESULTS

A total of 280 patients with PCNSN were identified, with annual age-adjusted incidence being 0.37 per 1,000,000 persons in 1973 and decreasing to 0.12 in 2013. Neuroblastoma (NBL) (ganglioneuroblastoma vs. NBL; odds ratio [OR], 25.01; P = 0.008) and tumor with distant metastasis (OR, 0.17; P = 0.002) were more likely to receive conservative treatment over surgery, whereas older age (OR, 1.02; P = 0.011) and tumors located in the brain (other nervous system vs. brain: OR, 0.31; P = 0.001) increased the likelihood of receiving combined surgery and radiotherapy over surgery alone. In addition, younger age, ganglioneuroblastoma, and surgery treatment were significantly associated with improved outcomes (all P < 0.05). Furthermore, a nomogram model was established to effectively estimate survival for patients with PCNSN.

CONCLUSIONS

We updated epidemiologic information of PCNSN and showed that age, histologic type, tumor extension, and surgery were independent prognostic factors. Moreover, treatment modalities of these tumors are influenced by patient and tumor characteristics.