Lhermitte-Duclos Disease in a Six-Year Old Child: A Rare Presentation

Lhermitte-Duclos Disease in an Eight-Year-Old Boy: A Case Report

Lhermitte-Duclos disease (LDD), also known as dysplastic cerebellar gangliocytoma, is a rare, slow-growing, benign lesion that occurs in the cerebellum and is very uncommon in the pediatric population. There is a lack of literature and evidence about LDD management, and only one systematic review is available. Thus, more case reports and studies are warranted. This study reports a pediatric case diagnosed with LDD and describes the patient's clinical presentation, radiological findings, and histopathological criteria. In addition, important aspects of the disease are discussed to help reach the best management options. The main management option is surgical resection, though a "wait and see" approach is also an alternative, especially for asymptomatic patients. More studies are still needed to determine the best management options.

Lhermitte-Duclos disease: A systematic review

Background

Lhermitte-Duclos disease (LDD) is a rare tumor, with only about 300 reported cases. It often shows comorbidity with Cowden syndrome (CS); however, it can occur by itself. Radiologically, the "tiger-stripe" appearance is considered pathognomonic. Surgical resection remains the mainstay of treatment. This report aims to describe the clinical and radiological characteristics of LDD and its relationship with CS according to age group.

Methods

PubMed electronic databases were searched in August 2022. The search terms included "Lhermitte- Duclos disease" and "dysplastic gangliocytoma," which yielded 297 and 103 research articles, respectively. The articles were collected and reviewed by three researchers.

Results

Out of 400 identified articles, we analyzed 302 reported cases. The mean age at presentation was 33.6 ± 16 years; 171 patients (56.6%) were female, and 123 (40.7%) were male. The most commonly reported symptom was headache (174 patients, 57.6%), followed by ataxia (109, 36.1%). In addition, 99 cases (32.8%) were associated with CS, and 60 (19.9%) had a confirmed phosphatase and tensin homolog (PTEN) mutation. A tiger-stripe appearance was observed in 208 cases (58.7%); surgical resection was performed in 64.2% of the cases. Mortality and recurrence rates were 4.3% and 8.6%, respectively. No statistically significant difference was found between adult- and pediatric-onset LDD for the association with CS (P = 0.128).

Conclusion

Our findings suggest that adult and pediatric LDD have major commonalities; however, further prospective studies are warranted.

MR imaging features of Lhermitte-Duclos disease: Case reports and literature review

RATIONALE

Lhermitte-Duclos disease (LDD) is a rare tumor of the nervous system with a typical "tiger striped'" sign, but its features on functional magnetic resonance imaging (fMRI) are still inconclusive.

PATIENT CONCERNS

To explore the characteristics of LDDs using fMRI.

DIAGNOSES

We report 3 cases of pathologically confirmed LDDs.

INTERVENTIONS

Three patients underwent brain tumor surgery.

OUTCOMES

All the patients had a good prognosis.

LESSONS

Magnetic resonance spectroscopy and susceptibility-weighted imaging combined with conventional MRI can be used to better diagnose LDDs. Perfusion-weighted imaging is not specific for distinguishing cerebellar tumors. The combined application of fMRI and conventional MRI can improve the accuracy of LDD diagnoses.

Lhermitte duclos disease: what to expect during surgery?

Lhermitte and Duclos first described the dysplastic gangliocytoma of the cerebellum in 1920. In the last 100 years, its clinical presentation, radiological features, pathological characteristics, and association with Cowden syndrome have been well described. However, documentation of surgical experiences is lagging. We here describe intraoperative experience during the removal of the tumor, which could help the operating surgeon plan and mental makeup.

Lhermitte–Duclos Disease Mimicking Cerebellopontine Angle Tumor: A Case Report

Lhermitte-Duclos disease (LDD) is dysplastic gangliocytoma of the cerebellum, which is rare, tends to grow slowly, usually has good prognosis, and wherein the cerebellar cortex becomes thick and the central white matter is not observed. On MRI of the brain, it has hyperintense and hypointense presentations on T2- and T1-weighted scans, respectively. It has nonhomogenous contrasting pattern on T1-contrast scans. LDD can be seen unilaterally or bilaterally in the cerebellum. When the disease is located at the cerebellopontine angle, it can be mistaken for the tumors located in this region. Recurrence can occur postoperatively, which is rare. The present case is a rare one because the tumor was located at the cerebellopontine angle and radiologically mimicked cerebellopontine angle tumors.

Imaging pitfalls in paediatric posterior fossa neoplastic and non-neoplastic lesions

Paediatric posterior fossa lesions can have much overlap in their clinical and radiological presentation. There are, however, a number of key imaging features that can help the reading radiologist to distinguish tumours from important tumour mimics which are often inflammatory or metabolic entities. This pictorial review provides a number of important cases that proved challenging on imaging and illustrates some common pitfalls when interpreting lesions in the posterior fossa in children. Not everything that is abnormal will be a tumour, but often other causes are overlooked and misinterpreted as tumours, leading to great morbidity for that child. This article highlights some lesions that were mistaken as tumours and will introduce the reader to less commonly seen pathologies which are important to consider on a differential list for this location.

Toward Systems Pathology for PTEN Diagnostics

Germline alterations of the tumor suppressor PTEN have been extensively characterized in patients with PTEN hamartoma tumor syndromes, encompassing subsets of Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, Proteus and Proteus-like syndromes, as well as autism spectrum disorder. Studies have shown an increase in the risk of developing specific cancer types in the presence of a germline PTEN mutation. Furthermore, outside of the familial setting, somatic variants of PTEN occur in numerous malignancies. Here we introduce and discuss the prospect of moving toward a systems pathology approach for PTEN diagnostics, incorporating clinical and molecular pathology data with the goal of improving the clinical management of patients with a PTEN mutation. Detection of a germline PTEN mutation can inform cancer surveillance and in the case of somatic mutation, have value in predicting disease course. Given that PTEN functions in the PI3K/AKT/mTOR pathway, identification of a PTEN mutation may highlight new therapeutic opportunities and/or inform therapeutic choices.