Primary diffuse leptomeningeal oligodendrogliomatosis: A case report and literature review

Clinical progression, pathological characteristics, and radiological findings in children with diffuse leptomeningeal glioneuronal tumors: A systematic review

Background

Diffuse leptomeningeal glioneuronal tumors are rare leptomeningeal neoplasms composed of oligodendrocyte-like cells characterized by neuronal differentiation and a lack of isocitrate dehydrogenase gene mutation.

Purpose

We aimed to analyze the clinical progression, pathological characteristics, and radiological findings of diffuse leptomeningeal glioneuronal tumors in children, as well as the relevance of clinico-radiological data.

Data Sources

We searched MEDLINE, PubMed, and Web of Science to identify case reports, original articles, and review articles discussing diffuse leptomeningeal glioneuronal tumors published between 2000 and 2021.

Study Selection

The analysis included 145 pediatric patients from 43 previous studies.

Data Analysis

Data regarding patient pathology, MRI manifestations, clinical symptoms, and progression were collected. The relationship between imaging classification and pathological findings was using chi-square tests. Overall survival was analyzed using Kaplan–Meier curves.

Data Synthesis

Parenchymal tumors were mainly located in the intramedullary areas of the cervical and thoracic spine, and patients which such tumors were prone to 1p-deletion (χ2 = 4.77, p=0.03) and KIAA1549-BRAF fusion (χ2 = 12.17, p<0.001). The median survival time was 173 months, and the survival curve fell significantly before 72 months. Parenchymal tumor location was associated with overall survival (p=0.03), patients with KIAA 1549-BRAF (+) and treated with chemotherapy exhibited a better clinical course (p<0.001).

Limitations

The analysis included case reports rather than consecutively treated patients due to the rarity of diffuse leptomeningeal glioneuronal tumors, which may have introduced a bias.

Conclusions

Early integration of clinical, pathological, and radiological findings is necessary for appropriate management of this tumor, as this may enable early treatment and improve prognosis.

A rare central nervous system tumor of childhood with spongiform appearance on brain magnetic resonance imaging; primary diffuse leptomeningeal oligodendrogliomatosis

Primary diffuse leptomeningeal oligodendrogliomatosis is a rare fatal tumor of childhood. Symptoms usually occur when the tumor causes hydrocephalus. Brain magnetic resonance imaging (MRI) may be nearly normal in the early stages of the disease, while hydrocephalus and multiple leptomeningeal cysts with spongiform appearance may appear later on. One may consider the diagnosis when radiologic findings become apparent with multiple leptomeningeal cysts. However, failure to recognize the imaging findings due to the rarity of the disease may delay the diagnosis. Here, we report a 3.5-year-old girl who presented with ataxia and vomiting and had a diagnosis of primary diffuse leptomeningeal glioneuronal tumor with remarkable brain MRI findings as diffuse multiple tiny cystic lesions on the brain and spinal cord. She benefited from radiotherapy and temozolomide treatment with remission of brain MRI findings. Increasing the number of reported cases will enable the elucidation of the disease's pathogenesis and the development of treatment protocols.

Cranial and Spinal Oligodendrogliomatosis: A Case Report and Review of the Literature

Secondary leptomeningeal gliomatosis is a condition known as a result of invasion of the subarachnoid space or the ventricular system of primary intraparenchymal glioma. In this article, we present a 7-year-old boy presented with neck and back deformity and deterioration of gait. Cranial and spinal magnetic resonance imaging revealed lesions in the supratentorial and infratentorial areas, in the brainstem downward the spinal cord. Disseminated oligodendrogliomatosis is extremely rare and our case we present is the 24^th in the literature.

A rare central nervous system tumor of childhood with spongiform appearance on brain magnetic resonance imaging; primary diffuse leptomeningeal oligodendrogliomatosis

Primary diffuse leptomeningeal oligodendrogliomatosis is a rare fatal tumor of childhood. Symptoms usually occur when the tumor causes hydrocephalus. Brain magnetic resonance imaging (MRI) may be nearly normal in the early stages of the disease, while hydrocephalus and multiple leptomeningeal cysts with spongiform appearance may appear later on. One may consider the diagnosis when radiologic findings become apparent with multiple leptomeningeal cysts. However, failure to recognize the imaging findings due to the rarity of the disease may delay the diagnosis. Here, we report a 3.5-year-old girl who presented with ataxia and vomiting and had a diagnosis of primary diffuse leptomeningeal glioneuronal tumor with remarkable brain MRI findings as diffuse multiple tiny cystic lesions on the brain and spinal cord. She benefited from radiotherapy and temozolomide treatment with remission of brain MRI findings. Increasing the number of reported cases will enable the elucidation of the disease's pathogenesis and the development of treatment protocols.

Diffuse meningeal oligodendrogliomatosis characterized by spinal intra-parenchymal nodules on magnetic resonance imaging in a dog

Meningeal oligodendrogliomatosis is a relatively rare neoplasm in dogs. Ante-mortem diagnosis is difficult due to nonspecific neurologic signs overlapping other conditions. The only reported consistent feature is a high level of protein in the cerebrospinal fluid. Veterinary literature offers only 1 case report with magnetic resonance imaging (MRI) of canine spinal meningeal oligodendrogliomatosis in a single dog. In contrast to the predominant diffuse meningeal enhancement shown in that report, we present the case of a young female cane corso dog with marked nodular invasion of the spinal cord on MRI, confirmed by histopathology to be consistent with diffuse meningeal oligodendrogliomatosis. Key clinical message: Meningeal oligodendrogliomatosis should be a differential diagnosis when marked nodular invasion of the spinal cord is seen on MRI, both with and without meningeal enhancement.