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Contemporary outcomes of diffuse leptomeningeal glioneuronal tumor in pediatric patients: A case series and literature review. Clin Neurol Neurosurg 2022; 218:107265. [DOI: 10.1016/j.clineuro.2022.107265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
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2
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Disseminated Oligodendroglial-like Leptomeningeal Tumor in the Adult: Case Report and Review of the Literature. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.02.160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Jiang Y, Chen J, He J, Pei A, Zhang J, Liu Y. Parenchymal Infiltration in Primary Diffuse Leptomeningeal Gliomatosis: Dynamic Changes in Brain MRI. Front Oncol 2017; 7:240. [PMID: 29062809 PMCID: PMC5640879 DOI: 10.3389/fonc.2017.00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/19/2017] [Indexed: 11/18/2022] Open
Abstract
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and fatal disease with no special clinical manifestations. Here, we report the dynamic brain magnetic resonance imaging (MRI) changes in a 30-year-old female PDLG patient over a 10-month period. MRI showed aggressive dilation of the subarachnoid space and the ventricular system, numerous encapsulated cysts in the subarachnoid space and the dilated cerebral sulci, diffuse reticulated or focal nodular enhancement in the subarachnoid space, as well as overall enhancement in the cystic walls. In addition to the aforementioned PDLG pathological findings, MRI also revealed non-contrasted solid lesions and a contrasted cyst-like lesion in the paraventricular areas. The dynamic and multiform neuroradiological changes help us to understand the pathological process of PDLG. Of particular interest is the discovery that parenchymal infiltration can occur in PDLG.
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Affiliation(s)
- Yun Jiang
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jing He
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Ao Pei
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jinsong Zhang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yinhong Liu
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
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Cho HJ, Myung JK, Kim H, Park CK, Kim SK, Chung CK, Choi SH, Park SH. Primary diffuse leptomeningeal glioneuronal tumors. Brain Tumor Pathol 2014; 32:49-55. [PMID: 24770606 DOI: 10.1007/s10014-014-0187-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
Diffuse leptomeningeal disseminated glioneuronal tumor (DL-GNT) is a rare brain tumor that presents as a plaque-like subarachnoid tumor, commonly involving the basal cisterns and interhemispheric fissure of children but lacking intraparenchymal tumor. Histologically, the tumors are composed of sheets of monotonous rounded cells. Here, we report three cases of DL-GNTs, focusing on clinicopathologic features. Two patients were adult male, but one patient was child. The patients presented with seizures (n = 1) or headaches (n = 2). In all patients, radiography revealed characteristic leptomeningeal thickening and enhancement with minor superficial parenchymal lesions. All three cases were diffusely positive for both GFAP and synaptophysin, and scattered positive for OLIG2 and NeuN, but negative for IDH-1 (H09). Electron microscopic examination showed astrocytic and neuronal differentiation. The patient with the anaplastic tumor died due to aggressive progression of the tumor, but the remaining two patients were stable without tumor recurrence for 23 and 37 months. Thus, these findings suggest that DL-GNT can occur in both children and adult and both supra- and infra-tentorial leptomeninges. It has unique radiological and histopathological features and biological behavior. Further clinicopathological data with molecular genetic study are required for establishing DL-GNT as a unique entity.
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Affiliation(s)
- Hwa Jin Cho
- Department of Pathology, Seoul National University Hospital, College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
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Hansen N, Wittig A, Hense J, Kastrup O, Gizewski ER, Van de Nes JAP. Long survival of primary diffuse leptomeningeal gliomatosis following radiotherapy and temozolomide: case report and literature review. Eur J Med Res 2012; 16:415-9. [PMID: 22024443 PMCID: PMC3352148 DOI: 10.1186/2047-783x-16-9-415] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare neoplasm with a short survival time of a few months. there is currently no standardized therapeutic approach for PDLG. Materials and methods We report on a 53-year-old male patient who presented with epileptic seizures, gait disturbance, paraparesis and sensory deficits in the dermatomes T8-10. Results Magnetic resonance imaging (MRI) revealing numerous spinal and cranial gadolinium-enhancing nodules in the meninges and histopathology led us to diagnose primary diffuse leptomeningeal gliomatosis with WHO grade III astrocytic cells. Consecutively, the patient underwent craniospinal radiotherapy (30 Gy) and 11 sequential cycles of temozolomide. This regimen led to partial tumor regression. Thirteen months later, spinal MRI revealed tumor progression. Second-line chemotherapy with 5 cycles of irinotecan and bevacizumab did not prevent further clinical deterioration. The patient died twenty-two months after diagnosis, being the longest survival time described thus far with respect to PDLG consisting of astrocytic tumor cells. Conclusions Radiochemotherapy including temozolomide, as established standard therapy for brain malignant astrocytomas, might be valid as a basic therapeutic strategy for this PDLG subtype.
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Affiliation(s)
- Niels Hansen
- Department of Neurology, Julius-Maximilians-University, Würzburg, Germany.
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6
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Neuro-Ophthalmological Features of Primary Diffuse Leptomeningeal Gliomatosis. J Neuroophthalmol 2011; 31:299-305. [DOI: 10.1097/wno.0b013e31821ee5c2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Knox MK, Ménard C, Mason WP. Leptomeningeal gliomatosis as the initial presentation of gliomatosis cerebri. J Neurooncol 2010; 100:145-9. [PMID: 20146082 DOI: 10.1007/s11060-010-0138-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/27/2010] [Indexed: 11/28/2022]
Abstract
Leptomeningeal gliomatosis is a known, yet uncommon, complication of malignant gliomas. In rare instances it can present with non-specific symptoms prior to the development of detectable intraparenchymal lesions, posing a diagnostic challenge. Gliomatosis cerebri is also a rare disease, characterized by extensive diffuse infiltration of neoplastic glial cells. For both entities, limited data exist to guide treatment and prognosis is poor. We describe the case of a patient who presented with symptoms of increased intracranial pressure and diffuse leptomeningeal enhancement in the brain and spinal cord on MRI. After a period of surveillance, intraparenchymal lesions developed in association with widespread diffuse infiltration. The diagnosis of gliomatosis cerebri with diffuse leptomeningeal gliomatosis was established in hindsight. Initial treatment consisted of six cycles of temozolomide chemotherapy. Following radiological progression, the patient received craniospinal radiotherapy. Four months later the patient's symptoms had resolved and MRI demonstrated near complete response of leptomeningeal enhancement and intraparenchymal lesions. Six months after radiotherapy, the patient remains clinically well without radiographic recurrence.
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Affiliation(s)
- Matthew K Knox
- Faculty of Medicine, UME Office, Health Sciences Centre, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
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8
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Ko MW, Turkeltaub PE, Lee EB, Gonatas NK, Volpe NJ, Moster ML, Galetta SL. Primary diffuse leptomeningeal gliomatosis mimicking a chronic inflammatory meningitis. J Neurol Sci 2009; 278:127-31. [DOI: 10.1016/j.jns.2008.11.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/19/2008] [Accepted: 11/21/2008] [Indexed: 11/28/2022]
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9
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King JAJ, Halliday W, Drake JM. High-grade primary diffuse leptomeningeal gliomatosis in a child with neurofibromatosis Type 1. J Neurosurg Pediatr 2008; 2:402-5. [PMID: 19035685 DOI: 10.3171/ped.2008.2.12.402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on a child with known neurofibromatosis Type 1 who developed high-grade diffuse leptomeningeal gliomatosis, without a known primary glioma. To the authors' knowledge, this is the first report of the coexistence of these conditions in a child.
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Affiliation(s)
- James A J King
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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10
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Ishige S, Iwadate Y, Ishikura H, Saeki N. Primary diffuse leptomeningeal gliomatosis followed with serial magnetic resonance images. Neuropathology 2007; 27:290-4. [PMID: 17645245 DOI: 10.1111/j.1440-1789.2007.00760.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of primary diffuse leptomeningeal gliomatosis (PDLG) followed up with serial magnetic resonance images (MRI). A 45-year-old man manifested with bilateral abducens nerve palsy and meningisms. Repeated MRI revealed diffuse leptomeningeal enhancement throughout the central nervous system without intra-axial mass accompanied with the dilatation of ventricles and focally enlarged cerebral sulci. Brain biopsies showed a leptomeningeal gliomatosis. The MRI findings described here would contribute to the diagnosis of PDLG among other common diseases diffusely spreading along the leptomeningeal structures.
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Affiliation(s)
- Satoshi Ishige
- Department of Neurological Surgery, Chiba University Graduate School of Medicine 1-8-1, Inohana, Chuo-ku, 260-8670 Chiba, Japan
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11
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Smith JS, Parney IF, Lamborn KR, McDermott MW, Sneed PK, Chang SM. Treatment for posterior fossa dissemination of primary supratentorial glioma. J Neurosurg 2007; 106:567-74. [PMID: 17432705 DOI: 10.3171/jns.2007.106.4.567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was designed to assess the presentation, management, and outcome of cases involving patients who had a supratentorial glioma that subsequently progressed in the posterior fossa (PF). METHODS The authors performed a retrospective chart review of adult patients treated between 1997 and 2005 for supratentorial gliomas that progressed in the PF. The 29 patients with PF progression in this study were relatively young (median age of 34 years at original presentation). Twenty of these patients presented with symptoms. The symptoms were typically nonspecific to this population, at times leading to delays in diagnosis. Overall, these symptoms resolved in eight patients (40%) and progressed or remained unchanged in 12 (60%). Patients treated with more than 5000 cGy of radiation administered to the PF were more likely to have symptom resolution than those who received any other form of treatment, including reduced doses of radiation (p = 0.004). The patients treated with higher doses also survived significantly longer after PF progression (univariate analysis, p = 0.01, and after adjusting for tumor grade, p = 0.04). CONCLUSIONS Patients with PF progression of supratentorial infiltrative gliomas may benefit from treatment, and the authors recommend more than 5000 cGy of radiation to the PF if prior radiotherapy ports and doses allow.
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Affiliation(s)
- Justin S Smith
- Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, California 94143-0350, USA
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12
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Yomo S, Tada T, Hirayama S, Tachibana N, Otani M, Tanaka Y, Hongo K. A case report and review of the literature. J Neurooncol 2006; 81:209-16. [PMID: 17031563 DOI: 10.1007/s11060-006-9219-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 07/10/2006] [Indexed: 11/27/2022]
Abstract
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare central nervous system neoplasm in which gliomatous tissue is diffusely identified in the subarachnoid space with no evidence of a primary intraparenchymal tumor. A 52-year-old man presented low back pain followed by sudden unconsciousness and had also cognitive dysfunction and meningeal sign. Examinations of cerebrospinal fluid (CSF) did not show malignant cells but increased protein and pleocytosis. Magnetic resonance (MR) imaging demonstrated diffuse leptomeningeal enhancement without any source of intraparenchymal lesion. Fluid-attenuated inversion recovery (FLAIR) also demonstrated individual diffuse high intensity area in the subarachnoid space. A biopsy disclosed wide spreading of anaplastic glial cells within the leptomeninges. He died 3 months later because of disease progression despite both radiotherapy and chemotherapy. Post-mortem examination identified PDLG and several neuropathological features of glioblastoma as well. Reviewing previous cases of PDLG instructs that this entity is rare, resembles meningitis in clinical pictures, usually occurs in a relatively younger population and has more progressive clinical course than the ordinary form of malignant gliomas.
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Affiliation(s)
- Shoji Yomo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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13
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Debono B, Derrey S, Rabehenoina C, Proust F, Freger P, Laquerrière A. Primary diffuse multinodular leptomeningeal gliomatosis: case report and review of the literature. ACTA ACUST UNITED AC 2006; 65:273-82; discussion 282. [PMID: 16488248 DOI: 10.1016/j.surneu.2005.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Accepted: 06/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary diffuse leptomeningeal gliomatosis is an exceptional neoplasm, and only 30 cases have been reported in the literature. We report a recent case and compare data with previously published observations. METHODS A 50-year-old man was admitted to the neurosurgery department for a previous 4-month history of headache, associated with nonspecific neurological signs. Biologic data and cerebrospinal fluid examination suggested an inflammatory process. The patient was given an antituberculous therapy. Magnetic resonance imaging revealed a multinodular enhancement of spinal nerve roots. A biopsy of sacral rootlets was performed. Histological examination revealed an anaplastic astrocytoma. Patient's status worsened, and death occurred 7 months later. RESULTS Complete neuraxis postmortem examination revealed no intraparenchymatous glioma and was conclusive for the diagnosis of primary leptomeningeal gliomatosis (astrocytic, World Health Organization grade III), with a multinodular pattern in the spinal cord, the brainstem, and the brain base with diffuse extension into the cerebellar subarachnoid spaces. CONCLUSIONS Our case illustrates the diagnostic difficulties in making the premortem diagnosis. The review of the literature indicates that there are no specific clinical or biologic signs. Magnetic resonance imaging using T1-weighted images with gadolinium enhancement and biopsy material may be useful diagnostic tools. In most cases, autopsy evaluation alone permits definitive primary diffuse leptomeningeal gliomatosis diagnosis. Whatever the histological characteristics of proliferating cells are, the prognosis remains poor. No prognostic factors have been shown to be correlated with survival time. Unfortunately, no routine treatment has been yet proposed.
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Affiliation(s)
- Bertrand Debono
- Department of Neurosurgery, Rouen University Hospital-Charles Nicolle, 76031 Rouen Cedex, France.
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14
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Wheen LC, Anderson NE, Baker PCH, Singh VK, Synek BJL. Leptomeningeal infiltration as the presenting manifestation of a malignant glioma. J Clin Neurosci 2006; 13:298-301. [PMID: 16431108 DOI: 10.1016/j.jocn.2005.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 01/11/2005] [Indexed: 11/23/2022]
Abstract
Infiltration of the leptomeninges by a malignant glioma typically occurs with recurrent supratentorial tumors, but patients may present with leptomeningeal gliomatosis before the primary tumor is diagnosed. This report describes two patients who presented with headache and signs of multifocal neurological disease. One of the patients had neurofibromatosis type I. In both patients the cerebrospinal fluid examination showed a mild pleocytosis, but malignant cells were not detected. The diagnosis of leptomeningeal gliomatosis was not confirmed until autopsy, but in retrospect imaging showed a small, asymptomatic primary tumor in both patients. Leptomeningeal gliomatosis should be considered in the differential diagnosis of chronic meningitis, if the patient is afebrile and if there are multifocal neurological signs, even when a primary tumor is not obvious.
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Affiliation(s)
- L C Wheen
- Anatomic Pathology, Auckland Hospital, Auckland, New Zealand
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15
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Berg SL, Chamberlain MC. Current treatment of leptomeningeal metastases: systemic chemotherapy, intrathecal chemotherapy and symptom management. Cancer Treat Res 2005; 125:121-46. [PMID: 16211887 DOI: 10.1007/0-387-24199-x_8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment of leptomeningeal metastases is multifaceted and includes symptomatic therapy, intrathecal and systemic chemotherapy, and radiotherapy. As the majority of patients have widespread incurable systemic tumor, treatment is predominantly palliative; however, some patients with leukemia, lymphoma or breast cancer may have prolonged remissions and the possibility of cure.
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Affiliation(s)
- Stacey L Berg
- Norris Cancer Center, University of Southern California, Los Angeles, Ca. 90089, USA
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16
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Berg SL, Chamberlain MC. Systemic chemotherapy, intrathecal chemotherapy, and symptom management in the treatment of leptomeningeal metastasis. Curr Oncol Rep 2003; 5:29-40. [PMID: 12493148 DOI: 10.1007/s11912-003-0084-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastasis to the leptomeninges occurs in many common cancers, including leukemia; lung, breast, and gastrointestinal cancers; and tumors of the brain. By way of the flow of cerebrospinal fluid, leptomeningeal metastasis spreads throughout the neuraxis. Consequently, therapy for leptomeningeal metastasis must be directed to the entire central nervous system (CNS). Treatment often consists of involved-field radiotherapy, systemic chemotherapy, and intrathecal chemotherapy. However, because meningeal spread occurs most often in advanced disease, treatment is mainly palliative, except in childhood leukemia, where durable remission has been reported. This article outlines the role of systemic and intrathecal chemotherapy in patients with leptomeningeal metastases. Strategies for symptom management in these patients are also described.
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Affiliation(s)
- Stacey L Berg
- Department of Pediatric Oncology, Texas Children's Cancer Center, Baylor College of Medicine, USA
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Motoyama Y, Ogi S, Nabeshima S. Pontine glioblastoma multiforme initially presenting with leptomeningeal gliomatosis. Neurol Med Chir (Tokyo) 2002; 42:309-13. [PMID: 12160312 DOI: 10.2176/nmc.42.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 49-year-old female presented with diffuse leptomeningeal gliomatosis as the initial manifestation of pontine glioblastoma. Magnetic resonance imaging initially revealed diffuse leptomeningeal enhancement caused by metastatic deposits, predominantly along the basal cistern and bilateral sylvian fissures. The primary pontine lesion appeared as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, but with no enhancement by gadolinium-diethylenetriaminepenta-acetic acid. There was no diffuse enlargement of the pons. The patient died 11 months after the initial presentation. The primary lesion in the pons was histologically confirmed at autopsy. Diffuse enhancement of leptomeningeal dissemination may occur as the initial manifestation of non-enhanced pontine glioblastoma.
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18
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Hill MD, Mackenzie I, Mason WP. Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report. J Neurooncol 2001; 55:113-6. [PMID: 11817701 DOI: 10.1023/a:1013337802429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Leptomeningeal gliomatosis is a rare and fatal disease. METHODS Case report. RESULTS We report the case of a man who was presented with severe intractable headaches, lymphocytic CSF pleocytosis, and spinal leptomeningeal enhancement on contrast MRI. Meningeal biopsy demonstrated diffuse infiltration by malignant glial cells, and symptom alleviation was achieved by CSF diversion. He later developed an enhancing thalamic tumor arising within the treatment field of a remotely irradiated pituitary adenoma. Subsequent management included chemotherapy and further radiotherapy with transient response, before death from leptomeningeal and parenchymal tumor progression 16 months after diagnosis. CONCLUSION We report a unique case embodying two rare conditions: radiation induced glioma and leptomeningeal gliomatosis. Our patient's course is novel in that symptomatic relief was achieved with CSF diversion and a combination of chemotherapy and focal radiation allowed prolonged survival.
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Affiliation(s)
- M D Hill
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
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19
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Affiliation(s)
- B Cirak
- Department of Neurosurgery, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.
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Abstract
Neoplastic meningitis is an increasingly recognized complication of advanced metastatic cancer and, if left undiagnosed or untreated, is characterized by rapid neurologic deterioration and death. Thus, the diagnosis and treatment of neoplastic meningitis present challenges for the clinical oncologist. The diagnosis of neoplastic meningitis is based on clinical signs and symptoms, laboratory analysis of cerebrospinal fluid to determine cell count and cytology, and analysis of neuroimaging studies for evidence of leptomeningeal or cranial nerve enhancement. Once diagnosed, conventional treatment regimens may include radiotherapy combined with systemic or intrathecal chemotherapy, often with the antimetabolites cytarabine and/or methotrexate. However, the prognosis for neoplastic meningitis secondary to an underlying solid tumor or recurrent leukemia is poor with conventional treatment regimens. Therefore, novel agents for intrathecal administration, including DepoCyttrade mark, mafosfamide, and topotecan, or novel therapeutic approaches, including conjugated monoclonal antibodies and immunotoxins or gene therapy, are currently under investigation. Such new agents and therapeutic approaches will facilitate the development of effective treatment strategies and will ultimately improve the outcome for patients with this devastating disease. This article provides an overview of the approaches to the diagnosis, evaluation, and treatment of neoplastic meningitis.
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Affiliation(s)
- S M Blaney
- Hematology/Oncology Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer Center and Hematology Service, Houston, TX 77030-2399, USA.
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Pradat PF, Hoang-Xuan K, Cornu P, Mokhtari K, Martin-Duverneuil N, Poisson M, Delattre JY. Treatment of meningeal gliomatosis. J Neurooncol 1999; 44:163-8. [PMID: 10619500 DOI: 10.1023/a:1006399804896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To evaluate whether vigorous treatment is beneficial for patients with meningeal gliomatosis (MG) we reviewed the case records of 20 consecutive patients treated for a symptomatic MG in our center. All received systemic or intrathecal chemotherapy and six received additional cranial or spinal radiotherapy. Six patients (30%) achieved a partial response (one low-grade astrocytoma, two anaplastic astrocytomas, one anaplastic oligodendroglioma and two glioblastomas). In these cases, clinical improvement was associated with radiological improvement on CT scan or MRI in five and with a major cerebrospinal fluid improvement in three. Three patients (15%) were stable for 3 months or more and 11 (55%) had progressive disease. Median survival was longer for the responding patients (10 months) than for the other patients (2 months). This study suggests that some patients with MG may benefit from a treatment combining radiotherapy to symptomatic areas and chemotherapy with agents that cross the blood-brain barrier or are delivered directly into the CSF.
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Affiliation(s)
- P F Pradat
- Department of Neurology, Hôpital de la Salpêtrière, Paris, France
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Abstract
Leptomeningeal gliomatosis is a primary glioma residing mainly in the leptomeninges. We describe a rare case of diffuse leptomeningeal glioma, occurring in a six year old girl, in which the morphological features of the cellular infiltrates were those of an oligodendroglioma. To our knowledge, this is the fifth case of diffuse oligodendrogliomatosis reported in the English language literature.
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Affiliation(s)
- H K Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong.
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Singh M, Corboy JR, Stears JC, Kleinschmidt-DeMasters BK. Diffuse leptomeningeal gliomatosis associated with multifocal CNS infarcts. SURGICAL NEUROLOGY 1998; 50:356-62; discussion 362. [PMID: 9817460 DOI: 10.1016/s0090-3019(97)00371-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Widespread dissemination of astrocytoma throughout the cerebrospinal fluid is unusual, especially as the initial presentation in a patient, and association with cerebral infarcts is rare. CASE DESCRIPTION A 47-year-old man subacutely developed progressive headache and backache, vomiting, altered consciousness, and numbness in both arms. Brain computerized axial tomography showed calcification in the fourth ventricle and magnetic resonance imaging demonstrated diffuse meningeal enhancement, a lesion in the canal of Magendie, and T2-weighted hyperintense lesions in several locations. Angiography showed vasospasm/vasculopathy involving multiple cerebral vessels. Biopsy of the fourth ventricular mass revealed a subependymoma with an overlying leptomeningeal anaplastic astrocytoma with numerous Rosenthal fibers. The patient was treated with three doses of intrathecal methotrexate via lumbar puncture but suddenly became unresponsive and died 6 days later, 8 weeks after initial symptoms. Autopsy demonstrated the subependymoma and a widespread leptomeningeal anaplastic astrocytoma, which showed no clear-cut origin from the subependymoma, but microscopically infiltrated the left medial temporal lobe. Multiple subacute and acute infarcts of the brain, brain stem, and upper spinal cord were seen only in areas with leptomeningeal tumor. CONCLUSION Glioma cells surrounding and focally permeating central nervous system vessels without lumenal occlusion can lead to vasospasm and widespread infarcts.
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Affiliation(s)
- M Singh
- Department of Pathology, University of Colorado Health Sciences Center, Denver 80262, USA
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Abstract
Gliomas very rarely arise from the leptomeninges. They can be both solitary and diffuse, and histological examination reveals mostly astrocytic tumors. The authors report a case (the 12th reported in the literature) of a solitary primary glioma of the leptomeninges in a 79-year-old man who presented with repeated seizures. A magnetic resonance image revealed an ill-defined enhancing lesion in the cerebral meninges. Autopsy examination showed a poorly demarcated astrocytoma in the sylvian fissure infiltrating the adjacent subarachnoid space. The literature concerning primary leptomeningeal glioma is reviewed.
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Affiliation(s)
- H K Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong
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25
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Abstract
The authors describe a case of a diffuse primary leptomeningeal oligodendroglioma in a 17-year-old girl who presented with raised intracranial pressure and hydrocephalus. She underwent imaging studies and a left frontotemporal craniotomy that revealed a cystic oligodendroglioma in the suprasellar cistern and spread of neoplastic cells to the spinal leptomeninges. The tumor showed little response to maximum radiotherapy and chemotherapy, and the patient died from complications of high-dose chemotherapy 2 years after diagnosis. Postmortem examination of the brain and spinal cord revealed diffuse meningeal infiltration by neoplastic cells and no evidence of an intraparenchymal origin. Glial heterotopias were noted at several sites along the brain base, adding circumstantial support to the theory that leptomeningeal gliomas are derived from ectopic glial tissue in the subarachnoid space.
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Affiliation(s)
- R Chen
- Department of Clinical Neurological Sciences, Victoria Hospital, University of Western Ontario, Canada
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26
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Affiliation(s)
- S L Berg
- Department of Pediatrics, Texas Children's Hospital, Houston, USA
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27
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Jones HR, Edgar MA. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 8-1995. A 75-year-old man with multiple cranial-nerve defects and weakness and pain in the extremities. N Engl J Med 1995; 332:730-7. [PMID: 7854382 DOI: 10.1056/nejm199503163321108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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28
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Giordana MT, Bradac GB, Pagni CA, Marino S, Attanasio A. Primary diffuse leptomeningeal gliomatosis with anaplastic features. Acta Neurochir (Wien) 1995; 132:154-9. [PMID: 7754854 DOI: 10.1007/bf01404866] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of primary diffuse leptomeningeal gliomatosis with anaplastic features, diagnosed during life and confirmed at autopsy, is presented. The clinical, radiological and pathological features are compared with those of the very few cases reported in the literature. Early papilloedema and hydrocephalus were followed by spinal and cranial nerve palsies. The NMR images and the tissue biopsy turned out to be useful for reaching an in vivo diagnosis. While in the previously reported cases the glial proliferation was microscopically a slow growing astrocytoma, the present case was histologically malignant and had a high labelling index (LIs) for proliferation markers (PCNA and KI-67). The high growth rate and the wide diffusion of the tumour at presentation may account for the poor prognosis of diffuse leptomeningeal gliomatosis and the inefficacy of radiotherapy and chemotherapy. The presence of basal lamina arount tumour cells and the immunohistochemical distribution of the proliferation markers are consistent with the origin of primary leptomeningeal gliomatosis from ectopic glia.
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Affiliation(s)
- M T Giordana
- Department of Neurology, University of Turin, Italy
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29
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Vahedi K, Ameri A, Poisson M. Frontal oligo-astrocytoma with orbito-ethmoidal involvement. J Neurooncol 1993; 17:159-60. [PMID: 8145059 DOI: 10.1007/bf01050218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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