Atypical imaging in a desmoplastic non-infantile astrocytoma

Progression and diagnostic challenges of desmoplastic infantile ganglioglioma in a non-infant: a case report with 5-year follow-up

Desmoplastic infantile ganglioglioma (DIG) is a rare intracranial benign tumor occurring in infants under 2 years of age. It has good biological and behavioral characteristics and occasionally has malignant characteristics, such as multiple intracranial lesions, postoperative progression or recurrence, meningeal diffusion, and metastasis. We present a non-infant with DIG who underwent tumor progression. A 16-year-old girl presented with DIG in the cerebral cistern and underwent subtotal resection. A magnetic resonance imaging (MRI) of the brain 2 years later revealed that the area of abnormal enhancement in the surgical site was approximately the same as before, and follow-up was continued. A reexamination 5 years later showed that the residual extent of the operative area was significantly larger than before and involved the right frontal and temporal lobes, considering the progression of the residual part of the tumor. This case report focuses on the occurrence of DIG and its potential malignant features, as assessed through magnetic resonance imaging.

Infantile and Noninfantile Desmoplastic Astrocytoma and Ganglioglioma: Only Different Age of Onset?

OBJECTIVE

The purpose of this study was to investigate clinical, pathological, and prognostic discrepancies between infantile and noninfantile desmoplastic astrocytoma/ganglioglioma patients.

METHODS

From January 2012 to December 2019, we retrospectively reviewed patients aged <18 years who underwent craniotomies at Beijing Tiantan Hospital. Patients diagnosed with desmoplastic infantile astrocytoma and ganglioglioma (DIA/DIG) were included.

RESULTS

The group consisted of 9 infantile patients and 8 noninfantile patients. The mean age of onset was 30.11 months in infantile patients and 103.75 months in noninfantile patients. Comparing with infantile patients, noninfantile patients had a mild female predominance (P = 0.335). The most common presentation in noninfantile patients was seizure (n = 4, 50%), whereas abnormal head circumference (n = 3, 33.3%) was the most common presentation in the infantile group. All cases showed a ki-67 index <2%. Preoperative tumor volume in infantile patients (213.98 cm³) was larger than that in noninfantile patients (21.99 cm³) (P = 0.043). Gross total resection was achieved in 5 (55.6%) infantile patients and 6 (75%) noninfantile patients (P = 0.62). All patients are alive by last follow-up visit, and 1 infantile patient recurred 8 months postoperative.

CONCLUSIONS

Infantile and noninfantile patients with DIA/DIGs share similar clinical and histopathological features. Compared with infantile patients, noninfantile patients tend to have different symptom predominance. Lesions in noninfantile patients are prone to present with different cystic-solid patterns and smaller volume. Patients with DIA/DIGs have favorable prognosis regardless of extent of resection.

Mixed Solid and Cystic Mass in an Infant

Desmoplastic infantile tumors are rare supratentorial brain tumors that occur in pediatric patients. Desmoplastic infantile tumors are made up of 2 subtypes: desmoplastic infantile gangliogliomas and desmoplastic infantile astrocytomas. Desmoplastic infantile tumors are often identifiable on imaging on the basis of multiple characteristics. Nevertheless, pathologic analysis is required to confirm the diagnosis, particularly when the imaging features are atypical. Here, the radiology findings, surgical approach and subsequent management, and pathology of a desmoplastic infantile ganglioglioma are described.