Rosette-forming glioneuronal tumor originating in the hypothalamus

Gamma knife radiosurgery for a rare Rosette-forming glioneuronal tumor in the brainstem region: A case report and literature review

RATIONALE

Rosette-forming glioneuronal tumor (RGNT) is a rare primary nervous system tumor, with limited treatment guidelines due to its rarity, especially in the brainstem. This report presents a unique case of brainstem RGNT treated with gamma knife radiosurgery (GKRS).

PATIENT CONCERNS

A 35-year-old woman sought medical attention after sudden syncope and rapid decline in consciousness. Magnetic resonance imaging revealed a mass in the pineal region, extending to the brainstem and thalamus. Due to the critical location, only partial resection of the pineal tumor was possible, leaving most of the residual tumor in the vital brainstem area, requiring urgent intervention to control its growth and prevent sudden complications.

DIAGNOSES

Postoperative histopathological results confirmed a diagnosis of RGNT.

INTERVENTIONS

The patient underwent 25 Gy/5 fractions of GKRS using the frameless Gamma Knife ICON™ (Elekta) device, as confirmed by cone-beam computed tomography scans for precise dose distribution and patient alignment.

OUTCOMES

GKRS was performed successfully and safely. The tumor significantly shrank 3 months post-GKRS, and the patient experienced symptom relief without any adverse effects.

LESSONS

GKRS is considered an effective modality for RGNT in high-risk brainstem areas, minimizing risks while controlling tumor growth and alleviating symptoms. In addition, the frameless Gamma Knife ICON™ device enhanced patient comfort and treatment precision. GKRS offers a noninvasive alternative for similar RGNT cases.

Rosette-Forming Glioneuronal Tumor Mimicking Foramen Monro Colloid Cyst: Case Presentation and Systematic Literature Review

BACKGROUND

Rosette-forming glioneuronal tumors (RGNTs) are rare indolent and benign tumors, typically associated with the fourth ventricle. Cases in the third ventricle are less common, especially those involving only the anterior part.

METHODS

A literature review using "rosette-forming glioneuronal tumor" on PubMed yielded 176 articles from 2002 to 2024. Articles excluding third ventricle RGNTs were omitted, with titles and abstracts screened for relevance. We also present our case of an anterior third ventricle RGNT, tracking from initial presentation to follow-up.

RESULTS

Our patient, a 62-year-old woman, experienced 3 months of recurrent Hakim Triad symptoms-gait instability, urinary incontinence, and cognitive issues. Magnetic resonance imaging revealed a 1.0 × 0.7 cm mass, hypointense on T1-weighted imaging and heterogeneous on T2-weighted imaging, initially suspected as a colloid cyst. Given its high colloid cyst risk score, surgery was performed, but histopathology confirmed an RGNT diagnosis. To date, this is the first case of exclusive anterior third ventricle RGNT microsurgery reported, with 26 months of recurrence-free follow-up. Our literature review identified 20 articles detailing 23 cases of third ventricle RGNT, with only 7 achieving gross total resection, while most underwent biopsy and ventriculostomy.

CONCLUSIONS

RGNTs in the anterior third ventricle may resemble other tumor types, requiring careful monitoring. This case is significant due to the patient's clinical presentation, imaging, and extended recurrence-free follow-up.

Rosette-forming glioneuronal tumor of the fourth ventricle; A case report and review of the literature

Despite mostly indolent course and favorable postoperative outcome long-term follow-up studies are needed to identify the most appropriate therapeutic strategies to minimize surgical morbidity and neurologic injury in patients with RGNT.

A case of a rosette-forming glioneuronal tumor with clinicopathological features of a dysembryoplastic neuroepithelial tumor and fibroblast growth factor receptor 1 internal tandem duplication

Rosette-forming glioneuronal tumors (RGNTs) are benign WHO grade 1 tumors that occur in the ventricular system, particularly the fourth ventricle. RGNTs and dysembryoplastic neuroepithelial tumors (DNTs) are both categorized as neuronal and mixed neuronal-glial tumors and may be difficult to distinguish. Coexistence of the two tumor types has been reported. Here, we report a pediatric case of RGNT with DNT-like features showing intraventricular dissemination. The tumor occurred in the medial temporal lobe and presented with specific pathological glioneuronal elements including floating neurons, which are typical in DNTs, but was diagnosed as RGNT because of the presence of neurocytic rosettes. Genetic analysis detected fibroblast growth factor receptor 1 internal tandem duplication (FGFR1-ITD) of the tyrosine kinase domain, which was previously reported to be specific for DNT. RGNTs with FGFR1-ITD may show atypical clinical presentation and pathological features.

Rosette-forming Glioneuronal Tumor in the Optic Pathway of a Child

Rosette-forming glioneuronal tumor is a rare World Health Organization grade I neoplasm, primarily involving the posterior fossa. Most cases have been reported in young adults. Although maximal surgical resection is advocated, a precise treatment modality is yet to be established. We describe an unusual presentation of rosette-forming glioneuronal tumor occurring in the optic pathway in a child. As the site of the tumor was not amenable to resection, he underwent radiotherapy and is currently well on follow-up.

Rosette-forming glioneuronal tumor: an illustrative case and a systematic review

Background

Rosette-forming glioneuronal tumors (RGNTs) are rare, low-grade, primary CNS tumors first described in 2002 by Komori et al. RGNTs were initially characterized as a World Health Organization (WHO) grade I tumors typically localized to the fourth ventricle. Although commonly associated with an indolent course, RGNTs have the potential for aggressive behavior.

Methods

A comprehensive search of PubMed and Web of Science was performed through November 2019 using the search term “rosette-forming glioneuronal tumor.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. English, full-text case reports and series with histopathological confirmation were included. Patient demographics, presentations, MRI features, tumor location, treatment, and follow-up of all 130 cases were extracted.

Results

A 19-year-old man with a history of epilepsy and autism presented with acute hydrocephalus. MRI scans from 2013 to 2016 demonstrated unchanged abnormal areas of cortex in the left temporal lobe with extension into the deep gray-white matter. On presentation to our clinic in 2019, the lesion demonstrated significant progression. The patient’s tumor was identified as RGNT, WHO grade I. One hundred thirty patients were identified across 80 studies.

Conclusion

RGNT has potential to transform from an indolent tumor to a tumor with more aggressive behavior. The results of our systematic review provide insight into the natural history and treatment outcomes of these rare tumors.

Dysembryoplastic neuroepithelial tumor presenting as a hypothalamic hamartoma in a child with gelastic seizures: case report

Dysembryoplastic neuroepithelial tumors (DNETs) are benign intracranial tumors of neuroglial origin, mostly located in the supratentorial regions and particularly in the temporal lobe. Few cases of DNETs in the hypothalamus have been described. The authors present the case of a DNET in the hypothalamus. The 5-year-old girl with complaints of limb and gelastic seizures was admitted to the neurosurgical department of Xiangya Hospital. Neurological examination findings were unremarkable. MRI showed isointensity without significant enhancement on T1- and T2-weighted images. The lesion exhibited clearly defined borders on the sagittal, coronal, and axial images. The preliminary diagnosis was hypothalamic hamartoma (HH); however, the lesion was surgically removed, and histopathological examination confirmed the diagnosis of a DNET. Hypothalamic DNETs are extremely rare. Based on their clinical manifestation and imaging, DNETs are easily misdiagnosed as HHs. Diagnoses apart from HHs must be entertained when a hypothalamic lesion is being investigated.

Rosette-Forming Glioneuronal Tumor of the Fourth Ventricle in Children: Case Report and Literature Review

BACKGROUND

Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare World Health Organization (WHO) grade I neoplasm. Gross total resection (GTR) is the treatment of choice, and there is no firm evidence supporting other treatment options when GTR is not feasible.

CASE DESCRIPTION

We report a 6-year-old boy who, following an initial subtotal resection of a fourth ventricular RGNT, received an individualized chemotherapy protocol with vincristine, etoposide, and carboplatin for 3 cycles. The tumor was stable for 2 years after the completion of chemotherapy but then began to progress, at which point GTR was successfully performed. In addition, we completed a comprehensive literature review of RGNT cases. To date, a total of 104 cases have been reported, 33 of which are pediatric cases. Recurrence has been reported in only 7 cases of all ages (4 in the pediatric population). Radiotherapy has been used in several cases, but adjuvant chemotherapy has been reported only once following a recurrence.

CONCLUSIONS

We report a case of chemotherapy administration as a first-line treatment for a subtotally resected RGNT. Chemotherapy may be considered as an adjuvant therapy option for RGNT when GTR cannot be achieved. Furthermore, increased incidence of recurrence in the pediatric population may suggest that the tumor biology of RGNT in children differs from that in adults.

Rosette-forming glioneuronal tumor outside the fourth ventricle: a case-based update

INTRODUCTION

Rosette-forming glioneuronal tumors (RGNTs) that do not involve the fourth ventricle are rare. RGNTs were originally thought to be exclusively localized into the fourth ventricle but were found in various anatomical localizations.

MATERIAL AND METHODS

We review the literature and found 32 cases of this particular RGNT. The outcome was excellent with no mortality reported after surgical treatment. Only two patients had received adjuvant therapy for progression. We added one case of a RGNT located in the cerebellar hemisphere.

CASE AND CONCLUSION

She underwent a subtotal removal with no evidence of progression after. This WHO grade I tumor with a specific biphasic histopathology is of a good oncological outcome after surgical treatment. A long follow-up is needed as recurrence or metastatic progressions exist.