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Cockle JV, Corley EA, Zebian B, Hettige S, Vaidya SJ, Angelini P, Stone J, Leitch RJ, Albanese A, Mandeville HC, Carceller F, Marshall LV. Novel therapeutic approaches for pediatric diencephalic tumors: improving functional outcomes. Front Oncol 2023; 13:1178553. [PMID: 37886179 PMCID: PMC10598386 DOI: 10.3389/fonc.2023.1178553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/06/2023] [Indexed: 10/28/2023] Open
Abstract
Pediatric diencephalic tumors represent a histopathologically and molecularly diverse group of neoplasms arising in the central part of the brain and involving eloquent structures, including the hypothalamic-pituitary axis (HPA), optic pathway, thalamus, and pineal gland. Presenting symptoms can include significant neurological, endocrine, or visual manifestations which may be exacerbated by injudicious intervention. Upfront multidisciplinary assessment and coordinated management is crucial from the outset to ensure best short- and long-term functional outcomes. In this review we discuss the clinical and pathological features of the neoplastic entities arising in this location, and their management. We emphasize a clear move towards 'function preserving' diagnostic and therapeutic approaches with novel toxicity-sparing strategies, including targeted therapies.
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Affiliation(s)
- Julia V. Cockle
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Elizabeth A. Corley
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, Kings College Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - Samantha Hettige
- Atkinson Morley Neurosurgery Centre, St George’s University Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sucheta J. Vaidya
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paola Angelini
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Joanna Stone
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - R Jane Leitch
- Department of Ophthalmology, Epsom and St Hellier University Hospitals Trust, Carshalton, United Kingdom
| | - Assunta Albanese
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Pediatric Endocrinology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Henry C. Mandeville
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Fernando Carceller
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Lynley V. Marshall
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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La Spina M, Caruso M, Gulizia C, Comella M, Soma R, Meli M, Samperi P, Bertuna G, Di Cataldo A, Russo G. Diencephalic Syndrome: Misleading Clinical Onset of Low-Grade Glioma. Curr Oncol 2023; 30:8401-8410. [PMID: 37754525 PMCID: PMC10529672 DOI: 10.3390/curroncol30090610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Diencephalic Syndrome is an atypical early manifestation of low-grade gliomas; so, it is important to detect it in patients that experience a failure to thrive despite adequate length growth and food intake. The purpose of this article is to focus attention on this rare but potentially dangerous cause of poor weight gain or stunting in childhood. MATERIALS AND METHODS We describe four patients with Diencephalic Syndrome and low-grade gliomas who were evaluated in our institution from January 2017 to December 2021. CASE DESCRIPTION AND RESULTS two patients presented with suspected malabsorption, and two presented with a suspected eating disorder. In all cases, neurological symptoms appeared late, explaining the reason for the diagnostic delay, which impacts negatively on prognosis and on quality of life. Currently, patients 1 and 2 have stable disease in second-line therapy, patient 3 has stable disease post end of second-line therapy, and patient 4 has stable disease in first-line therapy. Everyone is in psychophysical rehabilitation. CONCLUSIONS A multidisciplinary evaluation is essential in order to make an early diagnosis and improve prognosis and quality of life.
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Affiliation(s)
- Milena La Spina
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Manuela Caruso
- Pediatric Endocrinology and Diabetology Center, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Carmela Gulizia
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Mattia Comella
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Rachele Soma
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Mariaclaudia Meli
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Piera Samperi
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Gregoria Bertuna
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.L.S.); (C.G.); (M.C.); (R.S.); (M.M.); (P.S.); (G.B.); (A.D.C.)
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Baeesa S, Maghrabi Y, Moshref R, Al-Maghrabi J. Optic Pathway–Hypothalamic Glioma Apoplexy: A Report of Two Cases and Systematic Review of the Literature. Front Surg 2022; 9:891556. [PMID: 35733436 PMCID: PMC9208329 DOI: 10.3389/fsurg.2022.891556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hemorrhage into optic pathway–hypothalamic glioma (OPHG) is rare. Variable clinical presentations and outcomes are associated with such pathology. We aim to present two infants presented with OPHG and a systematic review of the literature. Methods We describe two cases of infants presenting with sudden decreased vision, poor feeding, and irritability due to OPHG. Both patients underwent urgent craniotomy and subtotal resection followed by chemotherapy. We systematically reviewed the literature using PubMed, Google Scholar, and Embase. In addition, we included all English published reports for all ages discussing the optic pathway (optic nerve and optic chiasm) or hypothalamic glioma associated with hemorrhage from the year of the first reported case (1970) to January 2022. Results Of 17,949, 44 articles met the inclusion criteria of this review. A total of 56 cases were described with a mean of 21.35 years (0.5–70), with the male gender 52% and the female gender 45%. The hemorrhage location was sellar/suprasellar in 43% cases. Histopathology of included cases was pilocytic astrocytoma in 41%, followed by pilomyxoid astrocytoma in 16% cases. The outcome was unfavorable; 37.5% cases showed improvement, whereas 18% cases resulted in death. Conclusion Apoplexy of the OPHG can be fatal and associated with poor outcomes. A systematic review of the literature has shown that younger age, pilocytic or pilomexyoid astrocytoma histopathology, and chiasmal/hypothalamic locations are associated with a higher risk of intertumoral hemorrhage and poor prognosis. Further genetic studies for OPHG may provide information for high-risk patients.
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Affiliation(s)
- Saleh Baeesa
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Correspondence: Saleh Baeesa
| | - Yazid Maghrabi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rana Moshref
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Jaudah Al-Maghrabi
- Department of Pathology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Bizzarri C, Bottaro G. Endocrine implications of neurofibromatosis 1 in childhood. Horm Res Paediatr 2016; 83:232-41. [PMID: 25659607 DOI: 10.1159/000369802] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/07/2014] [Indexed: 11/19/2022] Open
Abstract
In 1882, von Recklinghausen described a group of patients with multiple tumors arising from the 'endoneurium' of peripheral nerves, and called them 'neurofibromas'. The term von Recklinghausen disease was used up to the end of the 20th century, when the gene of neurofibromatosis (NF1) was cloned on chromosome 17q11.2. The gene product is a cytoplasmic protein termed neurofibromin, regulating proliferation and maturation of both glial and neuronal progenitors during embryogenesis. Loss of neurofibromin function determines the hyperactivation of the proto-oncogene RAS, leading to an increased risk of tumor formation, predominantly affecting the skin, bone and the nervous system. NF1 is clinically and genetically distinct from neurofibromatosis type 2, characterized by bilateral vestibular schwannomas and other nervous system tumors. An increased incidence of central precocious puberty, diencephalic syndrome, GH deficiency and GH hypersecretion has been described in NF1 children. These conditions are commonly complications of optic pathway gliomas (OPG) involving the hypothalamic and sellar region. Nevertheless, these endocrine disorders have been observed also in children without evidence of OPG at magnetic resonance imaging. Clinical and laboratory follow-up is crucial in all children with NF1, particularly in those with an OPG, aiming at the early identification of signs suggestive of secondary endocrine alterations.
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Affiliation(s)
- Carla Bizzarri
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Rome, Italy
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Patni N, Alves C, von Schnurbein J, Wabitsch M, Tannin G, Rakheja D, Garg A. A Novel Syndrome of Generalized Lipodystrophy Associated With Pilocytic Astrocytoma. J Clin Endocrinol Metab 2015; 100:3603-6. [PMID: 26252356 PMCID: PMC4596037 DOI: 10.1210/jc.2015-2476] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A rare presentation of hypothalamic tumors in infants and young children is profound emaciation and generalized loss of sc adipose tissue, also known as "diencephalic syndrome." Similar loss of sc fat can be observed in children with acquired generalized lipodystrophy or congenital generalized lipodystrophy. Precise diagnosis may be challenging early in the course of the disease, especially in the absence of metabolic abnormalities. CASE DESCRIPTION We report three males who presented with poor weight gain and generalized loss of sc fat at birth to 3 years of age consistent with generalized lipodystrophy, with subsequent development of pilocytic astrocytoma. Two of them had hypothalamic tumors, and one had a multicentric tumor with a large right parietal mass. Our patients are unique because the onset of lipodystrophy occurred 2.5 to 7.3 years before the diagnosis of brain tumor, and all of them gained body fat or weight after surgical removal and/or chemotherapy. One patient had hepatosplenomegaly and impaired glucose tolerance, and another patient had severe hyperglycemia and hypertriglyceridemia during the course of the disease. Two patients presented with central precocious puberty and advanced bone age at the chronological age of 6 years. CONCLUSIONS It is likely that pilocytic astrocytoma may induce generalized lipodystrophy by paraneoplastic antiadipocyte antibody formation or by excessive hormones or cytokine secretion resulting in excess lipolysis from adipocytes. We conclude that young children presenting with idiopathic acquired generalized lipodystrophy or atypical congenital generalized lipodystrophy, with or without metabolic abnormalities, should prompt investigation for brain tumors.
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Affiliation(s)
- Nivedita Patni
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Crésio Alves
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Julia von Schnurbein
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Martin Wabitsch
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Grace Tannin
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Dinesh Rakheja
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
| | - Abhimanyu Garg
- Division of Pediatric Endocrinology (N.P., G.T.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390; Hospital Universitario Prof. Edgard Santos (C.A.), Pediatric Endocrinology Unit, Faculty of Medicine Federal University of Bahia, 401157-190 Salvador, Bahia, Brazil; Division of Pediatric Endocrinology and Diabetes (J.v.S., M.W.), Department of Pediatrics and Adolescent Medicine, University of Ulm, 89075 Ulm, Germany; and Departments of Pathology and Pediatrics (D.R.), and Division of Nutrition and Metabolic Diseases, Department of Internal Medicine (A.G.), UT Southwestern Medical Center, Dallas, Texas 75390
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Bergthold G, Bandopadhayay P, Bi WL, Ramkissoon L, Stiles C, Segal RA, Beroukhim R, Ligon KL, Grill J, Kieran MW. Pediatric low-grade gliomas: how modern biology reshapes the clinical field. Biochim Biophys Acta Rev Cancer 2014; 1845:294-307. [PMID: 24589977 DOI: 10.1016/j.bbcan.2014.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/20/2014] [Indexed: 12/17/2022]
Abstract
Low-grade gliomas represent the most frequent brain tumors arising during childhood. They are characterized by a broad and heterogeneous group of tumors that are currently classified by the WHO according to their morphological appearance. Here we review the clinical features of these tumors, current therapeutic strategies and the recent discovery of genomic alterations characteristic to these tumors. We further explore how these recent biological findings stand to transform the treatment for these tumors and impact the diagnostic criteria for pediatric low-grade gliomas.
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Affiliation(s)
| | - Pratiti Bandopadhayay
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lori Ramkissoon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles Stiles
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rosalind A Segal
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Rameen Beroukhim
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jacques Grill
- Departement de Cancerologie de l'enfant et de l'adolescent, Gustave Roussy and Unité Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Université Paris-Sud, Villejuif, France
| | - Mark W Kieran
- Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Diencephalic syndrome as sign of tumor progression in a child with neurofibromatosis type 1 and optic pathway glioma: a case report. Childs Nerv Syst 2013; 29:1941-5. [PMID: 23615855 DOI: 10.1007/s00381-013-2109-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
ILLUSTRATIVE CASE We describe the case of a 3-year-old child, diagnosed with familial neurofibromatosis type 1 (NF1) and asymptomatic optic pathway tumor at the age of two, who developed diencephalic syndrome (DS) due to tumor progression 1 year after diagnosis. Magnetic resonance imaging disclosed an enlarging hypothalamic contrast-enhanced mass. Because of the tumor progression, in terms of tumor volume and DS, chemotherapy (CT) treatment was started according to the international protocol for progressive low-grade glioma, with rapid clinical improvement in terms of gain weight and DS resolution. Interestingly, tumor volume was unchanged after CT. CONCLUSIONS This case report highlights the following facts: (1) optic pathway glioma (OPG) in young children with NF1 may have definitive growth potentials and thus, they are worth an accurate clinical follow-up; (2) also, OPG occurring in NF1 patients can be responsible for DS in case of hypothalamus involvement; (3) consequently, the child's growth pattern must be included among the clinical parameters, which must be specifically evaluated during the follow-up of children, with or without NF1, bearing an OPG; and, finally, (4) that DS can improve after CT, even in face of a stable tumor volume.
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Abstract
OBJETIVO: Avaliar a prevalência de desnutrição entre crianças com tumores sólidos em tratamento num centro oncológico brasileiro. MÉTODOS: Foram avaliados 44 pacientes durante o primeiro mês de tratamento, por meio de medidas antropométricas e, de acordo com recomendações da Organização Mundial de Saúde, seguindo os escores-Z de peso/idade, estatura/idade e peso/estatura para o diagnóstico nutricional. RESULTADOS: De acordo com os escores-Z de peso/idade, estatura/idade e peso/estatura, encontramos, respectivamente, 16%, 7% e 16% de desnutrição entre as 44 crianças. De acordo com os diagnósticos de câncer, 27% dos portadores de tumores cerebrais, 25% dos pacientes com neuroblastomas e 11% com tumores de Wilms, apresentaram desnutrição energético-protéica. CONCLUSÃO: Há uma elevada prevalência de desnutrição na população estudada, que pode estar relacionada à doença, ao tratamento e aos fatores socioeconômicos, como também à falta de um protocolo nutricional para identificar e tratar precocemente a desnutrição em crianças com tumores sólidos.
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Miyoshi Y, Yunoki M, Yano A, Nishimoto K. Diencephalic Syndrome of Emaciation in an Adult Associated with a Third Ventricle Intrinsic Craniopharyngioma: Case Report. Neurosurgery 2003. [DOI: 10.1227/00006123-200301000-00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Miyoshi Y, Yunoki M, Yano A, Nishimoto K. Diencephalic syndrome of emaciation in an adult associated with a third ventricle intrinsic craniopharyngioma: case report. Neurosurgery 2003; 52:224-7; discussion 227. [PMID: 12493122 DOI: 10.1097/00006123-200301000-00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Accepted: 09/06/2002] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Diencephalic syndrome of emaciation (DS) is seen almost exclusively in infants and young children, and only two cases of DS in adults have been reported previously. We describe a case of DS associated with a third ventricle intrinsic craniopharyngioma in an adult patient. CLINICAL PRESENTATION A 54-year-old man presented with profound emaciation, disorientation, memory loss, and psychological disorders. Computed tomographic scanning and magnetic resonance imaging of his brain disclosed a tumor within the third ventricle. The preoperative endocrinological examination indicated an elevated growth hormone level and a decreased somatomedin C level. INTERVENTION The patient underwent partial resection of the tumor, which was adherent to the floor of the third ventricle but not to the ventricle wall, by an interhemispheric-transcallosal approach. The histological examination revealed a squamous papillary-type craniopharyngioma. The patient received 50 Gy of radiotherapy, which resulted in 90 to 95% reduction of the tumor size within 6 months, as indicated by the magnetic resonance images presented. The psychological disorders, memory disturbance, and severe emaciation improved gradually thereafter. CONCLUSION Although extremely rare, DS can occur in an adult harboring a tumor in the anterior hypothalamus.
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Affiliation(s)
- Yasuyuki Miyoshi
- Department of Neurological Surgery, Sumitomo Besshi Hospital, Niihama, Japan.
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Squires LA, Thomas S, Betz BW, Cottingham S. Vein of Galen malformation with diencephalic syndrome: a clinical pathologic report. J Child Neurol 1998; 13:575-7. [PMID: 9853653 DOI: 10.1177/088307389801301110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A vein of Galen malformation is a dural extracranial vascular anomaly resulting in direct arteriovenous fistulae between the choroid or quadrigeminal arteries and an overlying single venous sac. The disorder can be identified on prenatal ultrasound examination and presents with macrocrania, with or without congestive heart failure, or cranial bruit. Therapeutic measures have included surgical clipping of feeding arteries and transarterial placement of wire, coils, or "bird cages. "2 Recently, newer endovascular techniques involving both a transarterial and transvenous approach have been promising. Prognosis for infants with the disorder remains poor, although improved with new endovascular techniques. Morbidity and mortality have improved to approximately 40% with mild to severe neurologic deficits.3 One cause of significant pre- and posttreatment morbidity might be the presence of vascular steal leading to visual deterioration, seizures, and signs of parenchymal loss, at times with striking progression. 4 The diencephalic syndrome of emaciation or failure to gain weight in an infant with extreme irritability or euphoria has not been reported previously with the vein of Galen malformation and is usually associated with a hypothalamic or chiasmatic glioma.
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Affiliation(s)
- L A Squires
- DeVos Children's Hospital at Butterworth, Grand Rapids, MI, USA
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Shuper A, Bloch I, Kornreich L, Horev G, Michowitz S, Zaizov R, Cohen I. Successful chemotherapeutic treatment of diencephalic syndrome with continued tumor presence. Pediatr Hematol Oncol 1996; 13:443-9. [PMID: 10897816 DOI: 10.3109/08880019609030856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 7-month-old infant with typical features of diencephalic syndrome (DES) associated with a hypothalamic mass, most probably a glioma, was treated with chemotherapy. The tumor showed clear shrinkage, but after more than 2 years regrowth was noted. During the treatment period the child regained normal growth and became free of symptoms. As radiation therapy, especially at a young age, has significant adverse effects and a neurosurgical approach to the diencephalic region also has the potential to cause significant sequelae, a chemotherapeutic option, when it exists, is preferred. Thus, in an infant in whom a glioma is suspected to be the cause of the DES, based on the clinical picture and the neuroimaging appearance, chemotherapy should be considered the primary therapeutic modality. Even if its effect is temporary, its use is well justified. The most appropriate treatment protocol still needs to be determined.
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Affiliation(s)
- A Shuper
- National Center for Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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Tanabe M, Watanabe T, Hori T. von Recklinghausen's disease with diencephalic syndrome in an adult. Case report. J Neurosurg 1994; 80:556-8. [PMID: 8113871 DOI: 10.3171/jns.1994.80.3.0556] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The case of a 39-year-old man with von Recklinghausen's disease, presenting with emaciation and a marked increase in serum growth hormone concentration, is presented. Neuroradiological and histological examination confirmed anaplastic astrocytoma in the optic chiasm-hypothalamic region. This is a rare case of diencephalic syndrome and von Recklinghausen's occurring together in an adult.
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Affiliation(s)
- M Tanabe
- Division of Neurosurgery, Tottori University, Yonago, Japan
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Vlachopapadopoulou E, Tracey KJ, Capella M, Gilker C, Matthews DE. Increased energy expenditure in a patient with diencephalic syndrome. J Pediatr 1993; 122:922-4. [PMID: 8501572 DOI: 10.1016/s0022-3476(09)90021-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Total energy expenditure, measured in an infant with diencephalic syndrome with doubly labeled water, was 30% to 50% higher than that reported for other healthy infants whose energy expenditure was measured by the same technique and 13% higher than the patient's energy intake. This result suggests that the weight loss and cachexia of the diencephalic syndrome are the result of abnormally increased energy expenditure.
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Affiliation(s)
- E Vlachopapadopoulou
- Department of Pediatrics, New York Hospital-Cornell University Medical Center, New York
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Abstract
Tumors of the hypothalamus present with a variety of clinical syndromes. Such syndromes appear to be both age and histology dependent. The diencephalic syndrome, an entity classically seen in infancy, presents as failure to thrive. In essentially all cases the pathologic substrate is a tumor with a predominance of gliomas. The traditional approach to treatment of the diencephalic syndrome has been surgery both for decompression and pathologic diagnosis followed by irradiation. Because of the tumor location, surgery is often confined to biopsy rather than radical extirpation. Furthermore, in infancy focal brain irradiation is not without significant morbidity. Within this context, we would like to present a case discussion regarding a 27-month-old boy with a hypothalamic-midbrain protoplasmic glioma treated with primary chemotherapy after surgical biopsy and pathologic documentation. The schedule of drugs utilized was based on the hypothesis of biochemical modulation of nitrosourea chemotherapy. Successful response to therapy was documented by sequential computed tomography (CT) studies and serial neurologic examinations beginning at age 5 months and every 2 months thereafter. The response of a single patient with the diencephalic syndrome treated primarily with chemotherapy makes extrapolation premature. Rather, the authors suggest chemotherapy as an alternative to focal brain irradiation. Such therapy could be utilized either in the event of recurrent tumor or as late consolidation after primary treatment with chemotherapy. The latter approach would allow a patient to have radiation therapy deferred until a later age at which time morbidity attending brain irradiation may be minimized.
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Affiliation(s)
- M C Chamberlain
- Department of Neurosciences, University of California, San Diego 92103
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de Castro EM, Silva IN, Perpétuo FO. [Russel's syndrome. Report of a case with development of precocious puberty]. ARQUIVOS DE NEURO-PSIQUIATRIA 1987; 45:72-80. [PMID: 3606439 DOI: 10.1590/s0004-282x1987000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Russel's syndrome is characterized by emaciation and hyperactivity in children and is caused by hypothalamic expansive process. This report presents the typical signs of the syndrome associated with growth hormone secretion disorders and precocious puberty pattern appearing at the age of four. The pathogenesis of the disorder is discussed and related to the hypothalamus-pituitary axis dysfunction caused by the tumor growth.
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Namba S, Nishimoto A, Yagyu Y. Diencephalic syndrome of emaciation (Russell's syndrome). Long-term survival. SURGICAL NEUROLOGY 1985; 23:581-8. [PMID: 3992458 DOI: 10.1016/0090-3019(85)90007-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Three cases of diencephalic syndrome are reported. Two of them, which have been observed postoperatively for more than 7 years, showed typical clinical and endocrinologic features at the time of their first admission, but showed mass signs uncharacteristic of diencephalic syndrome after recurrence of the tumor. Recent data showed a normal baseline for plasma growth hormone but abnormalities in provocation tests. The significance of age in the manifestation of the syndrome is briefly discussed, especially in relation to the tendency toward normalization in the growth hormone level at a later age.
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Lavery MA, O'Neill JF, Chu FC, Martyn LJ. Acquired nystagmus in early childhood: a presenting sign of intracranial tumor. Ophthalmology 1984; 91:425-53. [PMID: 6739045 DOI: 10.1016/s0161-6420(84)34269-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study is a multicenter, retrospective report of 10 infants in whom acquired nystagmus was the initial sign of chiasmal/ parachiasmal glioma. Nine patients presented before the age of 10 months. The nystagmus, primarily described as pendular and asymmetric, was difficult to differentiate from and therefore most often diagnosed as spasmus nutans . On average in the ten patients, the intracranial glioma was not recognized for 8.6 months after the onset of nystagmus. In the five diagnosed as spasmus nutans , the mean delay in recognizing the tumor was 14.5 months. Three associated clinical findings were present or developed in these patients to distinguish this entity from spasmus nutans : optic atrophy in all ten patients, poor feeding due to diencephalic syndrome in 5 of 10, and increased intracranial pressure with hydrocephalus in 3 of 10. The acquired nystagmus in these infants was evidence of a life-threatening chiasmal/ parachiasmal glioma.
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