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Salomão JFM, Protzenko T. Intracranial Tumors in the First Year of Life. Adv Tech Stand Neurosurg 2023; 46:23-52. [PMID: 37318568 DOI: 10.1007/978-3-031-28202-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intracranial tumors in the first year of life are rare and, in this age group, are the second most common type of pediatric cancer after leukemias. As the more common solid tumor in neonates and infants, they present some peculiarities such as the high incidence of malignancies. Routine ultrasonography made easier to detect intrauterine tumors, but diagnosis can be delayed due to the lack or scarcity of recognizable symptoms. These neoplasms are often very large and highly vascular. Their removal is challenging, and there is a higher rate of morbidity and mortality than seen in older children, adolescents, and adults. They also differ from older children with respect to location, histological features, clinical behavior, and management. Pediatric low-grade gliomas represent 30% of the tumors in this age group and comprise circumscribed and diffuse tumors. They are followed by medulloblastoma and ependymoma. Other non-medulloblastoma embryonal neoplasms, former known as PNETS, are also commonly diagnosed in neonates and infants. Teratomas have an expressive incidence in newborns but decline gradually until the end of the first year of life. Immunohistochemical, molecular, and genomic advances are impacting the understanding and targeting of the treatment of some tumors, but, despite all these advances, the extent of resection remains the most important factor in the prognosis and survival of almost all types of tumors. The outcome is difficult to estimate, and 5-year survival ranges from one-quarter to three-quarters of the patients.
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Affiliation(s)
- José Francisco M Salomão
- Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Tatiana Protzenko
- Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil
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Habib MH, Alavi MZ, Goraya A, Zaman S, Ahmed A. High-grade desmoplastic infantile astrocytoma in a 1-year-old child with Down’s syndrome: a case report. J Med Case Rep 2022; 16:427. [PMCID: PMC9635066 DOI: 10.1186/s13256-022-03615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Down’s syndrome is the most common chromosomal abnormality in humans. It has been associated with central nervous system tumors such as primary acute lymphoblastic leukemia and germinomas, but desmoplastic infantile astrocytoma has not yet been reported with Down’s syndrome. Desmoplastic infantile astrocytoma is a rare intracranial tumor that mostly occurs in the first 2 years of life. It usually presents as a large, aggressive tumor with both solid and cystic components. Genetically, it has been linked to the BRAF V600E mutation. Despite the rapid growth pattern, it usually has a favorable prognosis after neurosurgical excision. The presence of this extremely rare, genetically linked tumor, and its combination with Down’s syndrome, the most common human genetic defect, makes this a very novel clinical presentation. It also raises a very research-worthy question of an undiscovered link between these two genetic disorders.
Case presentation
In this case, we report a 1-year-old Pakistani origin male child with Down’s syndrome, who presented with progressive macrocephaly and developmental regression over the last 2 months. He was unable to sit by himself, and had lost his handgrip bilaterally. Down’s Syndrome was diagnosed soon after birth, based on typical facial features and presence of palmar crease, and later confirmed karyotypically for Trisomy 21. Upon presentation, initial blood tests did not show any abnormality. Magnetic resonance imaging of the brain was done, and showed a mixed intensity cystic mass with solid dural component posteriorly in the right parieto temporo occipital region. Craniotomy was performed, and about 85% of the tumor mass was excised. Histological examination and immunochemistry confirmed the suspected radiological diagnosis of desmoplastic infantile astrocytoma. After surgical excision, our patient gradually reacquired his previously regressed developmental milestones. Unfortunately, the remaining mass, which could not be excised due to its attachment to the highly vascular dura mater, showed regrowth on repeat brain magnetic resonance imaging. As his parents did not consent to further surgery, chemotherapy was offered as the next treatment option to prevent tumor regrowth.
Conclusions
This case report highlights the need for more case data and research to understand desmoplastic infantile astrocytoma, and their genetic correlation with Down’s syndrome. From a clinical standpoint, since desmoplastic infantile astrocytoma has a good postresection prognosis in a majority of early-diagnosed clinical cases, pediatricians, radiologists, and pathologists should consider desmoplastic infantile astrocytoma in their initial differential diagnosis in Down’s syndrome patients with macrocephaly and developmental regression during the first 2 years of life.
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Nicoletti GF, Umana GE, Riolo C, Magro G, Bartoloni G, Scalia G. Purely Intraventricular Desmoplastic Infantile Astrocytoma. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0041-1723755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractDesmoplastic infantile astrocytomas (DIAs) are rare pediatric tumors characterized by superficial brain cortex involvement, along with the meninges of the supratentorial compartment, and are classified as grade I neoplasms according to the 2016 World Health Organization. A 5-year-old girl child patient was admitted to our unit with abnormal decorticate posturing, bilateral mydriasis with weak pupillary light reflex, and brisk lower limbs reflexes. Her medical history was unremarkable. Magnetic resonance imaging of the brain revealed a massive lesion with bilateral intraventricular growth mainly prevailing on the left and involving the ipsilateral foramen of Monro. After external ventricular drainage positioning, Dandy's transfrontal transcortical approach to the left lateral ventricle, a meticulous ependymal microsurgical dissection of the lesion was performed, resulting in an excision of the cystic component of the left lateral ventricle. A gross total removal of the lesion was performed with an en bloc resection of the deeper cystic part. Thirty days after surgery, the patient presented with fluent speech, conserved axial, and extremity sensorimotor functions, except a mild central facial paresis which progressively improved. To the best of our knowledge, this is the first case of DIA characterized by purely intraventricular growth. Tumor recurrence, although considered rare, represents an unpredictable event. Therefore, an adequate follow-up must be reserved for each patient.
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Affiliation(s)
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Carmelo Riolo
- Neurosurgery Unit, Highly Specialized Hospital of National Importance “Garibaldi,” Catania, Italy
| | - Gaetano Magro
- Anatomic Pathology Section, Department of Medical, Surgical Sciences and Advanced Technologies and Biotechnological Sciences, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Giovanni Bartoloni
- Anatomic Pathology Unit, Highly Specialized Hospital of National Importance “Garibaldi,” Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital of National Importance “Garibaldi,” Catania, Italy
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Li Z, Yu Y, Lu Z, Gong J. Infantile and Noninfantile Desmoplastic Astrocytoma and Ganglioglioma: Only Different Age of Onset? World Neurosurg 2020; 144:e189-e194. [PMID: 32822952 DOI: 10.1016/j.wneu.2020.08.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Zhicen Li
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaxiong Yu
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zheng Lu
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Gong
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Fukushima T, Ueda T, Hirato J, Kataoka H. RELA fusion-positive ependymoma accompanied by extensive desmoplasia: a case report. Brain Tumor Pathol 2020; 37:159-164. [PMID: 32754892 DOI: 10.1007/s10014-020-00376-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
We report a case of 33-year-old Japanese male who presented with a headache and visual disturbances. Magnetic resonance imaging revealed a large tumor in the left frontal lobe, measuring 7 cm in diameter, which was diagnosed as supratentorial anaplastic ependymoma accompanied by extensive desmoplasia. The patient underwent a gross total resection. Histologically, the tumor cells had oval or short, spindle-shaped nuclei, and proliferating cells in perivascular pseudorosettes with anucleate zones and mitotic figures. Desmoplasia with abundant collagen fibers among the tumor cells was detected at numerous sites, and perinuclear dot- or ring-like immunoreactivity for epithelial membrane antigen was identified. Five years and six months after the initial procedure, a small recurrent tumor was identified at the removal site. The patient underwent a second total resection. The histology of the resected tumor showed decreased collagen production and more apparent anaplastic features as compared to those of the initial tumor. In addition to the histological findings, molecular examinations revealed ependymoma, RELA fusion positive. Although not commonly observed, this case suggests that desmoplasia could be associated with ependymomas, including RELA fusion-positive variant. Moreover, our findings indicate that high-grade ependymoma requires careful, long-term follow-up even if gross total resection is performed.
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Affiliation(s)
- Tsuyoshi Fukushima
- Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | | | - Junko Hirato
- Department of Pathology, Public Tomioka General Hospital, Gunma, Japan
| | - Hiroaki Kataoka
- Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Ajithkumar T, Imbulgoda N, Rees E, Harris F, Horan G, Burke A, Jefferies S, Price S, Cross J, Allinson K. Uncommon low-grade brain tumors. Neuro Oncol 2020; 21:151-166. [PMID: 30239861 DOI: 10.1093/neuonc/noy151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The 2016 World Health Organization (WHO) classification of primary central nervous system (CNS) tumors includes numerous uncommon (representing ≤1% of tumors) low-grade (grades I-II) brain neoplasms with varying clinical behaviors and outcomes. Generally, gross tumor or maximal safe resection is the primary treatment. Adjuvant treatments, though their exact role is unknown, may be considered individually based on pathological subtypes and a proper assessment of risks and benefits. Targetable mutations such as BRAF (proto-oncogene B-Raf), TRAIL (tumor necrosis factor apoptosis inducing ligand), and PDGFR (platelet derived growth factor receptor) have promising roles in future management.
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Affiliation(s)
- Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Naduni Imbulgoda
- Department of Oncology, National Cancer Institute, Maharagama, Sri Lanka
| | - Elliott Rees
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Fiona Harris
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Amos Burke
- Department of Paediatric Hematology, Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Stephen Price
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Justin Cross
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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