Expansion and shrinkage of central nervous system tumor coinciding with human growth hormone therapy: case report

Ganglioneuroma of adrenal gland in a patient with Turner syndrome

A 15-year-old girl with Turner syndrome was unexpectedly found to have a left suprarenal mass. Extensive investigations showed a clinically and biochemically inapparent mass. Computed tomography disclosed a well-defined solid lesion in the left adrenal measuring 6.5 x 5 cm with minimal contrast enhancement. Laparoscopic adrenalectomy was done. Histologic examination revealed an encapsulated mass originated from the left adrenal medulla. Tumor tissue comprised abundant collagen fibers and spindloid cells admixed with mature ganglion cells. The tumor was diagnosed as left adrenal ganglioneuroma. According to literature, we report the eighth case of ganglioneuroma complicating Turner syndrome. Patients with this syndrome are predisposed to the development of neuroblastoma and related tumors. Reasons for this predisposition might relate to genetic and hormonal factors. Given that these tumors are often limited stage and of good prognosis, we recommend their screening in all patients with Turner syndrome.

Incidence of first primary central nervous system tumors in California, 2001-2005: children, adolescents and teens

This study used data from the California Cancer Registry to comprehensively examine first primary central nervous system tumors (PCNST) by the International Classification of Childhood Cancers (ICCC) diagnostic groups and to compare their incidence by age groups, sex, race/ethnicity, socioeconomic status and tumor behavior. The study period, 2001–2005, represents the first 5 years of benign PCNST data collection in the state. The age-adjusted incidence rates were 2.1 for malignant and 1.3 for benign per 100,000. Children younger than 5 years old had the highest incidence of malignant PCNST (2.6 per 100,000). Teens aged 15–19 had the highest incidence of benign PCNST (1.8 per 100,000). Age-specific incidence rates were nearly the same for Hispanics, non-Hispanic whites, and Asian/Pacific Islanders for malignant PCNST among children younger than 5 (2.6–2.7 per 100,000); non-Hispanic whites had the highest rates in the 5–14 year-old age group (2.5 per 100,000) and Asian/Pacific Islanders the highest among the 15–19 year old age group (2.3 per 100,000). We found no statistically significant differences in the incidence of malignant PCNST by race/ethnicity in any age group. Astrocytoma had the highest incidence for both malignant and benign histology in most age groups.

Acromegaly and anaplastic astrocytoma: coincidence or pathophysiological relation?

Insulin-like growth factor type I (IGF-I) is an important promoter in the tumorigenesis of several extracranial and intracranial neoplasms. In astrocytic-cell tumors, the role of autocrine and paracrine IGF-I expression in enhancing tumoral progression is well established. However, the influence of systemic IGF-I levels on the clinical behavior of astrocytic neoplasms remains an open subject of research. We report the case of a 28-year-old man who presented simultaneously with acromegaly and an anaplastic astrocytoma, which had rapidly progressed from a low-grade astrocytoma. The coexistence of systemic IGF-I hypersecretion with a quick progression in the histopathological grade of the astrocytoma raises the compelling question of whether the clinical behavior of the astrocytic tumor was influenced by the acromegalic status. The role of IGF-I signaling in the pathogenesis of astrocytic-cell tumors and the experience with therapeutic strategies addressing this pathway in astrocytomas are also discussed.

Reduction in head size in patients with aspartylglucosaminuria

OBJECTIVE

To show that the head may shrink in adult patients with aspartylglucosaminuria (AGU), a neurodegenerative disease.

METHOD

The head circumference (HC) of 40 adult patients (age at baseline 15 to 47) was measured twice with an interval of 10 years. Of these 40, 21 aged 15-47 and 19 young patients aged 5-14 as well as 40 healthy controls underwent lateral cephalometric radiography.

RESULTS

During 10 years' follow-up, the HC of 26 (65%) had decreased by 1 to 4.5 cm (mean 1.7, P < 0.001). Evaluation of lateral skull radiographs revealed that patients aged 15 or more had significantly thicker skulls than did younger patients (P = 0.015). Mean intracranial length (glabella-opisthocranium) of the patients aged 15 or more was significantly shorter than in patients aged 14 years or less (P = 0.029). These measurements indicated that brain volume had decreased.

CONCLUSIONS

Macrocephalia in childhood followed by reduced brain volume in adulthood is evident in patients with AGU and is reflected by a decrease in head size.

Ganglioneuroma Manifesting as an Incidental Adrenal Mass in an Adult With Turner’s Syndrome

OBJECTIVE

To report a case of ganglioneuroma masquerading as an incidental adrenal mass in an adult patient with Turner's syndrome.

METHODS

We present the clinical, laboratory, radiologic, and pathologic findings in this patient.

RESULTS

A 31-year-old woman with Turner's syndrome who had previously been treated with growth hormone replacement had an incidentally discovered mass, apparently arising from the left adrenal gland. The mass was "silent" clinically and biochemically, but imaging characteristics were not reassuring for a benign cortical adenoma. Because of uncertainty regarding the nature of the mass, it was removed laparoscopically; during this procedure, it was noted to be intimately associated with, but anatomically distinct from, the left adrenal gland. The pathology report confirmed the presence of a benign ganglioneuroma.

CONCLUSION

Although ganglioneuroma has previously been noted to be associated with Turner's syndrome (especially in pediatric patients), to the best of our knowledge this is the first report of a ganglioneuroma manifesting as an incidental adrenal mass in an adult patient with Turner's syndrome.

Glioma occurrence after sellar irradiation: case report and review

OBJECTIVE

Tumor neogenesis is an uncommon but known consequence after therapeutic irradiation of the central nervous system. Causative agents for glioma induction remain unknown, but laboratory and clinical data suggest a possible role for radiation as a promotor. In the treatment of both pituitary adenomas and craniopharyngiomas, adjunctive conventional radiation therapy has long played a role.

CLINICAL PRESENTATION

This report details two cases in which patients received standard sellar irradiation for growth hormone-secreting pituitary adenomas and later were diagnosed with gliomas, after a latency period of 11 and 18 years, respectively. Additionally, a comprehensive review of the literature with 30 reports of gliomas developing after conventional radiation for treatment of pituitary adenomas and craniopharyngiomas is presented. The mean dose for craniopharyngiomas (n = 8) was 5800 cGy, with a mean latency of 11.5 years from initial diagnosis to the eventual discovery of the gliomas. The mean dose for the treatment of pituitary adenomas (n = 24) was 5300 cGy, with a mean latency of 10.4 years.

CONCLUSION

Typical features of the resulting gliomas included presentation in young patients, histologically high grades, and occurrence within the temporal lobe. A large proportion of gliomas were associated with growth hormone-secreting adenomas. This review assesses the implication of doses of conventional radiotherapy that were previously thought to be benign and concludes that although radiation-associated gliomas are uncommon, they represent a potentially devastating long-term risk. Based on this analysis, treatment of sellar tumors with conventional fractionated radiotherapy should be carefully considered and perhaps used primarily in those cases for which radiosurgery is not appropriate.