Massive leptomeningeal dissemination of a low-grade thalamic astrocytoma in an adult patient

Leptomeningeal dissemination of paraganglioma is rare, with only 2 prior cases in the literature. The authors present the case of a metastatic low-grade lumbar paraganglioma via leptomeningeal dissemination. This report emphasizes the utility of 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA) PET scanning for diagnosis, as well as the combination of radiation therapy and alkylating chemotherapeutic agents for the treatment of this rare phenomenon. The patient was a 61-year-old woman who presented with low-back pain and was found to have an isolated L-3 intrathecal tumor on MRI. Sixteen months after gross-total en bloc resection of the paraganglioma, the patient again became symptomatic with new neurological symptoms. MRI findings revealed enhancing leptomeningeal nodules throughout the spine. 18F-FDOPA PET/CT scanning was used to confirm the diagnosis of disseminated paraganglioma. Intrathecal thiotepa, radiation therapy, and systemic therapy with capecitabine and temozolomide have been used sequentially over a 2-year period, with each able to stabilize tumor growth for several months. The authors also summarize the 2 other reports of leptomeningeal dissemination of paragangliomas in the literature and compare the course and management of the 3 cases.

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Leptomeningeal dissemination of low-grade intramedullary gliomas: About one case and review

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2008.11.013 ◽

2009 ◽

Vol 111 (4) ◽

pp. 390-394 ◽

Cited By ~ 7

Author(s):

Nicky D’Haene ◽

Nicolas Coen ◽

Carine Neugroschl ◽

Danielle Balériaux ◽

Isabelle Salmon

Keyword(s):

Low Grade ◽

Leptomeningeal Dissemination

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Low-grade gliomas and leptomeningeal dissemination: a poorly understood phenomenon

Child s Nervous System ◽

10.1007/s00381-003-0733-1 ◽

2003 ◽

Vol 19 (4) ◽

pp. 197-203 ◽

Cited By ~ 53

Author(s):

Giorgio Perilongo ◽

Maria Luisa Garrè ◽

Felice Giangaspero

Keyword(s):

Low Grade ◽

Leptomeningeal Dissemination ◽

Low Grade Gliomas

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Management of the deteriorating adult patient: does simulation-based education improve patient safety?

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0293 ◽

2021 ◽

pp. 1-8

Author(s):

Jacqueline Bennion ◽

Stephanie K Mansell

Keyword(s):

Human Factors ◽

Adult Patient ◽

Patient Outcomes ◽

Improve Patient Safety ◽

Low Grade ◽

Contributing Factors ◽

Educational Method ◽

Simulation Based ◽

The Impact

Failure to recognise the deteriorating patient can cause severe harm and is related to preventable death. Human factors are often identified as contributing factors. Simulation-based education is used to develop clinicians' human factors skills. This article discusses the evidence concerning the efficacy of simulation-based education for improving the recognition and management of the acutely deteriorating adult patient, and the limitations of simulation-based education. Findings demonstrated simulation-based education was the most effective educational method identified for training staff in recognising unwell patients. The evidence demonstrating the impact of simulation-based education on patient outcomes was equivocal. The quality of the evidence was low grade regarding the efficacy of simulation-based education on human factors. Further research is required to confirm the efficacy of simulation-based education for human factors and patient outcomes.

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Leptomeningeal dissemination of low-grade neuroepithelial CNS tumors in adults: a 15-year experience

Neuro-Oncology Practice ◽

10.1093/nop/npz020 ◽

2019 ◽

Vol 7 (1) ◽

pp. 118-126

Author(s):

Philipp Karschnia, ◽

Frank J Barbiero ◽

Michaela H Schwaiblmair ◽

Leon D Kaulen ◽

Joseph M Piepmeier ◽

...

Keyword(s):

Rare Complication ◽

Clinical Signs ◽

Cns Tumors ◽

Time Interval ◽

Communicating Hydrocephalus ◽

Histopathological Diagnosis ◽

Low Grade ◽

Leptomeningeal Dissemination ◽

Who Grade ◽

Systemic Treatments

Abstract Background Leptomeningeal dissemination (LD) in adults is an exceedingly rare complication of low-grade neuroepithelial CNS tumors (LGNs). We aimed to determine relative incidence, clinical presentation, and predictors of outcome. Methods We searched the quality control database of the Section of Neuro-Oncology, Yale Cancer Center, for patients with LGN (WHO grade I/II) seen between 2002 and 2017. For cases complicated by LD, we recorded demographics, clinical signs, histopathological diagnosis, and imaging findings. A comprehensive literature review was performed. Results Eleven consecutive patients with LD were identified, representing 2.3% of individuals with LGN seen at our institution between 2002 and 2017 (n = 475). Ependymoma was the predominant histological entity. Mean time interval from diagnosis of LGN to LD was 38.6 ± 10 months. Symptoms were mostly attributed to communicating hydrocephalus. Tumor deposits of LD were either nodular or linear with variable enhancement (nonenhancing lesions in 4 of 11 patients). Localized (surgery, radiosurgery, involved-field, or craniospinal radiation therapy) or systemic treatments (chemotherapy) were provided. All patients progressed radiographically. Median overall survival after LD was 102 months. Survival was prolonged when a combination of localized and systemic therapies was administered (188.5 vs 25.5 months; P = .03). Demographics and tumor spectrum reported in the literature were similar to our cohort. Conclusions LD is a rare complication of LGNs. A high level of suspicion is required for timely diagnosis as early symptoms are nonspecific and commonly do not occur until years after initial tumor diagnosis. Repeated aggressive treatment appears to be beneficial in improving survival.

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Leptomeningeal Dissemination of a Low-Grade Brainstem Glioma without Local Recurrence

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2012.51.2.109 ◽

2012 ◽

Vol 51 (2) ◽

pp. 109 ◽

Cited By ~ 7

Author(s):

Jung-Ho Moon ◽

Tae-Young Jung ◽

Shin Jung ◽

Woo-Youl Jang

Keyword(s):

Local Recurrence ◽

Brainstem Glioma ◽

Low Grade ◽

Leptomeningeal Dissemination

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Low grade mosaic for a complex supernumerary ring chromosome 18 in an adult patient with multiple congenital anomalies

Molecular Cytogenetics ◽

10.1186/1755-8166-3-13 ◽

2010 ◽

Vol 3 (1) ◽

pp. 13 ◽

Cited By ~ 18

Author(s):

Lars T van der Veken ◽

Marianne MJ Dieleman ◽

Hannie Douben ◽

Judith C van de Brug ◽

Raoul van de Graaf ◽

...

Keyword(s):

Adult Patient ◽

Congenital Anomalies ◽

Ring Chromosome ◽

Low Grade ◽

Multiple Congenital Anomalies ◽

Chromosome 18 ◽

Ring Chromosome 18

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Supratentorial Cortical Ependymoma: Report of Three Cases

Neurosurgery ◽

10.1227/01.neu.0000164171.29292.d6 ◽

2005 ◽

Vol 57 (1) ◽

pp. E192-E192 ◽

Cited By ~ 46

Author(s):

Federico Roncaroli ◽

Alessandro Consales ◽

Antonio Fioravanti ◽

Giovanna Cenacchi

Keyword(s):

Gray Matter ◽

Postoperative Radiotherapy ◽

Benign Tumors ◽

Surgical Removal ◽

Low Grade ◽

Leptomeningeal Dissemination ◽

Ki 67 ◽

Clinicopathological Findings ◽

S 100 ◽

Preoperative Magnetic Resonance

Abstract OBJECTIVE AND IMPORTANCE: Extraventricular ependymomas account for 50% of supratentorial ependymomas. Some tumors may extend to the gray matter reaching the pial surface, but pure cortical ependymomas are uncommon. Here, we report three patients with supratentorial intracortical ependymoma. CLINICAL PRESENTATION: We reviewed the clinicopathological findings of all patients operated on for ependymomas at the Bellaria Hospital during an 11-year period and found three lesions described as cortical ependymomas. The three lesions represented 2.5% of all ependymal tumors and 21.4% of supratentorial tumors operated on during the study period. The patient were aged 52, 24, and 11 years (mean, 32.3 yr). One was female. All presented with seizures. On imaging, the lesions were confined to the gray matter, were solid, and demonstrated diffuse enhancement. INTERVENTION: Gross total resection was achieved in all instances. Two patients were treated with surgery, and one was treated with surgery and postoperative radiotherapy. All tumors were low grade. After a mean follow-up of 92.6 months, no patient had recurrence or leptomeningeal dissemination. Review of preoperative magnetic resonance imaging scans confirmed an intracortical location. Routine sections were reviewed, and additional immunoreactions for epithelial membrane antigen, glial fibrillary acidic protein, synaptophysin, neurofilament proteins, S-100 protein, and Ki-67 and electron microscopy were performed. CONCLUSION: Cortical ependymomas seem to behave as benign tumors amenable to surgical removal. Local recurrence and leptomeningeal dissemination seem to be unlikely. Postoperative radiotherapy is unnecessary.

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