Medulloblastoma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors in a child

2010 ◽  
Vol 5 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Andrew Jea ◽  
Ernesto Coscarella ◽  
Murali Chintagumpala ◽  
Meena Bhattacharjee ◽  
William E. Whitehead ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Mr Imaging ◽  
Pilocytic Astrocytoma ◽  
Cell Types ◽  
Cerebellar Hemisphere ◽  
Pathological Examination ◽  
Primary Brain Tumors ◽  
Juvenile Pilocytic Astrocytoma ◽  
Multiple Primary ◽  
Different Cell Types

Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type have been published in the adult and pediatric literature. However, the simultaneous occurrence of multiple primary brain tumors with different cell types is rare. Even more rare is the pediatric presentation of multiple primary brain tumors with different cell types. The authors describe the case of an 8-year-old boy who presented with a 2-week history of progressive headache, nausea and vomiting, and imbalance. Brain MR imaging demonstrated a heterogeneously enhancing mixed solid/cystic mass of the left cerebellar hemisphere and a larger, midline, more homogeneously enhancing lesion of the superior vermis. Spinal MR imaging was unremarkable. The patient underwent a suboccipital craniotomy and subsequent gross-total resection of both mass lesions. Pathological examination revealed the left cerebellar and superior vermian lesions to be a juvenile pilocytic astrocytoma and a medulloblastoma, respectively. The patient did well in the immediate postoperative period, was discharged home, and underwent neurooncological follow-up. To the best of the authors' knowledge, they describe the first known pediatric case in which a medulloblastoma and a juvenile pilocytic astrocytoma presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and rehash potential mechanisms for their development.

Multiple Primary Brain Tumors of Different Cell Types

Neurosurgery ◽  
1981 ◽  
Vol 8 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Gordon H. Deen ◽  
Edward R. Laws
Keyword(s):  
Brain Tumors ◽  
Clinical Significance ◽  
Mayo Clinic ◽  
Clinical Presentation ◽  
Cell Types ◽  
Multiple Tumors ◽  
Primary Brain Tumors ◽  
Histological Types ◽  
Multiple Primary ◽  
Different Cell Types

Abstract Eighteen cases of multiple primary brain tumors of different histological types were found in a review of Mayo Clinic records from 1950 to 1978. The predisposing factors, clinical presentation, location, and type of tumor are discussed. The clinical significance and etiology of these multiple tumors are considered.

Oligodendroglioma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors

2004 ◽  
Vol 100 (4) ◽  
pp. 700-705 ◽  
Author(s):  
Peter Kan ◽  
Oren Gottfried ◽  
Deborah T. Blumenthal ◽  
Jeannette J. Townsend ◽  
Ela Drozd-Borysiuk ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Pilocytic Astrocytoma ◽  
Mass Effect ◽  
Low Grade ◽  
Content Type ◽  
Primary Brain Tumors ◽  
Juvenile Pilocytic Astrocytoma ◽  
Multiple Primary ◽  
Histological Characteristics ◽  
Fine Print

✓ Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type are well described in the literature. The concurrent presence of multiple primary brain tumors with different histological characteristics, however, is very rare. The authors describe the first known case in which an oligodendroglioma and a juvenile pilocytic astrocytoma (JPA) presented as synchronous primary brain tumors in the same patient. This 43-year-old man presented with a 2-month history of progressive headaches, nausea, and vomiting. Magnetic resonance imaging demonstrated an enhancing heterogeneous right medial cerebellar lesion and a larger calcified, nonenhancing, heterogeneous right frontal lesion with surrounding edema and a mass effect. The results of a metastatic workup were unremarkable. The patient underwent an initial right frontotemporal craniotomy and a subsequent suboccipital craniectomy 2 years later for resection of the posterior fossa lesion. Histological examination revealed the frontal and cerebellar lesions to be an oligodendroglioma and JPA, respectively. A molecular analysis detected a deletion of chromosome 1p36 in the oligodendroglioma, but not in the JPA. After the initial operation, the patient received follow-up care for his oligodendroglioma, but eventually required temozolomide for tumor progression. His condition remains stable both neurologically and according to imaging studies. The authors describe the first known case in which a low-grade oligodendroglioma and a JPA presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and discuss potential mechanisms for the development of these lesions.

scholarly journals Juvenile Pilocytic Astrocytoma in Association with Arteriovenous Malformation

2012 ◽  
Vol 18 (2) ◽  
pp. 140-147 ◽  
Author(s):  
M. Soltanolkotabi ◽  
S.E. Schoeneman ◽  
A.J. Dipatri ◽  
M.C. Hurley ◽  
S.A. Ansari ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Arteriovenous Malformation ◽  
Pilocytic Astrocytoma ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Etiologic Factor ◽  
Who Grade ◽  
Artery Pseudoaneurysm ◽  
Primary Brain Tumors ◽  
Juvenile Pilocytic Astrocytoma

Pilocytic astrocytomas are highly vascular, relatively common primary brain tumors in the pediatric population, but their association with a true arteriovenous malformation (AVM) is extremely rare. We describe an eight-year-old girl with a right supratentorial juvenile pilocytic astrocytoma (WHO grade I) with an angiographically documented AVM entangled in the tumor mass who presented with intracranial hemorrhage due to a ruptured anterior choroidal artery pseudoaneurysm encased in the lesion. The AVM nidus as well as the hemorrhage site was embolized with Onyx. A literature review revealed only one previous report of a true intermixture of these two lesions. We hypothesize whether the association of vascular malformations and primary brain tumors are merely coincidental or if they point to the existence of a distinct entity and/or a common etiologic factor.

scholarly journals Multiple Primary Brain Tumors of Different Histological Types

1991 ◽  
Vol 31 (3) ◽  
pp. 141-145 ◽  
Author(s):  
Takayuki TOKUNAGA ◽  
Minoru SHIGEMORI ◽  
Masaru HIROHATA ◽  
Yasuo SUGITA ◽  
Jun MIYAGI ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Primary Brain Tumors ◽  
Histological Types ◽  
Multiple Primary

Dual BRAF/MEK therapy in BRAF V600E-mutated primary brain tumors: a case series showing dramatic clinical and radiographic responses and a reduction in cutaneous toxicity

2020 ◽  
Vol 133 (6) ◽  
pp. 1704-1709 ◽  
Author(s):  
Aaron Bernstein ◽  
Oliver D. Mrowczynski ◽  
Amrit Greene ◽  
Sandra Ryan ◽  
Catherine Chung ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Pilocytic Astrocytoma ◽  
Case Series ◽  
Mek Inhibitor ◽  
Pleomorphic Xanthoastrocytoma ◽  
Inhibitor Therapy ◽  
Braf V600e ◽  
Dual Inhibitor ◽  
Cutaneous Toxicity ◽  
Primary Brain Tumors

OBJECTIVEBRAF V600E is a common oncogenic driver in a variety of primary brain tumors. Dual inhibitor therapy using dabrafenib (a selective oral inhibitor of several mutated forms of BRAF kinase) and trametinib (a reversible inhibitor of MEK1 and MEK2) has been used successfully for treatment of metastatic melanoma, anaplastic thyroid cancer, and other tumor types, but has been reported in only a few patients with primary brain tumors and none with pleomorphic xanthoastrocytoma. Here, the authors report on the substantial clinical response and reduction in cutaneous toxicity in a case series of BRAF V600E primary brain cancers treated with dual BRAF/MEK inhibitor therapy.METHODSThe authors treated 4 BRAF V600E patients, each with a different type of primary brain tumor (pilocytic astrocytoma, papillary craniopharyngioma, ganglioglioma, and pleomorphic xanthoastrocytoma) with the combination of dabrafenib and trametinib.RESULTSThe patients with pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and papillary craniopharyngioma experienced near-complete radiographic and complete clinical responses after 8 weeks of therapy. A substantial partial response (by RANO [Response Assessment in Neuro-Oncology] criteria) was observed in the patient with ganglioglioma. The patient with craniopharyngioma developed dramatic, diffuse verrucal keratosis within 2 weeks of starting dabrafenib. This completely resolved within 2 weeks of adding trametinib.CONCLUSIONSDual BRAF/MEK inhibitor therapy represents an exciting treatment option for patients with BRAF V600E primary brain tumors. In addition to greater efficacy than single-agent dabrafenib, this combination has the potential to mitigate cutaneous toxicity, one of the most common and concerning BRAF inhibitor–related adverse events.

Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma

2009 ◽  
Vol 4 (6) ◽  
pp. 495-505 ◽  
Author(s):  
Yaron A. Moshel ◽  
Robert E. Elliott ◽  
David J. Monoky ◽  
Jeffrey H. Wisoff
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Mr Imaging ◽  
Surgical Approach ◽  
Pilocytic Astrocytoma ◽  
Diffusion Tensor ◽  
Gross Total Resection ◽  
Total Resection ◽  
Juvenile Pilocytic Astrocytoma ◽  
White Matter Tractography

Object The choice of surgical approach during resection of a thalamic juvenile pilocytic astrocytoma (JPA) is dictated by the location of the displaced normal thalamus and posterior limb of the internal capsule (PLIC). Diffusion tensor (DT) imaging and white matter tractography can identify the location of the PLIC in relation to the tumor and may be useful in planning the operative trajectory. Methods Diffusion tensor imaging was used to localize the PLIC on preoperative MR imaging in 6 children undergoing resection of thalamic JPAs. After review of the standard T2-weighted MR imaging sequences, the anticipated position of the PLIC was determined. This result was compared with the location of the PLIC determined by a blinded radiologist with the use of DT imaging. The utility of DT imaging in determining the surgical approach to a thalamic JPA, degree of resection, and neurological outcomes were all evaluated. Results Diffusion tensor imaging confirmed the expected location of the PLIC as approximated on conventional T2-weighted images in all 6 cases. In 1 patient in particular, unexpected medial deviation of the PLIC was identified, and this proved useful in tailoring the approach to a more lateral trajectory. Gross-total resection of all cystic and solid tumor components was confirmed on postoperative imaging in all cases. All patients experienced mild to moderate worsening of neurological status immediately following resection, but 4 of 6 patients were back to their preoperative baseline at 6-month follow-up. Conclusions Diffusion tensor imaging and white matter tractography successfully identified the white matter fibers emanating from the precentral gyrus within the PLIC in children with thalamic JPAs prior to surgery. Diffusion tensor imaging served as a valuable tool for stereotactic planning of operative approaches to thalamic JPAs. Localizing the position of the PLIC helped minimize potential neurological morbidity and facilitated gross-total resection.

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