leptomeningeal spread
Recently Published Documents


TOTAL DOCUMENTS

67
(FIVE YEARS 23)

H-INDEX

14
(FIVE YEARS 1)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Imen Maaloul ◽  
Marwa Moussaoui ◽  
Ameni Salah ◽  
Wiem Feki ◽  
Hela Fourati ◽  
...  

Introduction. Meningeal melanocytoma (MM) is a very rare neuroectodermal neoplasm arising from the leptomeninges. Primary suprasellar melanocytomas are exceedingly rare, with only a handful of cases reported. The systemic spread of a nontransformed meningeal melanocytoma is an unusual occurrence. Herein, we report the first case of a primary sellar melanocytoma with cerebral and spinal meningeal seeding. Case Report. A 30-year-old male with no previous medical history presented to the endocrinology department with a loss of body hair. The endocrine workup concluded with isolated hypogonadotropic hypogonadism. The Magnetic Resonance Imaging (MRI) of the brain and sella revealed a large suprasellar mass continuous with the infundibulum of the pituitary gland. It was heterogeneously hyperintense on T1-, T2-, and FLAIR-weighted images and was enhanced with contrast, along with cerebral and spinal leptomeningeal spread. The patient was referred to the neurosurgery department, and a lumbar spine biopsy was indicated. The histopathological examination was suggestive of a grade I meningeal pigmented melanocytoma. Conclusion. Thus, primary sellar melanocytomas with leptomeningeal spread are an extremely rare phenomenon. Metastatic malignant melanoma should be ruled out. Being aware of differential diagnosis and the unusual behavior of meningeal melanocytoma will be necessary to manage the patient appropriately. Complete tumor resection is the best treatment whenever possible, and radiotherapy should be considered in case of unresectability or partial resection.


2021 ◽  
Author(s):  
Jamie Miller ◽  
Rowan Valentine ◽  
Ema Knight ◽  
Jorn Van Der Veken

Author(s):  
Robert C. Rennert ◽  
Michael G. Brandel ◽  
Shanmukha Srinivas ◽  
Divya Prajapati ◽  
Omar M. Al Jammal ◽  
...  

OBJECTIVE Children with nonoperative brain tumors, such as diffuse intrinsic pontine gliomas (DIPGs), often have life-threatening hydrocephalus. Palliative shunting is common in such cases but can be complicated by hardware infection and mechanical failure. Endoscopic third ventriculostomy (ETV) is a minimally invasive alternative to treat hydrocephalus without implanted hardware. Herein, the authors report their institutional experience with palliative ETV for primary pediatric brain tumors. METHODS The authors conducted a retrospective review of consecutive patients who had undergone palliative ETV for hydrocephalus secondary to nonresectable primary brain tumors over a 10-year period at Rady Children’s Hospital. Collected variables included age, sex, tumor type, tumor location, presence of leptomeningeal spread, use of a robot for ETV, complications, ETV Success Score (ETVSS), functional status, length of survival, and follow-up time. A successful outcome was defined as an ETV performed without clinically significant perioperative complications or secondary requirement for a new shunt. RESULTS Fifteen patients met the study inclusion criteria (11 males, 4 females; average age 7.9 years, range 0.8–21 years). Thirteen patients underwent manual ETV, and 2 patients underwent robotic ETV. Preoperative symptoms included gaze palsy, nausea/vomiting, headache, lethargy, hemiparesis, and seizures. Tumor types included DIPG (3), intraventricular/thalamic glioblastoma (2), and leptomeningeal spread of medulloblastoma (2), anaplastic oligo-/astrocytoma (2), rhabdoid tumor (2), primitive neuroectodermal tumor (1), ganglioglioma (1), pineoblastoma (1), and embryonal carcinoma (1). The mean preoperative ETVSS was 79 ± 8.8. There was 1 perioperative complication, a wound breakdown consistent with refractory hydrocephalus. The mean follow-up was 4.9 ± 5.5 months overall, and mean survival for the patients who died was 3.2 ± 3.6 months. Two patients remained alive at a mean follow-up of 15.7 months. Palliative ETV was successful in 7 patients (47%) and unsuccessful in 8 (53%). While patients with successful ETV were significantly older (11.9 ± 5.6 vs 4.4 ± 4.1 years, p = 0.010), there were no significant differences in preoperative ETVSS (p = 0.796) or postoperative survival (p = 0.476) between the successful and unsuccessful groups. Overall, functional outcomes were similar between the two groups; there was no significant difference in posttreatment Karnofsky Performance Status scores (68.6 ± 19.5 vs 61.3 ± 16.3, p = 0.454), suggesting that including ETV in the treatment algorithm did not worsen outcomes. CONCLUSIONS Palliative ETV is a safe and potentially efficacious treatment option in selected pediatric patients with hydrocephalus from nonoperative brain tumors. Close follow-up, especially in younger children, is required to ensure that patients with refractory symptoms receive appropriate secondary CSF diversion.


2021 ◽  
Vol 12 ◽  
pp. 359
Author(s):  
Khadeja Khan ◽  
Evan Luther ◽  
Alexis A. Morrell ◽  
Sze Kiat Tan ◽  
Daniel G. Eichberg ◽  
...  

Background: Infratentorial pilocytic astrocytomas are uncommon tumors in adulthood but are thought to be prognostically similar to their pediatric counterparts with excellent overall survival following gross total resection. However, given the relative rarity of these tumors, no management guidelines exist for recurrent adult pilocytic astrocytomas (APAs). This lack of consensus is especially problematic for inoperable recurrences or those with aggressive features concerning for malignant transformation. Case Description: In 2017, a 26-year-old female presented with headaches, nausea, vomiting, and blurry vision. A brain magnetic resonance imaging (MRI) demonstrated a large, well-circumscribed mass within the fourth ventricle causing obstructive hydrocephalus. She underwent near-total resection through a midline suboccipital transtonsillar approach. Pathology demonstrated a World Health Organization Grade 1 pilocytic astrocytoma. Despite initial improvement in her symptoms, she developed worsening headaches and lethargy 10 months after surgery and repeat MRI demonstrated recurrent tumor within the entire ventricular system and the subarachnoid spaces of the left cerebellopontine angle suggesting leptomeningeal spread. Due to the unresectable nature of the recurrence, the patient declined any further intervention and succumbed to her disease 6 months later. Conclusion: We present the first case of a recurrent APA presenting with intraventricular and leptomeningeal spread. Although thought to be a benign neoplasm, close interval follow-up with serial imaging is of essential, especially in those patients with known residual tumor, to prevent aggressive recurrences such as this.


2021 ◽  
Vol 7 (3) ◽  
pp. 153-158
Author(s):  
Tamajyoti Ghosh ◽  
◽  
Subir Dey ◽  

Background and Importance: Anaplastic Oligodendroglioma (ODG) constitutes 24% of all pediatric ODG. The mean age of presentation of ODG is 12±6 years. They are most common in frontal and temporal lobes; however, rare cases of intraventricular ODGs are reported. Most commonly they arise from the anterior part of lateral ventricles. Third ventricle ODG is extremely rare and only a few cases of lateral and third ventricle anaplastic ODG are reported. ODGs infiltrate locally to meninges and rarely have leptomeningeal spread. Thus, ODG forms a differential diagnosis of pediatric intraventricular tumor. Case Presentation: Here we present a case of a 15-month-old male child with raised intracranial pressure due to obstructive hydrocephalus. The patient was detected to be COVID-19 RT–PCR (Reverse Transcriptase Polymerase Chain Reaction) positive in the preoperative period and underwent emergency Right-sided Ventriculo Peritoneal (VP) shunt. His contrast MRI (Magnetic Resonance Imaging) Brain showed a 50×24×39 mm heterogeneously enhancing mass epicenter at third ventricle and extending to lateral and fourth ventricle with spinal drop metastasis. Preoperative differential diagnosis of Ependymoma was made and definitive surgery was done once the child recovered from COVID-19. However, his biopsy specimen pathology and Immunohistochemistry (IHC) were suggestive of anaplastic oligodendrogliomas and the child responded well to chemotherapy. Conclusion: Intraventricular ODG is an extremely rare pediatric tumor. Patients usually present with obstructive hydrocephalus. Contrast MRI findings are nonspecific and help in detecting leptomeningeal spread to the spine. IHC and chromosomal analysis are important diagnostic and treatment prognostication tools. These tumors have a high recurrence and poor prognosis despite gross total resection.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
In Young Jo ◽  
Seung-Gu Yeo ◽  
Hyuk-Jin Oh ◽  
Jae-Sang Oh

Abstract Background Choroid plexus carcinoma is an intraventricular neoplasm originating from the choroid plexus epithelium and is of rare occurrence in adults. However, owing to the low prevalence of choroid plexus carcinoma, there is very limited information about the disease entity and treatment. Here we report a rare case of choroid plexus carcinoma in an adult patient. Case presentation A 46-year-old South Korean (East Asian) male presented with low back pain, headache, and diplopia. Magnetic resonance imaging demonstrated enhancing mass lesion in the left trigone, cerebellar with leptomeningeal spread. Surgery was performed via left parietal craniotomy, and the lesion was histologically confirmed to be choroid plexus carcinoma. The patient received adjuvant craniospinal irradiation for remnant mass and leptomeningeal spread. Magnetic resonance imaging performed immediately after completion of the treatment revealed a partial decrease in the size of the tumor. However, the patient expired died as a result of acute respiratory distress syndrome before follow-up of long-term outcome. Conclusion Choroid plexus carcinoma with leptomeningeal spread in adults is very important for rapid diagnosis and treatment. In the case of the presence of leptomeningeal spread, craniospinal irradiation can be considered as a treatment method, but may have serious complications. Hence, the technique should be applied with care.


2021 ◽  
pp. 179-183
Author(s):  
Ann-Kristin Becker ◽  
Marta Leonora Frank ◽  
Michael Friese ◽  
Joachim Röther

The most malignant type of intrinsic brain tumor is glioblastoma (WHO grade IV). Primary leptomeningeal spread is rare and leads to a variety of differential considerations, as there is no typical clinical or imaging pattern. Here we present a rare and uncommon case of a primary leptomeningeal glioblastoma in combination with a low-grade glioma in a 21-year-old male, initially presenting with only headache and lower back pain. The presented case illustrates the challenging differential considerations and the severe course of leptomeningeal glioblastomas.


2021 ◽  
pp. 407-414
Author(s):  
Cong Li ◽  
Wenyu Li ◽  
Shuang Dai ◽  
Aruna Sharma ◽  
Hari Shanker Sharma ◽  
...  

2020 ◽  
Vol 17 (3) ◽  
pp. 36-40
Author(s):  
Damber Bikram Shah ◽  
Prasanna Karki ◽  
Prakash Poudel ◽  
Sumit Joshi ◽  
Prabhaw Upadhhya ◽  
...  

Lymphoplasmacyte-rich meningioma is a rare variant of World Health Organization (WHO) Grade I meningioma, which may present as diffuse granulomatous disease with leptomeningeal spread. Here, we report a case of 61 years old man who presented with gradual onset of progressive quadriperesis. Patient was initially treated with antitubercular medications as imaging studies and serum markers were suggestive of granulomatous lesion. Surgical intervention was adviced as patient did not respond to medical management. Histopathology and immunohistochemistry confirmed the diagnosis of lymphoplasmacyte-rich meningioma. This meningioma can present as diffuse leptomeningeal infiltrative lesion involving both the hemispheres and all the tentorial surfaces mimicking inflammatory lesion. Tuberculosis is very common in our part and the diffuse infiltrative nature oflymphoplasmacyte-rich meningioma with similar radiological features of these two pathologies may confuse and delay the diagnosis. Recognition of this entity is of utmost importance as it guides proper management.


2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii174-ii174
Author(s):  
Ralph Navarro ◽  
Danielle Golub ◽  
Travis Hill ◽  
Michelle McQuinn ◽  
Nora Kim ◽  
...  

Abstract BACKGROUND H3K27M-mutant midline lesions were recently reclassified by the WHO as “Diffuse Midline Glioma” (DMG) based on their molecular signature. DMG is one of the most common and most lethal pediatric brain tumors; terminal progression is typically caused by local progression or secondary leptomeningeal dissemination. H3K27M mutations have also been infrequently associated with a histologically diverse set of lesions, particularly spinal masses with early leptomeningeal spread, but the role of H3K27M in these atypical lesions remains poorly understood. CASE PRESENTATION A 15-year-old girl was found to have a T2/FLAIR-hyperintense and heterogeneously contrast-enhancing thalamic mass accompanied by severe leptomeningeal enhancement along the entire neuraxis. Initial infectious workup was negative, and open intracranial biopsy was inconclusive. Follow-up spinal arachnoid biopsy was diagnostic for H3K27M neuroepithelial tumor, thereafter classified as DMG. Biopsy also showed focal p53 immunopositivity, variable immunoreactivity for GFAP and synaptophysin, and an increased proliferation index, altogether suggestive of a glioneuronal origin. She received craniospinal irradiation (CSI) to 41.4Gy with a boost to the thalamic lesion to 54Gy. Imaging 1-month post-radiation demonstrated significant treatment response only with residual enhancement at the conus. CONCLUSIONS This case report describes the unique presentation of an H3K27M-mutant midline lesion with significant craniospinal leptomeningeal spread on admission and atypical glioneuronal histopathological markers. Given her avid leptomeningeal disease, spinal dural biopsy could have been considered earlier given its diagnostic yield in classifying the lesion as DMG. This lesion, however, additionally demonstrated synaptophysin positivity. Per extensive literature review, this histopathology is also potentially consistent with diffuse leptomeningeal glioneuronal tumor (DLGNT). This patient’s uniquely marked treatment response to CSI is also not typically observed in DMG, further supporting the possibility of an alternative molecular identity. In atypical DMG cases, particularly with early leptomeningeal spread, additional consideration of clinical and histopathological context is warranted for accurate diagnosis and prognostication.


Sign in / Sign up

Export Citation Format

Share Document