Aggressively recurring cervical intramedullary anaplastic astrocytoma in a pregnant patient

Background: Many patients with spinal juvenile pilocytic astrocytoma can experience prolonged remission after resection. However, some reports suggest that pregnancy may be associated with progression. Case Description: The authors provide an image report highlighting a case of rapid and aggressive transformation of an intramedullary astrocytoma of the cervical spine in a pregnant patient. Over the course of 1 year, the lesion progressed from a juvenile pilocytic astrocytoma to an anaplastic astrocytoma. Genetic testing revealed mutations associated with aggressive behavior. Conclusion: The case and associated imaging demonstrate the importance of close neurologic monitoring and counseling regarding risk of progression in pregnant patients with spinal gliomas.

ROLE OF DIFFUSION WEIGHTED MRI IN DIFFERENTIAL DIAGNOSIS OF PAEDIATRIC POSTERIOR FOSSA TUMORS

Background: Infratentorial tumors accounts for 65% of all paediatric tumors, and most common infratentorial tumors in children include juvenile pilocytic astrocytoma (JPA), medulloblastoma, ependymoma and brainstem glioma. An accurate diagnosis has important clinical implications related to treatment and prognosis. DWI and ADC maps provide information regarding the cellularity of tumors and have an important role in the preoperative differentiation of different tumor types. Aim: To evaluate the role of DWI and ADC measurement in distinguishing between the most common pediatric posterior fossa tumors. Methods: In this study, we evaluated 25 paediatric patients aged between 1 to 15 years suspected to have posterior fossa mass on the CT referred from neurosurgery department to our department for MRI brain. All these patients subjected to conventional MRI followed by diffusion MR imaging and calculation of the ADC values. Written consent was taken from the guardians. Results: In juvenile pilocytic astrocytoma ( n = 10), ADC values ranged between 1.3 and 1.9 × 10?3 mm2/s, ependymoma (n = 8), ADC values ranged between 1.1 and 1.5 × 10?3 mm2/s and medulloblastoma (n = 7), ADC values ranged between 0.45 and 0.9 × 10?3 mm2/s. Statistically significant difference in ADC value was detected between JPA, ependymomas and medulloblastomas, while no statistically significant difference was detected between JPA and ependymomas. Conclusion: Diffusion Imaging plays an important role in demonstrating the features of posterior fossa brain tumours for appropriate diagnosis of medulloblastomas, ependymomas, and pilocytic astrocytoma. Keywords: DWI, MRI, Posterior fossa

Radical Resection of Cerebellar Juvenile Pilocytic Astrocytoma - A 22-Year Survival: A Case Report

Summary Juvenile pilocytic astrocytoma (JPA) is a low-grade glioma, a most common astrocytoma in young patients. It is a tumor with relatively well-defined margins. Pilocytic astrocytomas (PA) comprise approximately 5-6% of all gliomas. Gross total resection ensures a radical cure of patients and long-time survival. In the literature, the data on the survival rate of more than 20 years is scarce. A 5.5-year old boy with a history of 3-month complaints of headache, dizziness, and vomiting was diagnosed after CT to harbour a hypodense cerebellar tumor mass, situated in the midline-right hemisphere. The compression of the fourth ventricle resulted in rostral hydrocephalus with transependymal resorption. Within a week, a VP shunt was applied, followed by a radical Nafziger-Town operation. Gross total resection of the tumor was achieved. Profound clinical improvement was observed immediately after the operation. Postoperative CT scans, including the ones 22 years after the operation, remained practically normal. The patient is now 28-year old and is a perspective economist now. He leads a healthy working life. In general, the prognosis is excellent. If the tumor is completely removed by surgery, the chances of being “cured” are very high. Pilocytic astrocytoma has a five-year survival rate in over 96 percent in children and young adults, which is one of the highest survival rates of any brain tumor. However, there is even a small percent possibility for malignant transformation (1-4%).