Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Pilocytic astrocytoma (PA) is a low grade benign tumor, commonly occurs in Cerebellum (42-60%), Optic & hypothalamic region (9-30%), Brain Stem (9%). They rarely spread. It rarely occurs within the ventricle. In this report, we described our experience with cranial pilocytic astrocytoma in a 14-year-old child, who initially treated with near total decompression of tumor. Four and half years later, recurrence of primary tumor with obstructive hydrocephalus occurred for which he underwent ventriculo-peritoneal shunt followed by re-excision. As further treatment was being evaluated for radiotherapy in view of recurrence at the primary site, he got detected to have significant spinal drop metastasis seen on MRI Spine. Finally, he underwent craniospinal irradiation (CSI).

RAS/MAPK Pathway Alteration in Pediatric Low-Grade Glioma Complicated with Ventriculo-Peritoneal Shunt Related Ascites

Introduction: Ventriculo-Peritoneal Shunt (VPS) related ascites is a rare complication of pediatric Low Grade Gliomas (pLGG). Physiopathology of this complication is not fully understood and there is paucity of data regarding the molecular profile of pLGG gliomas complicating with ascites and the optimal management of this unusual event. Methods: International multi-institutional retrospective analysis of patients diagnosed with BRAF altered pLGG and ascites arising as a complication of VPS. Demographics, tumor characteristics, therapeutic approaches and outcomes were recorded. Results: Nineteen patients were identified. Median age at diagnosis was 14 months (IQR:7-16). Most patients (16;84.2%) presented with lesions involving the optic pathway. Mean tumor standard volume was 34.8 cm2 (range:12.5-85.4). Pilocytic Astrocytoma was the most frequent histological diagnosis (14;73.7%). Eight (42.1%) tumors harbored BRAF V600-E mutation and seven (36.8%) KIAA1549 fusion. The onset of ascites was documented at a median time of 5 months following VPS insertion. Four (21%) patients were managed with paracentesis only, 7(36.8%) required both paracentesis and shunt diversion, 7(36.8%) required only a shunt diversion and 1 (5,2%) patient was managed conservatively. Ascites was the indication to change chemotherapy regimen in 10 patients. Eight patients received targeted therapy (4 dabrafenib/4 trametinib) and 5 were radiated. Eleven patients were alive at the time of this report with a median OS of 69 months (range:3-144). Conclusions: Ascites is an early feature in the course of pLGG irrespective of alterations in the RAS/MAPK pathway with high mortality rate and should be considered as an adverse prognostic risk factor in pLGG.

Operated case of tubercular meningitis with hydrocephalus in an immunocompromised patient and acute abdomen-management controversy: a case report

Tuberculosis is a very common infectious disease in developing countries like India. Most common form includes pulmonary tuberculosis. Other common forms are tubercular meningitis and intestinal tuberculosis. Hydrocephalus is one of the commonest complications of tubercular meningitis. We present a HIV positive case who had tubercular meningitis with hydrocephalus and was operated for ventriculoperitoneal shunting, later developed intestinal tuberculosis with perforation peritonitis. The presentation of an acute abdomen with a ventriculo-peritoneal shunt requires skillful diagnostic workup and management. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration. Tuberculosis has multiple presentations all of which should be kept in mind.

VENTRICULO PERITONEAL SHUNT WITH ABDOMINAL PSEUDOCYST – MANAGEMENT, A CASE SERIES STUDY.

Hydrocephalus is the excess accumulation of cerebral spinal uid. The appropriate management option for an individual still remains a dilemma in many situations. We discuss a case series of 10 patients with who presented with abdominal pseudocyst, to arrive at a conclusion which treatment option will be best for the individual

Low Detection Rate of H3K27M Mutations in Cerebrospinal Fluid Obtained from Lumbar Puncture in Newly Diagnosed Diffuse Midline Gliomas

Recent studies have suggested the feasibility of detecting H3K27M mutations in the cerebrospinal fluid of diffuse midline glioma (DMG) patients. However, cerebrospinal fluid from patients in these studies were collected mainly during biopsy, ventriculo-peritoneal shunt procedures or postmortem. We assessed circulating tumor DNA (ctDNA) extracted from cerebrospinal fluid (CSF) and plasma in a series of 12 radiographically suspected and/or pathologically confirmed diffuse midline glioma patients and assessed for H3F3A K27M mutation using digital droplet PCR. In 10 patients, CSF was obtained by lumbar puncture at presentation. A definitive detection of H3F3A K27M mutation was achieved in only one case (10%); H3F3A K27M mutation was suspected in three other cases (30%). H3F3A K27M mutation was detected in two patients in CSF obtained by ventricular tap during a ventriculo-peritoneal shunt for obstructive hydrocephalus. Cases in which a definitive assessment was possible (definite H3F3A K27M or definite H3F3A wildtype) tended to be younger (median 7.5 years vs. 40.5 years; p = 0.07) and have a higher concentration of CSF protein (median 123 mg/dL vs. 27.5 mg/dL; p = 0.21) compared to nondefinite cases. Low proliferation and apoptotic rates seemed to be characteristics of DMG unfavorable for liquid biopsy. More advanced lesions with necrosis and evidence of dissemination were unlikely to be candidates for lumbar puncture due to the fear of exacerbating obstructive hydrocephalus. Methods to safely sample CSF and a more sensitive detection of ctDNA are necessary for reliable liquid biopsy of DMG at presentation.