RARE-05. ANAPLASTIC ASTROCYTOMA AND OLIGODENDROGLIOMA PRESENTING AS SIMULTANEOUS PRIMARY BRAIN TUMORS IN A PEDIATRIC PATIENT: THE FIRST KNOWN REPORT OF A RARE CONDITION

Multiple metastatic brain tumors and multiple histologically identical primary brain tumors have been reported in adults and children. The concurrent presence of multiple histologically distinct primary brain tumors is rare without prior chemotherapy, radiotherapy, or phacomatosis. Exceedingly rare are simultaneous histologically distinct primary brain tumors in children without therapeutic or genetic predisposition, with only five previously reported cases. Gliomas are the most common primary brain tumor in adults and children. Gliomas encompass a heterogenous group characterized by astrocytic, oliogodendroglial, and ependymomal histology, further subdivided into pathologic World Health Organization (WHO) grades I to IV. In children, grade I astrocytomas are the most common, with grade III astrocytomas (anaplastic astrocytomas) and oligodendrogliomas being rare. We report a case of simultaneous anaplastic astrocytoma and grade II oligodendroglioma in a pediatric patient. A previously healthy 6-year-old female presented with persistent headaches. Initial magnetic resonance imaging (MRI) demonstrated non-enhancing right frontal lobe and left peri-thalamic lesions without mass affect. Serial MRIs showed progression of both lesions, prompting frontal lobe biopsy, which revealed a grade II oligodendroglioma. The patient was started on standard low-grade glioma chemotherapy, which was stopped due to an allergic reaction. Following chemotherapy cessation, both lesions increased in size, and the peri-thalamic lesion demonstrated new heterogenous enhancement. The patient underwent gross-total resection of the peri-thalamic lesion and repeat biopsy of the frontal lobe lesion. Pathology confirmed the frontal lobe lesion to be a grade II oligodendroglioma and revealed the peri-thalamic lesion to be an anaplastic astrocytoma. The tumors were additionally proven molecularly distinct. The patient responded well to cranial radiotherapy and standard high-grade glioma chemotherapy. To the best of the authors’ knowledge, this is the first case of simultaneous anaplastic astrocytoma and oligodendroglioma in a child, increasingly unique given the histological and molecular rarity of the tumors in pediatric patients.

Recurrent bilateral frontal lobe lesion with maladaptive schema modes and PTSD symptoms: a case study

The frontal lobe is responsible for high-order functioning, such as memory, attention, decision-making, and personality. Lesions in the frontal lobe may lead to different physical and psychological problems. The current study was conducted to examine the emotional, cognitive, and behavioural states and coping strategies of a patient with recurrent bilateral frontal lobe lesion. It also attempted to determine post-traumatic stress disorder (PTSD) symptoms in a patient. This study described the case of an adult with recurrent bilateral frontal lobe tumour. It covered the clinical presentation, administration of Urdu translation of the Schema Mode Inventory (SMI) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and analysis of the case. The results of the study showed that the recurrent bilateral frontal lobe brain tumour patient engaged in child mode and had a dysfunctional coping style and a maladaptive punitive parent mode. Furthermore, the patient also had moderate PTSD symptoms. Continuous....

Intracranial intraaxial cerebral tufted angioma: case report

Tufted angioma (TA) is a rare, slow-growing, vascular lesion that commonly presents as a solitary macule, papule, or nodule arising in the soft tissues of the torso, extremities, and head and neck in children and young adults. Adult-onset cases have been infrequently reported. While typically benign, TAs may be locally aggressive. Complete physical examination and hematological workup are recommended in patients with TA to exclude the presence of Kasabach-Merritt phenomenon (KMP). The authors describe the case of a 69-year-old man with a contrast-enhancing frontal lobe lesion, with surrounding vasogenic edema, which was treated by gross-total resection. Characteristic histological features of a TA were demonstrated, with multiple cannonball-like tufts of densely packed capillaries emanating from intraparenchymal vessels in cerebral cortex and adjacent white matter. Tumor recurrence was detected after 4 months and treated with adjuvant Gamma Knife radiosurgery. To the extent of the authors' knowledge, this case illustrates the first report of TA presenting in an adult as an intracranial intraaxial tumor without associated KMP. The fairly rapid regrowth of this tumor, requiring adjuvant treatment after resection, is consistent with a potential for locally aggressive growth in a TA occurring in the brain.

Agrammatism in Adult Persian Broca's Aphasia: A Case Study

The grammar of a right-handed monolingual adult native speaker of Persian who suffered from Broca's aphasic following a left hemisphere frontal lobe lesion subsequent to CVA was analyzed, discussed, and compared with control data. The spontaneous speech and descriptive speech were designed and performed. The data suggested that Persian agrammatism appears like this syndrome in other studied languages; there are severe impairments in the verbs and patients rely more on nouns than on verbs. The patterns of omissions and substitutions of grammatical morphemes seem show extreme variations in different patients, both in terms of the occurrence of errors in different grammatical morphemes as and in terms of the occurrence of omissions versus substitutions. There were also some language-particular patterns.

Orbital Cellulitis with Exudative Retinal Detachment

Exudative retinal detachment occurs extremely rarely with orbital cellulitis. TB can affect majority of the structures of the eye with marked variability of the lesions. We herein report a 40 year old male who presented with acute left eye protrusion with sudden diminution of vision. On examination there was proptosis of the left eye with restricted extraocular movements. Exudative retinal detachment with subretinal abscess was present in the same eye. Magnetic Resonance Imaging (MRI) of brain showed right sided frontal lobe lesion suggestive of tuberculoma with positive Quantiferon - TB Gold test.