Meningiomas em pacientes pediátricos: relato de 2 casos

Abstract

RESUMO -Os meningiomas correspondem de 1% a 4% das neoplasias intracranianas primárias em pacientes pediátricos; a incidência nesta população aumenta de acordo com a faixa etária. Não há predominância quanto ao sexo, ao contrário do que acontece na população adulta onde predominam no sexo feminino. Relatamos dois casos de meningioma em crianças, discutindo os aspectos clínicos, radiológicos e histológicos desta entidade. O primeiro paciente é do sexo masculino, com 2 anos de idade e apresentava com crises convulsivas há 4 meses. Os exames de imagem revelaram uma lesão expansiva de 20 mm na região parietooccipital direita, a qual foi totalmente ressecada. Os exames histológico e imunohistoquímico definiram o diagnóstico de meningioma. Atualmente, 17 meses após a cirurgia, o paciente encontra-se bem, sem evidências de recidiva tumoral. O segundo paciente é do sexo feminino, com 11 anos, e queixava-se de cefaléia frontal há 2 anos. Os exames radiológicos demonstraram presença de lesão expansiva de 5 cm em região frontal direita. Realizou-se craniotomia frontal com ressecção total do tumor. O diagnóstico histológico foi de meningioma. Atualmente, 20 meses após a cirurgia, encontra-se sem evidência de recidiva tumoral. Os autores discutem ainda o tratamento e prognóstico dos meningiomas pediátricos ressaltando que apesar de incomuns, estes devem fazer parte do diagnóstico diferencial de lesões intracranianas expansivas nesta faixa etária. PALAVRAS-CHAVE: meningioma, crianças, sistema nervoso central. Meningiomas in pediatric patients: report of two casesABSTRACT -Meningiomas correspond to 1% -4% of primary intracranial tumors in pediatric group, with their incidence raising according to age. There is not gender prevalence, in spite of some authors describe a male tendency opposed to female one in adulthood. At present study we describe two cases of pediatric meningiomas reviewing clinical, radiological and histological aspects of these lesions. The authors review also treatment options and prognosis of childhood meningiomas. A two-year-old boy was admitted with seizures. Computerized tomography showed a right parietal lesion, which was totally resected. Histological features were compatible with meningioma. After 17 months the child is doing well, with no deficits or seizures. The second case is a 12-year-old girl, with a headache complain. During investigation, a CT revealed a right frontal lesion. She was operated under a right frontal craniotomy with total tumor resection. Nowadays she is asymptomatic, 20 months after surgery. Despite meningiomas in pediatric group are uncommon; they should be included in differential diagnosis list of expansive intracranial lesions of childhood.

Intracranial Meningiomas in Children: Report of 27 New Cases and Critical Analysis of 440 Cases Reported in the Literature

“…14,95 A high frequency of intra-or peritumoral cysts (15%) results from this analysis, whereas in the adult population, cystic forms are present in 2% to 4% of all meningiomas. 2,17,32,91,92,102,108,109 Cystic prevalence in the first 2 years of life can be ascribed to the tendency of cystic tumors to manifest earlier than solid ones. Effectively, we have found the average duration of the clinical history of meningiomas in pediatric patients (1.2 years) to be shorter than meningiomas at other ages (2.8-3.5 years).…”

“…12,13,17,54,59,60,78 The lack of dural attachment is probably due to derivation of the tumor from leptomeningeal elements lodging within the parenchyma or in or near the ventricles rather than from the dura mater. 91 Histologically, the meningiomas were mainly meningothelial (32%), 19,20,91,94,97,99,102,104,[106][107][108][109][110] followed by fibrous (25%), 9,19,20,91,[99][100][101]104 transitional (22%), 19,20,97,99,103,104,[106][107][108][109] anaplastic (9%), 19,20 angiomatous (6%), 19,20,104,107 psammomatous (2%), 99,104 atypical (1.2%), 99,100,…”

“…14,19,20,91,92,95,[97][98][99]102,104,106,108,110,111 In 13% of these cases, tumor recurrence is described. 19,20,97,99,102,104,106,108 Recurrence seems to be strictly related to incomplete resection and/or the histologic subtype of the meningioma: 54% of the recurring meningiomas were removed subtotally and 46% totally. Most of the latter were malignant or malignant variants; more precisely, 31% were anaplastic, 15% atypical, 10% papillary, and 10% sclerosing with brain invasion.…”

Diagnóstico e acompanhamento evolutivo dos meningiomas através da ressonância magnética

“…O quadro 1 evidencia os principais aspectos e características dos meningiomas. 15 ; Mazzola (2009) 16,17 ; Gasparetto et al (2007) 18 .…”

“…Em pacientes pediátricos com suturas não fundidas, pode haver aumento do perímetro cefálico. É descrito ainda déficit neurológico focal, convulsão, sinais e sintomas de hipertensão intracraniana, cefaleia e crise parcial simples motora 15 .…”