Brainstem Glioma: Comparative Study of Clinico-Radiological Presentation, Pathology and Outcome in Children and Adults

Abstract

Although the clinical and imaging features and behaviour of brain stem gliomas in children are well documented, similar data are not available, for adults. We have carried out a retrospective study, on 101 consecutive patients (71 children and 30 adults) with a histologically verified brain stem glioma. Duration of symptoms, clinical features, imaging characteristics, histopathology and outcome were specifically compared in children and adults with brain stem glioma. Peak incidence was in the first decade in children and in the third and fourth decades in adults. Mean duration of symptoms before admission was 9.7 months in adults and 3.6 months in children (P < 0.001). There were no significant differences in the clinical features between adults and children. Imaging characteristics revealed no major differences except that diffuse hypodense lesions involving the whole brainstem accounted for 41.2% of the lesions in children and only 11.1% of adults (P < 0.001). A stereotactic biopsy was performed in 92 patients and an open biopsy or partial excision in 9 patients. Histopathological examination showed that the majority of gliomas were diagnosed as grade II astrocytomas in both groups. Survival was significantly shorter in children when compared to adults (P < 0.01). While the tumour grade was a significant factor in predicting survival in adults, in children it did not correlate with outcome. Therefore, determination of the grade of a brain stem glioma may be of prognostic significance in adult patients.

Treatment of paediatric pontine glioma with oral trophosphamide and etoposide

“…But there appears to be a biologically different tumour entity in the paediatric age group of pontine glioma. In this age group, histological grading has not been of prognostic significance (Steck and Friedman, 1995;Selvapandian et al, 1999;Kaplan et al, 1996). Two distinct age peaks in the incidence of brain stem glioma (first decade and third to fourth decade of life) support this hypothesis of biologically different tumours (Tokuriki et al, 1986;Steck and Friedman, 1995;Selvapandian et al, 1999).…”

“…In this age group, histological grading has not been of prognostic significance (Steck and Friedman, 1995;Selvapandian et al, 1999;Kaplan et al, 1996). Two distinct age peaks in the incidence of brain stem glioma (first decade and third to fourth decade of life) support this hypothesis of biologically different tumours (Tokuriki et al, 1986;Steck and Friedman, 1995;Selvapandian et al, 1999). Diffuse pontine glioma in children remains almost unique as a diagnosis, in which radiation and intensive chemother-apy is done without molecular or histological diagnosis (Albright et al, 1993;Allen et al, 1999).…”

“…In other locations and age groups, tumour gradings such as the WHO classification, have proven to be of high prognostic value. This even includes adult patients with brain stem glioma (Selvapandian et al, 1999). But there appears to be a biologically different tumour entity in the paediatric age group of pontine glioma.…”

Magnetic resonance spectroscopy of atypical diffuse pontine masses

“…Third, in intrinsic pontine gliomas of childhood, histological type has not been shown to affect outcome. 19 Although the MR images are highly predictive of these tumors, other lesions with similar radiographic appearances may occur. In rare cases, inflammatory and infectious lesions, or other tumor types may develop, with important treatment and prognostic implications.…”

Tectal glioblastoma

“…In adults they are not so well known and account for less than 2% of gliomas 1 . The peak of incidence is the fi rst decade in children and third and fourth decades in adults 2 . There are no significant clinical differences between the two groups with mean duration of symptoms being usually longer in adults.…”