Cystic pilomyxoid astrocytoma on suprasellar region in 7-year-old girl: Treatment and strategy

Abstract

Pilomyxoid astrocytoma (PMA) is a recently described entity with similar features to pilocytic astrocytoma but with a rare occurrence. As a new diagnosis, no treatment guideline of PMA has been established; but generally, as for any low-grade gliomas, radical resection is performed if the location is favorable. In this report, we wished to share our experience treating the PMA. The authors presented a case of a 7-year-old girl with bitemporal hemianopia. From the history, the patient had a 4-month history of headache, following with nausea and projectile vomiting 1 week before hospital admission. Past history of seizure, weakness of left extremities, and decreased consciousness were reported. Computed tomography (CT) scanning showed acute obstructive hydrocephalus and an isohypodense mass at suprasellar region with the cystic component. We performed ventriculo-peritoneal-shunt to reduce the acute hydrocephalus, followed by craniotomy tumor removal 2 weeks later. The patient underwent radiotherapy and medical rehabilitation. Diagnosis of PMA was made on the basis of pathologic anatomy result, which showed a myxoid background with pseudorosette. Postoperative CT showed a residual tumor at right parasellar area without hydrocephalus. After the surgery, the treatment was followed with radiotherapy for 20 times within 2 months. Postradiation CT performed 1-year later showed a significant reduction of the tumor mass. There were no new postoperative deficits. The patient had improvement of the visual field and motor strength. The authors reported a case of a 7-year-old girl with PMA. Surgical resection combined with radiotherapy was performed to control the growth of PMA. More observation and further studies are required to refine the treatment methods.

The impact of extent of resection in surgical outcome of pilomyxoid astrocytoma: a case study

“…Chemotherapy is currently used sparingly for incurable or partly resected malignancies, and it may postpone the need for radiation in early infancy. Radiotherapy is often reserved for patients over the age of 5 who have had an initial surgical resection and have tumors near the midline [16].…”

Pilomyxoid Astrocytoma: Case Report

“…2 Surgery is not an option when it cannot be performed without aggravating or creating neurological deficit. 10 Granted that PMA is mainly located on the hypothalamus, GTR is often not possible, leading to partial or subtotal resection of the tumor. 5,7 Ventriculoperitoneal shunt is often performed, given the findings of mass effect and symptoms of intracranial hypertension.…”

“…5,7 Ventriculoperitoneal shunt is often performed, given the findings of mass effect and symptoms of intracranial hypertension. 10 Adjuvant therapy is administered in the cases in which surgery is not an option of treatment, GTR is not possible or in cases of recurrence of the tumor. 2 The main types of adjuvant therapy are chemotherapy, radiotherapy and radiosurgery.…”

“…Chemotherapy is the usual choice of treatment, once PMA is more frequent during infancy and radiosurgery and radiotherapy are not indicated in early ages. 7,10 Surgery is considered the choice of treatment for recently diagnosed circumscribed gliomas in which the rates of progression of disease are lower; however, PMA shows a higher rate of recurrence after surgery when compared with PA. 5,6,10 Regarding relapsed tumors, a combined therapy consisting of surgery, chemotherapy and radiotherapy displayed more favorable outcomes. 5 This case report shows a 16-year-old female patient with the diagnosis of PMA who underwent subtotal resection of the tumor associated with adjuvant therapy with temozolomide and radiosurgery, as the patient is old enough to accept radiation.…”

Nanomedicine in Clinical Photodynamic Therapy for the Treatment of Brain Tumors

“…Histologically, it shows greater cellular abnormalities and evidence of cell proliferation (mitosis) compared to Grade II tumors. Surgical resection is not considered a complete cure for these tumors and will always need to be followed by radiation therapy and chemotherapy [ 29 ].…”