Evaluation of intracranial cerebrospinal fluid cytology in staging pediatric medulloblastomas, supratentorial primitive neuroectodermal tumors, and ependymomas

Terterov, Sergei; Krieger, Mark D.; Bowen, Ira; McComb, J. Gordon

doi:10.3171/2010.5.peds09333

Cited by 35 publications

(32 citation statements)

References 14 publications

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“…The leptomeningeal disease is reported in about 30 % of medulloblastomas [ 64 ], and it is one of the major prognostic factors [ 6 ]. Therefore, the research of dissemination, by CSF cytology (lumbar and/or intracranial) together with magnetic resonance with gadolinium, plays a key role in the clinical management of these lesions.…”

Section: Cytologymentioning

confidence: 99%

Medulloblastoma: Pathology

Martino¹,

Guadagno²,

de³

2015

Posterior Fossa Tumors in Children

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Section: Cytologymentioning

confidence: 99%

Medulloblastoma: Pathology

Martino¹,

Guadagno²,

de³

2015

Posterior Fossa Tumors in Children

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“…39 Sensitivity of CSF cytology for detection of LD has ranged from 60% to 86% 14,30 and has been reported to increase with multiple spinal taps. 30,39 The sensitivity of MR imaging of the neuraxis for detecting LD has been comparatively reported to be approximate 82%–83%. 14,29 The use of both methods to assess for LD has been advocated.…”

mentioning

confidence: 99%

Use of T2 signal intensity of cerebellar neoplasms in pediatric patients to guide preoperative staging of the neuraxis

Forbes¹,

Chambless²,

Smith

et al. 2011

PED

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Object The question of whether to obtain routine or selective preoperative imaging of the neuraxis in pediatric patients with cerebellar neoplasms remains a controversial topic. Staging of the neuraxis is generally considered beneficial in patients with neoplasms associated with an elevated risk of leptomeningeal dissemination (LD). When these studies are obtained preoperatively, there is a decrease in the number of false-positive images related to debris in the immediate postoperative period. Additionally, knowledge of the extent of spread has the potential to affect the risk/benefit analysis of aggressive resection. Although the majority of pediatric neurosurgeons surveyed choose to obtain selective preoperative imaging of the neuraxis in cases of cerebellar neoplasms “with findings suggestive of high-grade pathology,” an evidence-based protocol in the literature is lacking. The goal of this study was to assess radiological characteristics of tumors with an elevated risk of LD and identify a method to help guide preoperative imaging of the neuraxis. Methods The authors first reviewed the literature to gain an appreciation of the risk of LD of pediatric cerebellar neoplasms based on underlying histopathology and/or grade. Available evidence indicates preoperative imaging of the neuraxis in patients with Grade I tumors to be of questionable utility. In contrast, evidence suggested that preoperative imaging of the neuraxis in patients with Grades II–IV neoplasms was clinically warranted. The authors then evaluated an extensive base of neuroradiological literature to identify possible MR imaging and/or CT findings with the potential to differentiate Grade I from higher-grade neoplasms in pediatric patients. They analyzed the preoperative radiological findings in 50 pediatric patients who had undergone craniotomy for resection of cerebellar neoplasms at Vanderbilt Children's Hospital since 2003 with reference to 7 chosen radiological criteria. Logistic regression models were fit using radiological features to determine the best predictors of Grades II–IV tumors. Receiver operating characteristic methods were used to identify diagnostic properties of the best predictors. Results The relative T2 signal intensity (RT2SI), an indirect measure of the water content of the solid component of the tumor, was best able to identify neoplasms with an elevated risk of LD. An RT2SI value of 0.71 was selected by the authors as the best operating point on the curve. Of the 31 neoplasms retrospectively designated as hypointense T2-weighted lesions (RT2SI ≤ 0.71), 30 (97%) were Grade II or higher. All medulloblastomas, ependymomas, and high-grade (Grades III and IV) neoplasms were hypointense T2-weighted lesions. Of the 19 T2-weighted hyperintense neoplasms (RT2SI > 0.71), 16 (84%) were Grade I and 3 were Grade II. Conclusions Measurement of the RT2SI can help predict Grade II–IV tumors at an elevated risk of leptomeningeal spread and guide staging of the neuraxis. Pediatric patients with cerebellar neoplasms found to have an RT2SI of less than or equal to 0.71 are recommended for neuraxis imaging prior to surgery.

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“…Few reports of leptomeningeal PNETs without evidence of primary tumors have been made (Table I) (4,(8)(9)(10)(11)(12)(13). These cases also occurred mainly in children and young adults, and patients usually presented with symptoms of chronic meningitis, such as headache and vomiting, which may be related to increased intracranial pressure.…”

Section: █ Discussionmentioning

confidence: 99%

Primary leptomeningeal pnets mimicking tb meningitis: a case report and literature review

Hsiao

Chen

Lee

et al. 2014

Turkish Neurosurgery

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ABSTRACTimaging (MRI) of the brain, with the addition of gadoliniumdiethylinium-diethylene triamine pentaacetic acid (Gd-DTPA) revealed diffuse linear leptomeningeal enhancement over the cerebral sulcus and bilateral sylvian fissure, without an intraparenchymal mass ( Figure 1A-C). Evaluation of the CSF from lumbar puncture revealed an initial pressure of 270 mmH 2 O, and CSF chemistry showed low glucose (26 mg/dL) and high protein (198 mg/dL) levels, but normal cell counts. The suspected diagnosis was chronic meningitis due to tuberculosis or cryptococcal infection. CSF cytology, culture, Indian ink test, autoimmune profile, and TB polymerase chain reaction (PCR) were all negative.The patient was treated with anti-tuberculosis agents and steroids for about one month, but her symptoms persisted. Lumbar puncture repeated on three occasions relieved her headache and nausea, as well as her blurred vision. CSF results remained unchanged. A right ventriculoperitoneal shunt was placed, and her symptoms gradually improved. The results of CSF studies from ventricular taps were similar to those after lumbar puncture, and cytologic results remained negative.█ INTRODUCTION P rimitive neuroectodermal tumors (PNETs) of the central nervous system (CNS) are highly malignant neoplasms that occur predominantly in children. They are typically circumscribed and carry a risk of spreading to the leptomeninges. Primary leptomeningeal PNETs are rarer and can mimic meningitis on neuro-imaging or cerebrospinal fluid (CSF) studies.We report a case of a 25-year-old female patient with primary disseminated PNET that produced elevated intracranial pressure without an identifiable mass. The final diagnosis was made through results of a spinal biopsy. █ CASE REPORTA 25-year-old previously healthy female patient had a 5-month history of episodic headaches and vomiting, with progressively blurred vision. Her symptoms occurred mostly in the early morning hours. Physical examination revealed bilateral papilledema with declining visual acuity. There were no obvious motor weakness or paresthesia. Magnetic resonance Primitive neuroectodermal tumors (PNETs) are easily detected, and the diagnosis made by neuroradiologic imaging. Leptomeningeal seeding is a common complication and carries a poor prognosis. Primary leptomeningeal PNETs are rarer and difficult to diagnose on magnetic resonance imaging (MRI) or cerebrospinal fluid (CSF) studies. We encountered a rare case of primary leptomeningeal primitive neuroectodermal tumor without intracranial mass lesion which was diagnosed by spinal lesion biopsy. This 25-year-old woman presented with worsening headaches and progressive visual impairment.The initial diagnosis was tubercle bacillus (TB) meningitis, and the final diagnosis of primary leptomeningeal PNET was made by spinal biopsy. We present this illustrative case, review previous cases in the literature, and suggest that diagnosis is considered in mildly affected patients with similar symptoms.

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Evaluation of intracranial cerebrospinal fluid cytology in staging pediatric medulloblastomas, supratentorial primitive neuroectodermal tumors, and ependymomas

Cited by 35 publications

References 14 publications

Medulloblastoma: Pathology

Medulloblastoma: Pathology

Use of T2 signal intensity of cerebellar neoplasms in pediatric patients to guide preoperative staging of the neuraxis

Primary leptomeningeal pnets mimicking tb meningitis: a case report and literature review

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