Low-grade astrocytoma with neuraxis dissemination at diagnosis

Abstract

Little is known about low-grade astrocytoma with neuraxis dissemination at diagnosis. A review of medical records identified this phenomenon in eight of 150 pediatric patients evaluated between 1985 and 1994 for histologically confirmed low-grade astrocytoma. These patients (five male and three female) ranged in age from 5 months to 20 years (median 8 years). Symptoms of neuraxis disease were minimal or absent. Primary tumor sites were the hypothalamus in four cases, brainstem/spinal cord in three, and temporal lobe in one. Patterns of dissemination (evaluated by computerized tomography and/or magnetic resonance imaging techniques) appeared to be related to the primary site: hypothalamic tumors metastasized along the ventricular cerebrospinal fluid pathways, and tumors in other locations disseminated along subarachnoid pathways. Following initial treatment with chemotherapy (in three), partial resection (in one), radiation therapy (in three), and chemotherapy plus irradiation (in one), four patients required salvage therapy for progressive or recurrent disease. Seven of the eight patients are alive with stable or progressive disease 6 to 105 months postdiagnosis (median 15 months). Low-grade astrocytoma with initial neuraxis dissemination is responsive to chemotherapy and radiation, a proportion showing periods of stable disease. The optimum therapy or combination of therapies remains unclear.

Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report

“…This is not, however, the only important factor. Tumor cells are able of crossing piamater and invade CSF pathways; their degree of adhesiveness, their metabolic capacities (adhesion molecule production, protease secretion and growth factor pathway activation) and their antigenic factors also may aid leptomeningeal spread 1,2,3,5,27 . A study with CD44 suggests that this adhesion molecule may play a role in astrocytic invasion and adherence 31 .…”

“…Leptomeningeal dissemination (LD) of primary central nervous system (CNS) tumors in children has been reported mainly in ependymomas, germ-cell tumors, primitive neuroectodermal tumors, high grade gliomas [2][3][4][5][6][7][8][9] . Low grade gliomas dissemination has been documented in few cases 1,2,5,6,9 .…”

“…Leptomeningeal dissemination (LD) of primary central nervous system (CNS) tumors in children has been reported mainly in ependymomas, germ-cell tumors, primitive neuroectodermal tumors, high grade gliomas [2][3][4][5][6][7][8][9] . Low grade gliomas dissemination has been documented in few cases 1,2,5,6,9 . Leptomeningeal dissemination of pilocytic astrocytoma in children is much more uncommon with 32 cases reported in the literature 1,2,6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] .…”

“…Low grade gliomas dissemination has been documented in few cases 1,2,5,6,9 . Leptomeningeal dissemination of pilocytic astrocytoma in children is much more uncommon with 32 cases reported in the literature 1,2,6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . These include only five with LD at diagnosis 13,[17][18][19] .…”

Intracranial Metastases of Cervical Intramedullary Low-Grade Astrocytoma without Malignant Transformation in Adult

“…When intramedullary low-grade astrocytomas metastasize intracranially, most of them have malignant transformation 6,19) . In most of the cases reported up until now, spinal cord tumors that spread intracranially had previous malignant transformation or were high-grade gliomas 7,21,24,25) , even though in children, some cases without malignant transformation have been reported 1,2,5,9,11,17) . In 1995, Claus et al 6) reported the case of a 43-year-old man with intracranial dissemination of a WHO Grade I pilocytic astrocytoma of the cauda equina.…”