Magnetic Resonance Scans Should Replace Biopsies for the Diagnosis of Diffuse Brain Stem Gliomas

Abstract

Children's Cancer Group Protocol CCG-9882 was designed to determine the effectiveness of hyperfractionated radiation for the treatment of children and young adults with brain stem gliomas. The study opened for the accrual of patients on September 21, 1988, and was closed on June 30, 1991. The first 54 children in the study were treated with irradiation doses of 100 cGy given twice daily to a total dosage of 7200 cGy. The next 66 children were treated with a similar daily regimens to a total of 7800 cGy. Tumors were diagnosed by clinical and radiographic criteria. Decisions about the need for surgery were left to the discretion of the treating neurosurgeon; tissue diagnosis did not alter the therapy in patients with diffuse infiltrating tumors. We reviewed the neuroradiology and neurosurgery reports as well as the pathological specimens of children entered on the study. By magnetic resonance (MR) imaging criteria, tumors involved the majority of the brain stem in 76% of cases; only three patients had tumors localized to the midbrain or medulla. Operations were performed on 56 of 120 patients (47%). Cerebrospinal fluid shunts were inserted in 27 (23%) of the children; insertion of a shunt was the only operation in 11, and a shunt was inserted in conjunction with a tumor operation in 16. Tumor operations were performed in 45 (38%) of the patients; 24 had stereotactic biopsies, and 21 had craniotomies. Of the 21 patients who had craniotomies, only biopsies were performed in 11; partial tumor resections were performed in 5 patients and subtotal resection in 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of paediatric pontine glioma with oral trophosphamide and etoposide

“…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).…”

“…By now, MRI morphology differentiates at least three groups of tumours to be treated in very different ways (Barkovich et al, 1990(Barkovich et al, , 1991Albright et al, 1993;Fischbein et al, 1996). (i) The dorsally exophilic cervicomedullary tumours appear to benefit significantly from surgical resection (Epstein and Constantini, 1996).…”

Expression of glioma-associated antigens in pediatric brain stem and non-brain stem gliomas

“…Radiologically, these lesions generally have a characteristic appearance on magnetic resonance imaging that, in most instances, obviates the need for a biopsy to establish the histological diagnosis in children with an appropriate clinical history [3]. Accordingly, in recent years, these lesions have seldom been biopsied.…”

“…Accordingly, in recent years, these lesions have seldom been biopsied. In the limited numbers of cases where tissue has been obtained, the diagnosis was most often high-grade glioma [3][4][5][6][7]. Given the paucity of information about the biology of brain stem gliomas, it is often necessary to make inferences about their molecular characteristics based on studies of pediatric highgrade gliomas at non-brain stem sites.…”

Pontine Malignant Astrocytoma With Hemorrhagic Onset-Case Report-

“…Therefore, the diagnosis of pontine gliomas should be established by imaging studies. 2,6) The onset and imaging findings were atypical for pontine glioma in our case, so we performed hematoma removal and open biopsy to establish the differential diagnosis from vascular malformations such as cavernous angioma. Histologically, the biopsy specimens identified a highly malignant astrocytic tumor, but diagnosis was anaplastic astrocytoma due to the absence of necrosis and endothelial proliferation.…”