Progressive multifocal exophytic pontine glioblastoma: a case report with literature review

Abstract

Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle (CPA) is rare. We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicating progressive multifocal exophytic pontine glioblastoma. Three lesions were reported, of which two were initially presented, and one was developed 2 months later. One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA. The other two lesions were located and confined within the pons. Initial magnetic resonance imaging and positron emission tomography–computed tomography indicated low-grade glioma or inflammatory disease. However, 2 and 3 months later, subsequent magnetic resonance spectroscopy (MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS, indicating a high-grade glioma. Subtotal resection was performed for the CPA lesion. Histopathologic examination showed discrepant features of different parts of the CPA lesion. The patient received no further chemotherapy or radiotherapy and died 2 months after surgery. The multifocal and exophytic features of this case and the heterogeneous manifestations on neurological images were rare and confusing for both diagnosis and surgical decision-making. Our case report may contribute knowledge and helpful guidance for other medical doctors.

Surgical management of primary and secondary pilocytic astrocytoma of the cerebellopontine angle (in adults and children) and review of the literature

“…Matsuda et al [ 29 ] summarized four cases [ 27 , 46 ] (including their case) of exophytic GBM of the cerebellum with secondary invasion in the CPA, and also other authors [ 1 , 10 , 36 ] published cases of GBM of the CPA, in some cases even with secondary invasion of the cranial nerves by GBM [ 28 , 33 ].…”

Glioblastoma in the Cerebellopontine Angle in a Patient with Neurofibromatosis Type I: A Case Report and Review of the Literature

“…Most of these tumors have an intra-axial site of origin within the cerebellum or pons and appear to exhibit secondary exophytic extension into the CPA. [4][5][6][7][8][9][10][11] Only three of the described lesions involved the IAC. 3,5,12 None of the patients in the literature had syndromic or genetic predispositions that contributed to tumorigenesis.…”

“…4,5 Within the CPA, they typically arise intra-axially from the cerebellum or pons with lateral exophytic extension. [4][5][6][7][8][9][10][11] Internal auditory canal (IAC) involvement is rare, with very few cases reported in the literature. 3,5,12 There is no documented association between CPA glioblastomas and genetic or syndromic disorders.…”

Anaplasic astrocytoma with exophytic growth in Sylvian fissure in a pediatric patient: a case report

“…The vast majority of astrocytomas are intra-axial, however, they may have exophytic growth which can resemble other intracranial neoplasms in the image. The exophytic growth of gliomas is well known in the brainstem, however, there are few reports of cases from other locations, such as cerebellopontine angle [ 2 ], cerebellum [ 3 ] and brainstem [ 4 ]. To our knowledge, there is no previous report of any case of anaplastic astrocytoma with exophytic growth at the Sylvian fissure level in the pediatric population.…”