Spinal metastasis of pilocytic astrocytoma of the chiasma opticum

Abstract

We report a case of spinal seeding of a pilocytic astrocytoma of the chiasma opticum. Microscopic examination of the optic nerve tumor and the spinal tumor showed the same pathological patterns, without any signs of anaplastic transformation. The clinical course demonstrates the low growth rate of this kind of tumor, but spinal metastasis has not yet been described. We discuss different pathophysiological explanations of this atypical biological behavior with reference to the literature.

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

“…Mamelak defined it as either diffuse subependymal or leptomeningeal dissemination beyond the margins of the primary tumor or as discrete nodular disease separate from the primary tumor mass 1 . However, multiplicity of PAs might be due to the multiple genesis of the tumor instead of tumor spread to the subarachnoid space 12 . LD and multicentric disease can be distinct pathological entities with different pathogenesis and perhaps different clinical features.…”

“…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] .…”

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

“…Leptomeningeal dissemination of the cerebellar tumours into the spinal cord might occur many years after primary surgery [45,66,78]; less commonly the meningeal seeding appears at the initial presentation [67]. Spread into the spinal meninges can be observed in PAs of the spinal cord [1,9] and optic chiasm [4,48]. Extremely rarely, spinal cord PA can spread via the cerebrospinal fluid pathway (CSF) to the cerebral meninges [69].…”

Spinal Seeding of a Pilocytic Astrocytoma following Multiple Subtotal Resections

“…The incidence of LMD in patients with PAs is indicated to range from 4% up to 12% [1, 8, 16, 22], which would possibly increase with the widespread use of MRI in cases of PAs to report leptomeningeal metastases. Yet, craniospinal metastases were stated synchronously or delayed and were independent of progression of the primary tumor [1, 2, 4,6,7,8,9, 11, 12, 14,22,23,24]. …”