Thalamic tumors in children

Cuccia,; Monges, J

doi:10.1007/s003810050128

Cited by 61 publications

(45 citation statements)

References 11 publications

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“…In contrast, cerebellar tumors cause clumsiness, worsening headache, nausea, vomiting, and manifestations of hydrocephalus are common. Visual defects and hypothalamic dysfunctions are often present tumors arising in the optic nerve-chiasmahypothalamic axis which are often associated with NF1 [ 4 ].…”

Section: Pilocytic Astrocytomamentioning

confidence: 99%

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Tumors of the Central Nervous System

Fung

Petropoulou

2014

Pediatric Malignancies: Pathology and Imaging

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Knowledge of normal neuroanatomy and neurodevelopment is critical to proper diagnosis. A few normal structures may be mistaken as tumor particularly on frozen sections.The external granular layer (Fig. 6.1a ) is a layer of small neurons that covers the external surface of fetal/infant cerebellum. It is quite prominent at the time of birth but is almost completely regressed by the ninth postnatal month. It should not be misinterpreted as medulloblastoma or lymphocytic infi ltration in younger infants. The internal granular layer is also composed of small neurons. Without a size comparison, these cells may be mistaken for medulloblastoma or other small blue cell tumors in minute specimens or cytologic preparations. Conversely medulloblastoma cells, particularly those with smaller nuclei, can be mistaken as internal granular cells. Purkinje cells are rather large and should not be mistaken as rhabdoid cells (Fig. 6.1b ). Other normal structures that can be mistaken for neoplastic tissue include the posterior pituitary and the pineal gland which may be mistaken as glial neoplasm and normal choroid plexus being mistaken as choroid plexus papilloma. These misinterpretations are likely to be committed when the specimen is minute and communication between the pathologist and the neurosurgeon is poor. Overview and Classifi cationTumor of the CNS is not uncommon in the pediatric age group and some of these entities occur only rarely in adults (Table 6.1 ). While meningiomas are very common in adults, it is uncommon in children and almost nonexistent in infants. The most common pediatric tumors in descending order of frequency are pilocytic astrocytoma, diffuse astrocytomas, medulloblastomas, and craniopharyngiomas. Ependymal neoplasms and schwannomas are the most frequent infratentorial tumors. Most tumors occur in the brain with a supratentorial-to-infratentorial ratio of approximately 2-to-1. Malignant CNS neoplasms represent 16.6 % of all malignancies in the pediatric age group. In general, the incidence is higher in males than females and among white compared to black children. The incidence is 36.2 per million between infancy and 7 years of age and 21.0 per million between 7 and 10 years of age. As a group, they are the second most frequent malignancy and most common solid tumor in pediatric patients. About 2,200 new cases are diagnosed annually in the United States. Among CNS malignancies, astrocytic tumors account for 52 %, while medulloblastoma and primitive neuroectodermal tumor (PNET), other gliomas, and ependymomas accounted for 21, 15, and 9 %, respectively [ 2 ].In contrast to adults, there is a high occurrence of malignancies in the cerebellum and brain stem in young children. About 40 % of all thalamic tumors arise in patients under 18 years old and account for 2-5 % of all intracranial tumors in children [ 3 ]. About two third or pediatric thalamic tumors are high grade in histology [ 4 ]. Tumor of the spinal cord represents about 9.9 % and extramedullary tumors are slightly more common than intramedullary...

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Section: Pilocytic Astrocytomamentioning

confidence: 99%

“…About 40 % of all thalamic tumors arise in patients under 18 years old and account for 2-5 % of all intracranial tumors in children [ 3 ]. About two third or pediatric thalamic tumors are high grade in histology [ 4 ]. Tumor of the spinal cord represents about 9.9 % and extramedullary tumors are slightly more common than intramedullary tumors [ 5 ].…”

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confidence: 99%

Tumors of the Central Nervous System

Fung

Petropoulou

2014

Pediatric Malignancies: Pathology and Imaging

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“…Of these publications, 20 were case series (Table). 1,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Histologically, the vast majority (70%-90%) of reported thalamic tumors are classified as astrocytoma. However, this literature is limited and difficult to interpret regarding histologic subtypes in children, as many studies combine age groups, are confined to more specific entities (eg, pilocytic astrocytoma (PA) or ''high-grade astrocytoma''), group biologically distinct entities (eg, PA and low-grade diffuse astrocytoma [DA] as ''low-grade astrocytoma''), or are single case reports.…”

Section: Epidemiologymentioning

confidence: 99%

“…But with improved surgical techniques, total or partial resection is now more frequently performed, particularly for noninfiltrating, low-grade tumors. [1][2][3][4][5][6][7][8][9][10][11][12][13] Additionally, children with even incompletely resected low-grade thalamic gliomas can have a 5-year overall survival rate greater than 80% with adjuvant chemotherapy and radiation. 13,14 Therefore, histologic verification is now thought to be critical for planning treatment, and, as a result, biopsy and total/subtotal resections are much more common today than in the past.…”

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confidence: 99%

Pediatric Thalamic Gliomas: An Updated Review

Gupta¹,

Shaller

McFadden³

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Neoplasms originating in the thalamus are rare overall (1% of all brain tumors); however, they comprise approximately 5% of pediatric intracranial tumors and approach 15% of all malignant pediatric intracranial tumors in some series.Objective.-To update readers about the current understanding of the diverse histology, biology, and behavior of pediatric thalamic tumors. Histologic verification is now thought to be critical for planning treatment, and, as a result, biopsy and total/subtotal resections are much more common today than in the past.Data Sources.-A PubMed search using the keywords ''pediatric þ thalamic þ glioma'' yielded 45 publications with a total of 445 cases of thalamic gliomas in patients less than 18 years of age. We found only 9 substantial institutional series tabulating all encountered thalamic histologic types in children. This survey confirmed a high proportion of astrocytomas, 81% (214 of 265), of which approximately two-thirds were diffuse astrocytomas (146 of 214) and one-third were pilocytic astrocytomas (68 of 214). Of the diffuse astrocytomas, 34% (49 of 146) were low grade (World Health Organization grade II) and 55% (81 of 146) were high grade (World Health Organization grade III or IV), making the latter subgroup the largest single category of all pediatric thalamic tumors. Oligodendrogliomas and ependymomas (mostly anaplastic in both cases) comprised 10% and 3% of all pediatric thalamic tumors, respectively.Conclusions.-Tissue diagnosis is now thought crucial for prognostication and treatment, particularly as more potentially therapeutic molecular targets are discovered. Secure diagnosis allows identification of tumors for which resection is more feasible and beneficial.

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“…4,6,9,13,21 Although the benefits of GTR for survival in patients with JPA have been described, concerns exist regarding postoperative neurological outcomes following surgery in the thalamus. 2,8,13,18,35 The use of volumetric stereotactic resection techniques for resection of thalamic JPAs has decreased the incidence of postoperative deficits and has enabled complete resection and favorable long-term survival. 24,25,27,28,32,34,35 Diffusion tensor imaging and white matter tractography are relatively new additions to MR imaging, which exploit the preferential movement of water protons within the brain along the axis of axons.…”

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confidence: 99%

Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma

Moshel¹,

Elliott²,

Monoky

et al. 2009

PED

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Object The choice of surgical approach during resection of a thalamic juvenile pilocytic astrocytoma (JPA) is dictated by the location of the displaced normal thalamus and posterior limb of the internal capsule (PLIC). Diffusion tensor (DT) imaging and white matter tractography can identify the location of the PLIC in relation to the tumor and may be useful in planning the operative trajectory. Methods Diffusion tensor imaging was used to localize the PLIC on preoperative MR imaging in 6 children undergoing resection of thalamic JPAs. After review of the standard T2-weighted MR imaging sequences, the anticipated position of the PLIC was determined. This result was compared with the location of the PLIC determined by a blinded radiologist with the use of DT imaging. The utility of DT imaging in determining the surgical approach to a thalamic JPA, degree of resection, and neurological outcomes were all evaluated. Results Diffusion tensor imaging confirmed the expected location of the PLIC as approximated on conventional T2-weighted images in all 6 cases. In 1 patient in particular, unexpected medial deviation of the PLIC was identified, and this proved useful in tailoring the approach to a more lateral trajectory. Gross-total resection of all cystic and solid tumor components was confirmed on postoperative imaging in all cases. All patients experienced mild to moderate worsening of neurological status immediately following resection, but 4 of 6 patients were back to their preoperative baseline at 6-month follow-up. Conclusions Diffusion tensor imaging and white matter tractography successfully identified the white matter fibers emanating from the precentral gyrus within the PLIC in children with thalamic JPAs prior to surgery. Diffusion tensor imaging served as a valuable tool for stereotactic planning of operative approaches to thalamic JPAs. Localizing the position of the PLIC helped minimize potential neurological morbidity and facilitated gross-total resection.

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Thalamic tumors in children

Cited by 61 publications

References 11 publications

Tumors of the Central Nervous System

Tumors of the Central Nervous System

Pediatric Thalamic Gliomas: An Updated Review

Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma

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