Glioblastoma multiforme with very rapid growth and long-term survival in children: report of two cases and review of the literature

Glioblastoma occurs rarely in pediatric patients (0.6–7.9% of all glioblastomas). Symptom duration is about 3–5 months prior to diagnosis with a dismal prognosis (median survival of 50 weeks). The authors describe two pediatric age patients with histopathologically confirmed glioblastoma multiforme whose lesions appeared within just 1 week of normal computed tomography scan and magnetic resonance imaging. Both patients had long-term survival (one of them 6 years and the other 3 years and 7 months) following tumor resection. The present report serially illustrates the very rapid development of glioblastoma in childhood and emphasizes the importance of serial neuroimaging as well as paying attention to sudden onset headaches in pediatric patients with inconclusive imaging findings.     

Glioblastoma multiforme presenting with ischemic stroke: case report and review of the literature

A 58-year-old woman presented with acute onset of global aphasia. Imaging studies revealed a left frontotemporal enhancing tumor and ischemic stroke in the territory of the middle cerebral artery. The patient was operated on, and the diagnosis of glioblastoma multiforme was confirmed. At the time of surgery, several branches of the left middle cerebral artery were found embedded in the tumor. One branch, which was infiltrated by tumor and completely occluded, was resected to achieve complete resection. Postoperatively, the stroke area within the middle cerebral artery territory increased, together with worsening of the patient's clinical status, thus requiring urgent decompressive craniectomy. Thereafter, the patient gradually improved, and received radiation therapy and chemotherapy with no recurrence after 24 months of follow-up. To our knowledge, glioblastomas presenting with ischemic stroke are rare, and such patients should be considered to be at high surgical risk.     

Glioblastoma of the cerebellum in children: report of five cases and review of the literature

Purpose

Cerebellar glioblastomas in children are rare. As a result, an optimal treatment strategy has not yet been identified. A review of the characteristics of the disease as well as the effectiveness of various therapeutic modalities would help in optimizing the treatment paradigm.

Methods

We performed a detailed clinical, radiographic, and pathologic retrospective review of five patients (three boys and two girls, average age at presentation 7.2 years (range, 3–14 years)) and surveyed the literature for an additional 55 cases.

Results

Computed tomography and magnetic resonance imaging usually revealed a large lesion with minimal edema, heterogeneous contrast enhancement, and a discrete border. Subtotal tumor resection was performed in two patients and gross total resection in three patients. Immunostaining of the tumor cells with antisera to glial fibrillary acidic protein and vimentin was variably positive. Adjuvant therapy included local radiation and chemotherapy in all followed patients. Tumor recurrence was seen in two patients. Patients were followed from 2 months to 3.5 years (mean, 12 months). Two patients were dead at last follow-up with a mean survival of 9.5 months.

Conclusions

The prognosis for pediatric patients with cerebellar glioblastomas is dismal, even when compared to adult counterparts or other malignant posterior fossa tumors in children. Cerebellar glioblastomas have a tendency to recur and disseminate despite treatment with surgery, chemotherapy, and radiation. The poor outcomes seen with this tumor suggest that the optimal treatment strategy has yet to be elucidated and much work needs to be done.     

Glioblastoma multiforme in a child with acute lymphoblastic leukemia: case report and review of literature

An 11-year-old boy with acute lymphoblastic leukemia had received prophylactic cranial irradiation (1800 cGy /10 fractions) and intrathecal methotrexate. Five years later, he developed a glioblastoma multiforme in the right frontal region while the leukemia was in remission. It is possible that the glioma may have been induced by radiation and /or chemotherapy.     

Congenital glioblastoma multiforme: a report of three cases and a review of the literature

The clinical histories, histologic features, and immunohistochemical staining patterns for glial fibrillary acidic protein, vimentin, p53, and epidermal growth factor receptor (EGFR) of three cases of congenital glioblastoma multiforme are given and previous case reports are reviewed. Of the three cases reported in this series, two have had long-term survivals of greater than 2 1/2 and 5 1/2 years after surgery and surgery followed by chemotherapy, respectively. Both of these cases also demonstrated p53 protein accumulation, a finding in pediatric glioblastoma multiforme associated with poor prognosis. The third case occurred in an infant who died at birth and demonstrated a well-circumscribed tumor that did not invade adjacent brain parenchyma. Considering these three cases, the biological behavior in congenital glioblastoma multiforme may not be unfavorable as portrayed in the literature or as seen in its adult counterpart.     

婴儿头颅骨化性骨膜下血肿的个体化治疗

目的 探讨婴儿头颅骨化性骨膜下血肿的治疗方法及其疗效。方法 回顾性分析2015年6月至2021年10月收治的13例婴儿骨化性骨膜下血肿的临床资料。结果 2例外板较薄且不连续患儿采取穿刺抽吸术+加压包扎治疗,11例外板较厚且连续患儿采取骨化外板切除术治疗。13例均治愈;术中、术后无需输血,无头皮下感染、复发。术后随访半年,头颅外形均恢复正常,复查头颅CT显示颅骨恢复正常形态,脑组织发育正常。结论 婴儿骨化性骨膜下血肿应尽早治疗,薄层骨化行血肿穿刺抽吸术+加压包扎;出现厚壁骨化行骨化外板切除术是一种简单、有效的治疗措施。     

Glioblastoma presenting as spontaneous intracranial haemorrhage: Case report and review of the literature

Glioblastoma (GB) classically presents with symptoms of raised intracranial pressure and gradual progressive neurological deficits. An acute presentation, with intracerebral haemorrhage (ICH) and rapid clinical deterioration, occurs infrequently. Contemporary imaging modalities do not reliably reflect underlying mass lesions in parenchymal brain haemorrhage at first presentation. We report a delayed diagnosis of GB in a 21-year-old patient presenting with spontaneous ICH and a negative initial neurovascular workup. A comprehensive literature review was performed to investigate the incidence of malignant aetiology for spontaneous ICH in young adults, and to underscore the importance of early utilisation of diagnostic magnetic resonance imaging (MRI) in such cases.     

Meningioangiomatosis: report of two cases and literature review

Meningioangiomatosis (MA) is a rare benign intracraneal lesion. The majority of cases are sporadic although the association of this lesion with familial neurofibromatosis (NF) type 2 is well known. NF-associated MA may be multifocal and is often asymptomatic and diagnosed at autopsy. Non-associated cases are usually symptomatic, occurs in children and young adults and frequently arise in leptomeninges and underlying cerebral cortex. In the present work, we describe two new non-associated cases of MA in two boys, seven and one year old with seizures that disappeared after surgical excision. Histopathologically, the lesion was predominantly cellular in one case and more fibrous in the other. From the literature review we concluded that sporadic cases present as single lesions which manifest by seizures or persistent headaches. Rarely MA has been described to coexist with meningiomas. Histopathologically, MA is characterized by a plaque-like proliferation of meningothelial and fibroblast- like cells surrounding small vessels and trapping islands of gliotic cortical tissue. The lesion does not show significant atypia, mitosis or necrosis. Although all cases of MA share unifying features, there are different degrees of histological presentation with cases predominantly cellular and others more fibrous and calcified. This could correspond to different stages in the evolution of the MA. Symptoms disappear with the complete excision of the lesion.     

Psychogenic movement disorders in children: A report of 15 cases and a review of the literature

Data on psychogenic movement disorders (PMD) in children are scarce, with most existing literature relating to adults only. We report 15 cases with the aim of highlighting the clinical characteristics, risk factors, comorbidity, treatment, outcome, and prognosis of PMD in children. Only 13% of cases had onset before age 10, with the mean age at onset being 12.3 years. Females were predominantly affected (F:M = 4:1). The most common types of movement disorders seen were dystonia (47%), tremor (40%), and gait disorders (13%). Multiple hyperkinetic phenomenologies were observed in many cases. Abrupt onset and precipitation by minor injuries, and stressful life events were commonly reported. Clinical clues on examination suggesting a psychogenic origin were similar to those identified in adults. A distinct feature of PMD in children was the predominant involvement of the dominant limb. The underlying psychiatric diagnosis was conversion disorder in the majority of cases. Time from symptom onset until diagnosis of a PMD varied broadly (between 2 weeks and 5 years). Treatment with cognitive and behavioral therapy and rehabilitation by a multidisciplinary team led to improvement in most cases. However, treatment was much more effective in children with a short time from symptom onset to diagnosis and treatment. © 2008 Movement Disorder Society     

Glioblastoma multiforme and meningioma in the same patient - a case report

We describe a case of a 64-year-old female who presented with concurrent left parietal glioblastoma multiforme and left occipital parasagittal meningioma. Both lesions were excised during the operation. There was no clinical evidence of phacomatosis. Aetiological and clinical aspects of the phenomenon are discussed.     

Glioblastoma multiforme of the cerebellum

Glioblastoma multiforme (GBM) is a highly malignant glial tumor seen commonly in the cerebral hemispheres, but rarely encountered in the cerebellum. It may occur at any age, but is seen more often in adult age groups. Despite its rarity, GBM should be considered in patients with a ring-enhancing lesion in the cerebellum. No consensus regarding the best management has yet been established. However, multimodal treatment is currently available to deal with these lesions: wide excision with radiochemotherapy may improve and prolong the patients life. Although the outcome remains dismal, we emphasize that timely multi modal treatment may provide the patient a better outcome and longer life. Herein, we report 2 new cases of cerebellar GBM and discuss their outcome and present a review of the relevant literature.     

Glioblastoma multiforme in the Muir-Torre syndrome

Muir-Torre syndrome (MTS) is an autosomal dominant subtype of nonpolyposis colorectal carcinoma (HNPCC) characterized by the development of sebaceous gland tumors and visceral malignancies. The most common subtype of MTS is characterized by germline mutations in mismatch repair (MMR) genes leading to microsatellite instability (MSI). Central nervous system tumors have only rarely been associated with MTS. In this report, we describe the development of a glioblastoma multiforme (GBM) in a patient with MTS. Immunohistochemical analysis of the patient's colon carcinoma and his GBM both revealed loss of the mismatch repair proteins mutS homolog 2 (MSH2) and mutS homolog 6 (MSH6).     

Sellar-suprasellar tuberculomas in children: 2 cases and literature review

Sellar and suprasellar tuberculomas are rare. Patients with these lesions usually experience headache, vomiting, and hypofunction of pituitary gland; imaging reveals an enhancing sellar-suprasellar mass. We report 2 rare cases of sellar-suprasellar tuberculomas in children aged 8 and 6 years. One child presented with features of headache and vomiting, and the other presented with posterior pituitary dysfunction. In both cases, imaging revealed sellar-suprasellar masses. Both cases were multidrug-resistant tuberculomas. We discuss sellar-suprasellar tuberculomas, a rare form of neurotuberculosis in the background of an overall increase in multidrug-resistant tuberculosis, especially in children.     

中枢神经细胞瘤5例报告及文献复习

目的探讨提高中枢神经细胞瘤诊疗水平的策略和方法。方法回顾分析2004年8月至2006年4月我院收治的5例中枢神经细胞瘤，总结其临床表现、影像学表现、病理学特征及显微外科手术治疗效果。结果肿瘤位于侧脑室前部或室间孔附近，呈宽基底与侧脑室壁或透明隔相连。肿瘤边缘及内部可见多发囊泡，常见钙化，MRI检查T1WI、T2WI相均表现为等或略高信号，增强后呈轻至中度强化。免疫组织化学染色均显示神经突触素阳性。显微外科手术治疗5例，其中全切除4例，次全切除1例，1例死于术后并发症，4例随访至今未复发。结论中枢神经细胞瘤影像学表现具有一定特征，是术前诊断的重要参考。显微手术切除肿瘤是最佳的治疗手段，预后良好。