J Korean Neurosurg Soc.  2012 Feb;51(2):109-112. 10.3340/jkns.2012.51.2.109.

Leptomeningeal Dissemination of a Low-Grade Brainstem Glioma without Local Recurrence

• Moon JH
• Jung TY
• Jung S
• Jang WY

• KMID: 1441421
• DOI: http://doi.org/10.3340/jkns.2012.51.2.109

Abstract

It is rare for low-grade gliomas to disseminate to the leptomeninges. However, low-grade gliomas with dissemination to the leptomeninges have been occasionally reported in children, and have generally been associated with local recurrence. A 16-year-old boy sought evaluation for diplopia and gait disturbance. A brain magnetic resonance imaging (MRI) revealed pontine mass, which was proved to be fibrillary astrocytoma on biopsy, later. Radiation therapy (5400 cGy) was given and the patient's symptoms were improved. He was followed-up radiologically for brain lesion. Seven months after diagnosis he complained of back pain and gait disturbance. A brain MRI showed a newly-developed lesion at the left cerebellopontine angle without an interval change in the primary lesion. A spinal MRI demonstrated leptomeningeal dissemination of the entire spine. Radiation therapy (3750 cGy) to the spine, and adjuvant chemotherapy with a carboplatin plus vincristine regimen were administered. However, he had a progressive course with tumoral hemorrhage and expired 13 months after diagnosis. We report an unusual case of a low-grade brainstem glioma with spinal dissemination, but without local recurrence, and a progressive course associated with hemorrhage.

Keyword

Children; Leptomeningeal dissemination; Low-grade glioma; Recurrence

MeSH Terms

Adolescent
Astrocytoma
Back Pain
Biopsy
Brain
Brain Stem
Carboplatin
Cerebellopontine Angle
Chemotherapy, Adjuvant
Child
Diplopia
Gait
Glioma
Hemorrhage
Humans
Magnetic Resonance Imaging
Recurrence
Spine
Vincristine
Carboplatin
Vincristine

Figure

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  Fig. 1 Initial radiologic findings. Brain MRI demonstrates 2.0×2.4 cm pontine lesion with low-signal intensity on T1 weighted image (A) and high-signal intensity on T2 weighted image (B) without gadolinium enhancement (C). The mass showed the edema on flair image (D). MRI : magnetic resonance imaging.

• 

  Fig. 2 Pathologic findings. The histologic features are conspicuous cytoplasmic processes, mild nuclear pleomorphism, modest hyperchromasia, and no mitotic activity. A fibrillary astrocytoma is diagnosed (original magnification ×200).

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  Fig. 3 Radiologic findings of leptomeningeal dissemination without local recurrence. (A) On the follow-up 4 months after diagnosis, decreased tumor size is noted. (B) On the follow-up 7 months after diagnosis, brain MRI shows a newly-developed lesion at the left cerebellopontine angle without an interval change in the primary lesion compared to last images. A spinal MRI demonstrates leptomeningeal dissemination of the entire spine including cervical (C) and lumbar (D) spinal canal. MRI : magnetic resonance imaging.

• 

  Fig. 4 Radiologic findings of tumor progression with hemorrhage. A : A brain MRI shows an enlarged lesion associated with hemorrhage (high-signal intensity on T1 weighted image) at the left cerebellopontine angle. B : A brain CT shows an enlarged hemorrhagic lesion involving the left cerebellopontine angle and pre-pontine space. MRI : magnetic resonance imaging, CT : computed tomography.

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