Imaging diagnosis
Case 314
【Progress】
He was introduced to center of Mother-Children Medical Hospital for further management.
【Discussion】
When brain tumor is categorized into low and high differentiated, low differentiated tumor is aggressive with malignant character while highly differentiated tumor is relatively obedient with benign character. Meanwhile, low grade tumor indicates gradually growing with relatively obedient, while high grade tumor indicated more aggressive with malignant character.
Brain tumor is the second highest mortality rate in children followed by acute leukemia (1-3). The most common brain tumor is glioma. Glioma is categorized into three or four types: pilocytic astrocytoma, (diffuse astrocytoma), anaplastic astrocytoma, glioblastoma multiforme (2). Of the gliomas, optic glioma and brain stem glioma are representative in children. The incidence of pilocystic astrocytoma in supratentorial area in children is most (4).
There are several brain diseases at temporal lobe causing epilepsy or headache in children. The representing diseases are temporal sclerosis, cortical dysplasia and meningioangiomatosis, and tumors such as pilocytic astrocytoma, DNET (dysembryoplastic neuroepithelial tumor), ganglioglioma, and pleomorphic xanthastrocytoma (4-10). Cortical dysplasia and meningioangiomatosis belong to hamartoma (5). Pilocystic astrocytoma, ganglioneuroma and DNET belong low-grade glioma, Grade 1 (5-8), while pleomorphic xanthoastrocytoma which is a kind of anaplastic astrocytoma Grade II (9, 10).
As cystic tumors with solid component in temporal lobe of children, are listed pilocystic astrocytoma, ganglioneuroma, DNET and pleomorphic xanthoastrocytoma. Of these, pleomorphic xanthoastrocytoma tend to be aggressive (4-10).
Our case came to our hospital for loss of consciousness, a kind of epilepsy, and MRI depicted a lesion with cystic and solid components in the left temporal lobe whose configuration is small, localized and smooth margin associated with no water molecules restriction, implying obedient character and Glioma grade I rather than Grade II.
【Summary】
We presented a nine-year-old boy for temporary loss of consciousness often in the morning. MRI showed a lesion with cystic and solid component in left temporal lobe. It is borne in mind that epilepsy in children onset at temporal sclerosis, hamartoma such as cortical dysplasia and meningioangiomatosis, and tumors such as pilocytic astrocytoma, DNET (dysembryoplastic neuroepithelial tumor), ganglioglioma, and pleomorphic xanthastrocytoma. Although tumors causing epilepsy own cystic and solid components, pilocytic astrocytoma, DNET (dysembryoplastic neuroepithelial tumor), ganglioglioma are Grade I glioma, while pleomorphic xanthoastrocytoma is Grade II glioma.
【References】
1.Brain Tumor Statistics. American Brain Tumor Association. January 2017.
2.Key Statistics for Brain and Spinal Cord Tumors. American Cancer Society. January 4, 2018.
3.Resende LL, et al. Imaging of brain tumors in children: the basics—a narrative review. Transl Pediatr. 2021 Apr; 10(4): 1138–1168.
4.Koeller K & Rushing E. From the Archives of the AFIP: Pilocytic Astrocytoma: Radiologic-Pathologic Correlation. Radiographics. 2004;24(6):1693-708
5.Takahashi A, et-al. Frequent association of cortical dysplasia in dysembryoplastic neuroepithelial tumor treated by epilepsy surgery. Surg Neurol. 2005;64 : 419-427.
6.Fernandez C, et al. The usefulness of MR imaging in the diagnosis of dysembryoplastic neuroepithelial tumor in children: a study of 14 cases. AJNR Am J Neuroradiol. 2003;24 : 829-34.
7.Lang, F. et al. Central nervous system gangliogliomas. Part 2: Clinical outcome. Journal of Neurosurgery. 1993; 79 : 867–873
8.Rumboldt Z, et al. Brain Imaging with MRI and CT. (2012) ISBN: 9781139576390 - Google Books
9.Rippe D, et al. MRI of Temporal Lobe Pleomorphic Xanthoastrocytoma. J Comput Assist Tomogr. 1992;16(6):856-9. doi:10.1097/00004728-199211000-00004 - Pubmed
10.Crespo-Rodríguez A, et al. MR and CT Imaging of 24 Pleomorphic Xanthoastrocytomas (PXA) and a Review of the Literature. Neuroradiology. 2007;49(4):307-15.
2023.10.20