Low-grade medullary astrocytoma presenting with supratentorial malignant glioma. Is it dissemination and malignant transformation?

Article type: Research Article

Authors: Kumar, Raj | Kawal, Priyanka | Mehrotra, Anant | Mahapatra, Ashok K.

Affiliations: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Note: [] Correspondence: Dr. Raj Kumar, Department of Neurosurgery SGPGIMS, Raibarelli road 226014, Lucknow, India. Tel.: +91 522 2494440; 09450610933; Fax: +91 522 2668017/2668973; E-mail: rajkumar@sgpgi.ac.in, rajkumar1959@gmail.com

Abstract: Astrocytomas are the most common pediatric brain tumors and account for 40.9% of cerebral and 7.7% of all childhood cancers. Here we present a 16 yr male child who was diagnosed and operated for astrocytoma (grade II) of medulla oblongata; he received radiotherapy for residual tumor postoperatively. The patient developed large anaplastic astrocytoma (grade III) in splenium of corpus callosum and bilateral parieto-occipital region after 3 yr of first operation. It seems this tumor disseminated from brainstem, though primary site remained silent because of the effect of postoperative radiation therapy. It might have disseminated through ventricular cerebrospinal fluid pathways. Little is known about low-grade astrocytoma with dissemination and their malignant transformation to high-grade glioma. The optimum therapy or combinations of therapies for such tumors remains unclear. Few aspects of dissemination and malignant transformation of low-grade astrocytoma to high-grade or appearance of fresh tumor etc are discussed in this report.

Keywords: Metastasis in glioma, malignant transformation of low-grade glioma, brain stem gliomas

DOI: 10.3233/JPN-2011-0468

Journal: Journal of Pediatric Neurology, vol. 9, no. 2, pp. 265-269, 2011