Skip to main content
SpringerLink
Log in

Pilocytic astrocytoma with leptomeningeal dissemination

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Pilocytic astrocytoma (PA) is a common pediatric glioma that is generally characterized by indolent growth. However, there are reports of PA disseminating throughout the central nervous system. Given the rarity of dissemination, the appropriate treatment for these patients is poorly defined. In this case series, we describe the clinical characteristics and treatment outcomes of six children treated for disseminated PA at our institution and review the current published literature.

Methods

Six cases of disseminated PA treated at the University of Texas MD Anderson Cancer Center were identified. Demographics, disease characteristics, and follow-up data were compiled. Fifty-three reported cases were identified in the published literature.

Results

Our cohort’s mean age at presentation was 7 years, and the mean time to identification of disseminated disease was 12 months after initial diagnosis. Two patients underwent chemotherapy, and all underwent proton beam radiation therapy to all or part of the craniospinal axis. With a median follow-up of 24 months after radiation therapy, five of six patients were alive, four with stable disease and one with progressive disease.

Conclusions

Treatment of disseminated PA is frequently multi-modal, including surgical resection, chemotherapy, and radiation therapy. On the basis of early clinical data, extended-field radiation therapy is a viable option for treating disseminated PA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004–2007. Source: Central Brain Tumor Registry of the United States, Hinsdale, IL. website: http://www.cbtrus.org

  2. Burkhard C, Di Patre PL, Schuler D, Schuler G, Yasargil MG, Yonekawa Y, Lutolf UM, Kleihues P, Ohgaki H (2003) A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98:1170–1174

    Article  PubMed  Google Scholar 

  3. Fouladi M, Gilger E, Kocak M, Wallace D, Buchanan G, Reeves C, Robbins N, Merchant T, Kun LE, Khan R, Gajjar A, Mulhern R (2005) Intellectual and functional outcome of children 3 years old or younger who have CNS malignancies. J Clin Oncol 23:7152–7160

    Article  PubMed  Google Scholar 

  4. Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P, Krull K, Chintagumpala M, Stargatt R, Ashley DM, Tyc VL, Kun L, Boyett J, Gajjar A (2005) Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol 23:5511–5519

    Article  PubMed  Google Scholar 

  5. Buschmann U, Gers B, Hildebrandt G (2003) Pilocytic astrocytomas with leptomeningeal dissemination: biological behavior, clinical course, and therapeutical options. Childs Nerv Syst 19:298–304

    Article  PubMed  Google Scholar 

  6. Mamelak AN, Prados MD, Obana WG, Cogen PH, Edwards MS (1994) Treatment options and prognosis for multicentric juvenile pilocytic astrocytoma. J Neurosurg 81:24–30

    Article  PubMed  CAS  Google Scholar 

  7. Pollack IF, Hurtt M, Pang D, Albright AL (1994) Dissemination of low grade intracranial astrocytomas in children. Cancer 73:2869–2878

    Article  PubMed  CAS  Google Scholar 

  8. Versari P, Talamonti G, D’Aliberti G, Fontana R, Colombo N, Casadei G (1994) Leptomeningeal dissemination of juvenile pilocytic astrocytoma: case report. Surg Neurol 41:318–321

    Article  PubMed  CAS  Google Scholar 

  9. Akar Z, Tanriover N, Kafadar AM, Gazioglu N, Oz B, Kuday C (2000) Chiasmatic low-grade glioma presenting with sacral intradural spinal metastasis. Childs Nerv Syst 16:309–311

    Article  PubMed  CAS  Google Scholar 

  10. Tamura M, Zama A, Kurihara H, Fujimaki H, Imai H, Kano T, Saitoh F (1998) Management of recurrent pilocytic astrocytoma with leptomeningeal dissemination in childhood. Childs Nerv Syst 14:617–622

    Article  PubMed  CAS  Google Scholar 

  11. Figueiredo EG, Matushita H, Machado AG, Plese JP, Rosemberg S, Marino R Jr (2003) Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report. Arq Neuropsiquiatr 61:842–847

    Article  PubMed  Google Scholar 

  12. Bruggers CS, Friedman HS, Phillips PC, Wiener MD, Hockenberger B, Oakes WJ, Buckley EG (1991) Leptomeningeal dissemination of optic pathway gliomas in three children. Am J Ophthalmol 111:719–723

    PubMed  CAS  Google Scholar 

  13. Ng HK, Leung CH, Boet R, Poon WS (2001) Spinal cord pilocytic astrocytoma with cranial meningeal metastases. J Clin Neurosci 8:374–377

    Article  PubMed  CAS  Google Scholar 

  14. Aryan HE, Meltzer HS, Lu DC, Ozgur BM, Levy ML, Bruce DA (2005) Management of pilocytic astrocytoma with diffuse leptomeningeal spread: two cases and review of the literature. Childs Nerv Syst 21:477–481

    Article  PubMed  Google Scholar 

  15. Abel TJ, Chowdhary A, Thapa M, Rutledge JC, Geyer JR, Ojemann J, Avellino AM (2006) Spinal cord pilocytic astrocytoma with leptomeningeal dissemination to the brain. Case report and review of the literature. J Neurosurg 105:508–514

    PubMed  Google Scholar 

  16. Claus D, Sieber E, Engelhardt A, Rechlin T, Neubauer U, Volk B (1995) Ascending central nervous spreading of a spinal astrocytoma. J Neurooncol 25:245–250

    Article  PubMed  CAS  Google Scholar 

  17. Gajjar A, Bhargava R, Jenkins JJ, Heideman R, Sanford RA, Langston JW, Walter AW, Kuttesch JF, Muhlbauer M, Kun LE (1995) Low-grade astrocytoma with neuraxis dissemination at diagnosis. J Neurosurg 83:67–71

    Article  PubMed  CAS  Google Scholar 

  18. Kocks W, Kalff R, Reinhardt V, Grote W, Hilke J (1989) Spinal metastasis of pilocytic astrocytoma of the chiasma opticum. Childs Nerv Syst 5:118–120

    Article  PubMed  CAS  Google Scholar 

  19. Auer RN, Rice GP, Hinton GG, Amacher AL, Gilbert JJ (1981) Cerebellar astrocytoma with benign histology and malignant clinical course. Case report. J Neurosurg 54:128–132

    Article  PubMed  CAS  Google Scholar 

  20. Zorlu F, Selek U, Akyuz C, Ozturk A, Soylemezoglu F, Akalan N (2005) Spinal seeding of a pilocytic astrocytoma following multiple subtotal resections. Pediatr Neurosurg 41:248–252

    Article  PubMed  Google Scholar 

  21. Fellgiebel A, Erbguth F, Neundorfer B (2001) Polyradiculopathy and ataxia: clinical manifestation of late recurrence of pilocytic astrocytoma with cerebral and spinal dissemination. Nervenarzt 72:143–146

    Article  PubMed  CAS  Google Scholar 

  22. Faria AV, Azevedo GC, Zanardi VA, Ghizoni E, Queiroz LS (2006) Dissemination patterns of pilocytic astrocytoma. Clin Neurol Neurosurg 108:568–572

    Article  PubMed  Google Scholar 

  23. McCowage G, Tien R, McLendon R, Felsberg G, Fuchs H, Graham ML, Kurtzberg J, Moghrabi A, Ferrell L, Kerby T, Duncan-Brown M, Stewart E, Robertson PL, Colvin OM, Golembe B, Bigner DD, Friedman HS (1996) Successful treatment of childhood pilocytic astrocytomas metastatic to the leptomeninges with high-dose cyclophosphamide. Med Pediatr Oncol 27:32–39

    Article  PubMed  CAS  Google Scholar 

  24. Mishima K, Nakamura M, Nakamura H, Nakamura O, Funata N, Shitara N (1992) Leptomeningeal dissemination of cerebellar pilocytic astrocytoma. Case report. J Neurosurg 77:788–791

    Article  PubMed  CAS  Google Scholar 

  25. Kanda M, Tanaka H, Shinoda S.et al (2002) Leptomeningeal dissemination of pilocytic astrocytoma via hematoma in a child. Case report. Neurosurg Focus 13: ECP2

  26. Crabtree KL, Arnold PM (2010) Spinal seeding of a pilocytic astrocytoma in an adult, initially diagnosed 18 years previously. Pediatr Neurosurg 46:66–70

    Article  PubMed  Google Scholar 

  27. Bohner G, Masuhr F, Distl R, Katchanov J, Klingebiel R, Zschenderlein R, von Deimling A, van Landeghem FK (2005) Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature. Acta Neuropathol 110:306–311

    Article  PubMed  Google Scholar 

  28. Morikawa M, Tamaki N, Kokunai T.et al (1997) Cerebellar pilocytic astrocytoma with leptomeningeal dissemination: case report. Surg Neurol 48: 49–51; discussion 51–42

  29. Obana WG, Cogen PH, Davis RL, Edwards MS (1991) Metastatic juvenile pilocytic astrocytoma. Case report. J Neurosurg 75:972–975

    Article  PubMed  CAS  Google Scholar 

  30. Jamjoom AB, Jamjoom ZA, al-Rayess M (1998) Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report. Br J Neurosurg 12:56–58

    Article  PubMed  CAS  Google Scholar 

  31. Andrychowski J, Taraszewska A, Czernicki Z, Jurkiewicz J, Netczuk T, Dabrowski P (2009) Ten years observation and treatment of multifocal pilocytic astrocytoma. Folia Neuropathol 47:362–370

    PubMed  Google Scholar 

  32. Civitello LA, Packer RJ, Rorke LB, Siegel K, Sutton LN, Schut L (1988) Leptomeningeal dissemination of low-grade gliomas in childhood. Neurology 38:562–566

    Article  PubMed  CAS  Google Scholar 

  33. McLaughlin JE (1976) Juvenile astrocytomas with subarachnoid spread. J Pathol 118:101–107

    Article  PubMed  CAS  Google Scholar 

  34. Parsa CF, Givrad S (2008) Juvenile pilocytic astrocytomas do not undergo spontaneous malignant transformation: grounds for designation as hamartomas. Br J Ophthalmol 92:40–46

    Article  PubMed  CAS  Google Scholar 

  35. Janss AJ, Grundy R, Cnaan A, Savino PJ, Packer RJ, Zackai EH, Goldwein JW, Sutton LN, Radcliffe J, Molloy PT et al (1995) Optic pathway and hypothalamic/chiasmatic gliomas in children younger than age 5 years with a 6-year follow-up. Cancer 75:1051–1059

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shelly X. Bian, Mary F. McAleer, Anita Mahajan & David R. Grosshans

  2. Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tribhawan S. Vats

  3. Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1150, Houston, TX, 77030, USA

    David R. Grosshans

Authors
  1. Shelly X. Bian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary F. McAleer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tribhawan S. Vats
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anita Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David R. Grosshans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David R. Grosshans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bian, S.X., McAleer, M.F., Vats, T.S. et al. Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst 29, 441–450 (2013). https://doi.org/10.1007/s00381-012-1970-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-012-1970-y

Keywords

Search

Navigation