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Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature

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Abstract

We describe a 25-year-old male patient with primary diffuse leptomeningeal gliomatosis (PDLG) presenting with gait ataxia, positive Lhermitte’s sign, double vision, and right abducens nerve palsy. Spinal magnetic resonance imaging showed extended intradural, extramedullary, contrast-enhancing masses with compression of the myelon. Spinal leptomeningeal biopsy revealed a pilocytic astrocytoma WHO grade I. Despite chemotherapy with vincristin and carboplatin, the patient died 2 months after admission. A thorough autopsy showed no evidence for primary neoplasms in brain, spine and optic nerve. Sequence analysis of tumor protein 53 gene (TP53) revealed a missense mutation in exon 5, and expression of phosphatase and tensin homolog (mutated in multiple advanced cancers 1) (PTEN) protein was not detected, which may have contributed to astrocytoma development. To our knowledge, this is the first definitive case of pilocytic astrocytoma presenting as PDLG.

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Acknowledgements

We thank Karl Riabowol for critically reading and discussing our manuscript. We thank Petra Matylewski and Ulrike Lass for excellent technical assistance.

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Authors and Affiliations

  1. Department of Radiology, Neuroradiology Section, Charité Medical Center, 13344, Berlin, Germany

    Georg Bohner & Randolf Klingebiel

  2. Department of Neurology, Charité Medical Center, 13344, Berlin, Germany

    Florian Masuhr, Juri Katchanov & Rolf Zschenderlein

  3. Institute of Neuropathology, Charité Medical Center, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Roland Distl, Andreas von Deimling & Frank K. H. van Landeghem

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  1. Georg Bohner
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Correspondence to Frank K. H. van Landeghem.

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Bohner, G., Masuhr, F., Distl, R. et al. Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature. Acta Neuropathol 110, 306–311 (2005). https://doi.org/10.1007/s00401-005-1051-3

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  • DOI: https://doi.org/10.1007/s00401-005-1051-3

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