Diseminación leptomeníngea de un astrocitoma pilocítico cervical en el adulto: publicación de un caso y revisión de la literatura

Jusué-Torres, I.; Alcázar-Vaquerizo, L.; Gómez-Angulo, J. C.; Navarro-Torres, R.; López-Serrano, R.; García-Miralles, N.
October 2011
Revista Neurocirugia;oct2011, Vol. 22 Issue 5, p445
Academic Journal
Background. The rarest location of pilocytic astrocytoma is intramedullary. Gliomas represent up to 24 - 30% of intramedullary tumors in adulthood and are second only after ependymomas. Leptomeningeal dissemination through cerebrospinal luid is unusual and occurs predominantly in medulloblastomas, ependymoblastomas, central neuroblastomas, ependymomas, germ cell tumors and high-grade gliomas. The majority of spinal cord gliomas reporting metastasis were anaplastic astrocytomas or glioblastomas multiforme and relatively few were low-grade gliomas. The incidence of leptomeningeal spread of low-grade tumors is rare. A rare cranial extension of brain leptomeningeal dissemination in an intramedullary pilocytic astrocytoma during adulthood is reported. Case report. A 51 year-old-man with a recurrent intramedullary mass at C5-C7 level operated 4 times with all pathological anatomy reports describing the lesion as Pilocytic Astrocytoma developed, after 15 years from the diagnosis, visual hallucinations and his level of consciousness worsened to Glasgow coma score 13/15. The MRI showed highly enhanced cranial and spinal leptomeninges and paquimeninges with a micro-nodular-granulomatous aspect associated with intense affectation of basal cisterns, subarachnoid spaces and convexity of both cerebral hemispheres suggestive of leptomeningeal spread of the spinal mass. The patient expired after three days. Conclusion. Leptomeningeal spread is a rare phenomenon and when it happens usually doesn't change the primary tumor's behavior. In our case the aggressivenes could be explained by a potential malignization of the primary tumor that it wasn't documented because of the partial resectionss from the lasts surgeries or instead the tumor was actually a monomorphous pilomyxoid tumor.


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