Pediatric posterior fossa incidentalomas
- 18 Downloads
Pediatric brain incidentalomas are increasingly being diagnosed. As the posterior fossa (PF) is the location of most brain tumors in children, lesions of this region are of special interest. Currently, the natural history of incidental lesions in the PF is unknown. We present our experience treating such lesions.
A retrospective study was carried out in two large tertiary pediatric centers. Patients were included if they had an incidental PF lesion suspected of being a tumor, and diagnosed before the age of 20 years. We analyzed treatment strategy, pathology, and outcome of operated and non-operated cases.
Seventy children (31 females) with a mean age of 8.4 ± 6.1 years were included. The three most common indications for imaging were headaches (16, assumed to be unrelated to the lesions), workup of unrelated conditions (14), and unspecified reasons (14). Twenty-seven patients (39%) were operated immediately, and 43 followed, of which 12 were eventually operated due to radiological changes, 28.9 ± 16.2 months after diagnosis. The most commonly found pathology was pilocytic astrocytomas (21 of 39 operated cases). Almost 10% were found to be malignant tumors including medulloblastomas (5) and ATRT (1).
Incidental PF lesions in children include both benign and malignant tumors. While certain lesions may be followed, others may require surgical treatment. Specific treatment decisions are based on initial radiological appearance, change in radiological characteristics over time, location, and evolving symptoms. The surgical risks must be balanced vis-à-vis the risk of missing a high-grade tumor and the very rare risk of malignant transformation.
KeywordsBrain tumor Posterior fossa tumor Incidentalomas Pediatric
We would like to thank Yaroslava A. Kozyreva for the drawing in this article, and Mrs. Adina Sherer for linguistic editing.
- 1.Broniscer A, Baker SJ, West AN, Fraser MM, Proko E, Kocak M, Dalton J, Zambetti GP, Ellison DW, Kun LE, Gajjar A, Gilbertson RJ, Fuller CE (2007) Clinical and molecular characteristics of malignant transformation of low-grade glioma in children. J Clin Oncol 25:682–689. https://doi.org/10.1200/JCO.2006.06.8213 CrossRefGoogle Scholar
- 2.Ishibashi K, Inoue T, Fukushima H, Watanabe Y, Iwai Y, Sakamoto H, Yamasaki K, Hara J, Shofuda T, Kanematsu D, Yoshioka E, Kanemura Y (2016) Pediatric thalamic glioma with H3F3A K27M mutation, which was detected before and after malignant transformation: a case report. Childs Nerv Syst 32:2433–2438. https://doi.org/10.1007/s00381-016-3161-8 CrossRefGoogle Scholar
- 4.Upadhyaya SA, Ghazwani Y, Wu S, Broniscer A, Boop FA, Gajjar A, Qaddoumi I (2018) Mortality in children with low-grade glioma or glioneuronal tumors: a single-institution study. Pediatr Blood Cancer 65. https://doi.org/10.1002/pbc.26717
- 7.Morris Z, Whiteley WN, Longstreth WT Jr, Longstreth WT, Weber F, Lee YC, Tsushima Y, Alphs H, Ladd SC, Warlow C, Wardlaw JM, al-Shahi Salman R (2009) Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 339:b3016. https://doi.org/10.1136/bmj.b3016 CrossRefGoogle Scholar
- 12.Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, Powell E, Miskin M, Dayan P, Holmes JF, Kuppermann N, for the Pediatric Emergency Care Applied Research Network (2013) Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics 132:e356–e363. https://doi.org/10.1542/peds.2013-0299 CrossRefGoogle Scholar
- 14.Jansen PR, Dremmen M, van den Berg A, Dekkers IA, Blanken LME, Muetzel RL, Bolhuis K, Mulder RM, Kocevska D, Jansen TA, de Wit MCY, Neuteboom RF, Polderman TJC, Posthuma D, Jaddoe VWV, Verhulst FC, Tiemeier H, van der Lugt A, White TJH (2017) Incidental findings on brain imaging in the general pediatric population. N Engl J Med 377:1593–1595. https://doi.org/10.1056/NEJMc1710724 CrossRefGoogle Scholar
- 16.Mistry M, Zhukova N, Merico D, Rakopoulos P, Krishnatry R, Shago M, Stavropoulos J, Alon N, Pole JD, Ray PN, Navickiene V, Mangerel J, Remke M, Buczkowicz P, Ramaswamy V, Guerreiro Stucklin A, Li M, Young EJ, Zhang C, Castelo-Branco P, Bakry D, Laughlin S, Shlien A, Chan J, Ligon KL, Rutka JT, Dirks PB, Taylor MD, Greenberg M, Malkin D, Huang A, Bouffet E, Hawkins CE, Tabori U (2015) BRAF mutation and CDKN2A deletion define a clinically distinct subgroup of childhood secondary high-grade glioma. J Clin Oncol 33:1015–1022. https://doi.org/10.1200/JCO.2014.58.3922 CrossRefGoogle Scholar
- 19.Leon SP, Folkerth RD, Black PM (1996) Microvessel density is a prognostic indicator for patients with astroglial brain tumors. Cancer 77:362–372. https://doi.org/10.1002/(SICI)1097-0142(19960115)77:2<362::AID-CNCR20>3.0.CO;2-Z CrossRefGoogle Scholar
- 20.Tate AR, Underwood J, Acosta DM, Julià-Sapé M, Majós C, Moreno-Torres À, Howe FA, van der Graaf M, Lefournier V, Murphy MM, Loosemore A, Ladroue C, Wesseling P, Luc Bosson J, Cabañas ME, Simonetti AW, Gajewicz W, Calvar J, Capdevila A, Wilkins PR, Bell BA, Rémy C, Heerschap A, Watson D, Griffiths JR, Arús C (2006) Development of a decision support system for diagnosis and grading of brain tumours using in vivo magnetic resonance single voxel spectra. NMR Biomed 19:411–434. https://doi.org/10.1002/nbm.1016 CrossRefGoogle Scholar
- 21.Vicente J, Fuster-Garcia E, Tortajada S, García-Gómez JM, Davies N, Natarajan K, Wilson M, Grundy RG, Wesseling P, Monleón D, Celda B, Robles M, Peet AC (2013) Accurate classification of childhood brain tumours by in vivo (1)H MRS - a multi-centre study. Eur J Cancer 49:658–667. https://doi.org/10.1016/j.ejca.2012.09.003 CrossRefGoogle Scholar