Simultaneous choroid plexus carcinoma and pilocytic astrocytoma in a pediatric patient

Case report

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  • 1 Department of Neurosurgery, Providence Hospital and Medical Center, Michigan State University, Southfield;
  • 2 Departments of Pathology and
  • 3 Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
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Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence. The authors report the case of a 4-year-old boy with simultaneous choroid plexus carcinoma and pilocytic astrocytoma with features of oligodendroglioma. Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas. A multiple staged resection was carried out for each tumor and gross-total resection was achieved. Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma. To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.

Abbreviation used in this paper: NF = neurofibromatosis.

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Contributor Notes

Address correspondence to: Kristophe J. Karami, D.O., M.S., Department of Neurosurgery, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, Michigan 48075. email: kristophe.karami@stjohn.org.
  • 1

    Bailey P, & Cushing HW: A Classification of the Tumors of the Glioma Group on a Histogenetic Basis With a Correlated Study of Prognosis Philadelphia, JB Lippincott Co, 1926. 175

    • Search Google Scholar
    • Export Citation
  • 2

    Baughman FA Jr, , List CF, , Williams JR, , Muldoon JP, , Segarra JM, & Volkel JS: The glioma-polyposis syndrome. N Engl J Med 281:13451346, 1969

    • Search Google Scholar
    • Export Citation
  • 3

    Bhattacharjee MB, & Brunner JM: P53 in pediatric malignant astrocytomas: a study of 21 patients. J Neurooncol 32:225233, 1997

  • 4

    Butti G, , Giodana MT, , Paoletti P, & Schiffer D: Multiple primary intracranial tumors of different cell types: association of anaplastic astrocytoma and acoustic neuroma—with review of the literature. Surg Neurol 18:336342, 1982

    • Search Google Scholar
    • Export Citation
  • 5

    Choi IS, & Tantivatana J: Neuroendovascular management of intracranial and spinal tumors. Neurosurg Clin N Am 11:167185, 2000

  • 6

    Cooper DR: Contiguous meningioma and astrocytoma in brain. N Y State J Med 4:969972, 1969

  • 7

    Courville CB: Multiple primary tumors of the brain. Review of the literature and report of twenty-one cases. Am J Cancer 26:703731, 1936

    • Search Google Scholar
    • Export Citation
  • 8

    Davis GA, , Fabinyi GC, , Kalnins RM, , Brazenor GA, & Rogers MA: Concurrent adjacent meningioma and astrocytoma: a report of three cases and review of the literature. Neurosurgery 36:599605, 1995

    • Search Google Scholar
    • Export Citation
  • 9

    Deen HG, & Laws ER: Multiple primary brain tumors of different cell types. Neurosurgery 8:2025, 1981

  • 10

    Do HM, , Marx WF, , Khanam H, & Jensen ME: Choroid plexus papilloma of the third ventricle: angiography, preoperative embolization, and histology. Neuroradiology 43:503506, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Drlicek M, , Aichholzer M, , Wurm G, , Bodenteich A, & Fischer J: [Collision tumour composed of glioblastome and meningioma— a case report.]. Pathologe 25:402405, 2004. (Ger)

    • Search Google Scholar
    • Export Citation
  • 12

    Ellenbogen RG, , Winston KR, & Kupsky WJ: Tumors of the choroid plexus in children. Neurosurgery 25:327335, 1989

  • 13

    Fitzpatrick LK, , Aronson LJ, & Cohen KJ: Is there a requirement for adjuvant therapy for choroid plexus carcinoma that has been completely resected?. J Neurooncol 57:123126, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Flinter FA, & Neville BG: Examining the parents of children with tuberous sclerosis. Lancet 2:1167, 1986

  • 15

    Grundy RG, , Wilne SA, , Weston CL, , Robinson K, , Lashford LS, & Ironside J, : Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study. Lancet Oncol 8:696705, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Gupta N: Choroid plexus tumors in children. Neurosurg Clin N Am 14:621631, 2003

  • 17

    Johnson MH, , Chiang VL, & Ross DA: Interventional neuroradiology adjuncts and alternatives in patients with head and neck vascular lesions. Neurosurg Clin N Am 16:547560, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Kimonis VE, , Goldstein AM, , Pastakia B, , Yang ML, , Kase R, & DiGiovanna JJ, : Clinical manifestations in 105 persons with nevoid basal cell carcinoma syndrome. Am J Med Genet 69:299308, 1997

    • Search Google Scholar
    • Export Citation
  • 19

    Kuroiwa T, , Ohta T, , Kobata H, , Yamamoto H, & Kimura N: Coexistence of intracranial meningioma and primary malignant lymphoma—case report. Neurol Med Chir (Tokyo) 30:268271, 1990

    • Search Google Scholar
    • Export Citation
  • 20

    Krutilkova V, , Trkova M, , Fleitz J, , Gregor V, , Novotna K, & Krepelova A, : Identification of five new families strengthens the link between childhood choroid plexus carcinoma and germline TP53 mutations. Eur J Cancer 41:15971603, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Lanzino DJ, & Lanzino G: Decompressive craniectomy for spaceoccupying supratentorial infarction: rationale, indications, and outcome. Neurosurg Focus 8:5 e3, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Lee EJ, , Chang CH, , Wang LC, , Hung YC, & Chen HH: Two primary brain tumors, meningioma and glioblastoma multiforme, in opposite hemispheres of the same patient. J Clin Neurosci 9:589591, 2002

    • Search Google Scholar
    • Export Citation
  • 23

    Levy ML, , Goldfarb A, , Hyder DJ, , Gonzales-Gomez I, , Nelson M, & Gilles FH, : Choroid plexus tumors in children: significance of stromal invasion. Neurosurgery 48:303309, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    Litofsky NS, , Hinton D, & Raffel C: The lack of a role for p53 in astrocytomas in pediatric patients. Neurosurgery 34:967983, 1994

  • 25

    Lorusso G, & Rüegg C: The tumor microenvironment and its contribution to tumor evolution toward metastasis. Histochem Cell Biol 130:10911103, 2009

    • Search Google Scholar
    • Export Citation
  • 26

    Lothe RA, , Saeter G, , Danielsen HE, , Stenwig AE, , Høyheim B, & O'Connell P, : Genetic alterations in a malignant schwannoma from a patient with neurofibromatosis (NF1). Pathol Res Pract 189:465474, 1993

    • Search Google Scholar
    • Export Citation
  • 27

    Malamud N, & Batzdorf U: The problem of multicentric gliomas. J Neurosurg 20:122136, 1963

  • 28

    Malkin D, , Chilton-MacNeill S, , Meister LA, , Sexsmith E, , Diller L, & Garcea RL: Tissue-specific expression of SV40 in tumors associated with the Li-Fraumeni syndrome. Oncogene 20:44414449, 2001

    • Search Google Scholar
    • Export Citation
  • 29

    Marra A, , Rampono G, & Grimaldi G: Simultaneous occurrence of right supratentorial meningioma and glioblastome multiforme. Acta Neurochir (Wien) 36:8391, 1977

    • Search Google Scholar
    • Export Citation
  • 30

    Matyja E, , Kuchna I, , Kroh H, , Mazurowski W, & Zabek M: Meningiomas and gliomas in juxtaposition: casual or causal coexistence? Report of two cases. Am J Surg Pathol 19:3741, 1995

    • Search Google Scholar
    • Export Citation
  • 31

    McEvoy AW, , Harding BN, , Phipps KP, , Ellison DW, , Elsmore AJ, & Thompson D, : Management of choroid plexus tumor in children: 20 years experience at a single neurosurgical center. Pediatr Neurosurg 32:192199, 2000

    • Search Google Scholar
    • Export Citation
  • 32

    McGirr SJ, , Ebersold MJ, , Scheithauer BW, , Quast LM, & Shaw EG: Choroid plexus papillomas: long-term follow-up results in surgically treated series. J Neurosurg 69:843849, 1988

    • Search Google Scholar
    • Export Citation
  • 33

    Myerson PG: Multiple tumors of the brain of diverse origin. J Neuropathol Exp Neurol 1:406415, 1942

  • 34

    Ostertag B, Anatomie und Pathologie der raumfordernden Prozesse des Schädelbinnenraums. Krause F: Die Spezielle Chirurgie der Gehirnkrankheiten Stuttgart, Enke, 1941. Vol 3:377624

    • Search Google Scholar
    • Export Citation
  • 35

    Otten ML, , Riina HA, , Gobin YP, & Souweidane MM: Preoperative embolization in the treatment of choroid plexus papilloma in an infant. Case report. J Neurosurg 104:6 Suppl 419421, 2006

    • Search Google Scholar
    • Export Citation
  • 36

    Packer RJ, , Perilongo G, , Johnson D, , Sutton LN, , Vezina G, & Zimmerman RA, : Choroid plexus carcinoma of childhood. Cancer 69:580585, 1992

    • Search Google Scholar
    • Export Citation
  • 37

    Pencalet P, , Sainte-Rose C, , Lellouch-Tubiana A, , Kalifa C, , Brunelle F, & Sgouros S, : Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 88:521528, 1998

    • Search Google Scholar
    • Export Citation
  • 38

    Pollack IF, , Finkelstein SD, , Woods J, , Burnham J, , Holmes EJ, & Hamilton RL, : Expression of p53 and prognosis in children with malignant gliomas. N Engl J Med 346:420427, 2002

    • Search Google Scholar
    • Export Citation
  • 39

    Quigg M, & Miller JQ: Clinical findings of the phakomatoses: tuberous sclerosis. Neurology 65:E22E23, 2005

  • 40

    Raco A, , Cervoni L, & Salvati M: Two distinct intracranial tumors of different cell types in a single patient. Case report and review of the literature. Neurosurg Rev 17:305308, 1994

    • Search Google Scholar
    • Export Citation
  • 41

    Raimondi AJ, & Tomita T: Medulloblastoma in childhood. Acta Neurochir (Wien) 50:127138, 1979

  • 42

    Riccardi VM: Von Recklinghausen neurofibromatosis. N Engl J Med 305:16171627, 1981

  • 43

    Rieke K, , Krieger D, , Adams HP, , Aschoff A, , Meyding-Lamade U, & Hacke W: Therapeutic strategies in space-occupying cerebellar infarction based on clinical, neuroradiological and neurophysiological data. Cerebrovasc Dis 3:4555, 1993

    • Search Google Scholar
    • Export Citation
  • 44

    Rieke K, , Schwab S, , Krieger D, , von Kummer R, , Aschoff A, & Schuchardt V, : Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 23:15761578, 1995

    • Search Google Scholar
    • Export Citation
  • 45

    Roach ES, , Gomez MR, & Northrup H: Tuberous sclerosis complex consensus conference: revised clinical diagnostic criteria. J Child Neurol 13:624628, 1998

    • Search Google Scholar
    • Export Citation
  • 46

    Robinson RG: A second brain tumor and irradiation. J Neurol Neurosurg Psychiatry 41:10051012, 1978

  • 47

    Russell DS, & Rubinstein LJ: Pathology of Tumours of the Nervous System London, Edward Arnold, 1959. 152158

  • 48

    Rutherford J, , Chu CE, , Duddy PM, , Charlton RS, , Chumas P, & Taylor GR, : Investigations on a clinically and functionally unusual and novel germline p53 mutation. Br J Cancer 86:15921596, 2002

    • Search Google Scholar
    • Export Citation
  • 49

    Schoenberg BS: Multiple primary neoplasms and the nervous system. Cancer 40:19611977, 1977

  • 50

    Sévenet N, , Sheridan E, , Amram D, , Schneider P, , Handgretinger R, & Delattre O: Constitutional mutations of the hSNF5/INI1 gene predispose to a variety of cancers. Am J Hum Genet 65:13421348, 1999

    • Search Google Scholar
    • Export Citation
  • 51

    Sherr CJ: Principles of tumor suppression. Cell 116:235246, 2004

  • 52

    Solomon A, , Perret GE, & McCormick WF: Multicentric gliomas of the cerebral and cerebellar hemispheres. Case report. J Neurosurg 31:8793, 1969

    • Search Google Scholar
    • Export Citation
  • 53

    Spallone A, , Santoro A, , Palatinsky E, & Giunta F: Intracranial meningiomas associated with glial tumors: a review based on 54 selected literature cases from the literature and 3 additional personal cases. Acta Neurochir (Wien) 110:133139, 1991

    • Search Google Scholar
    • Export Citation
  • 54

    Taylor MD, , Gokgoz N, , Andrulis IL, , Mainprize TG, , Drake JM, & Rutka JT: Familial posterior fossa brain tumors of infancy secondary to germline mutation of the hSNF5 gene. Am J Hum Genet 66:14031406, 2000

    • Search Google Scholar
    • Export Citation
  • 55

    Tomita T: Neurosurgical perspectives in pediatric neurooncology. Childs Nerv Syst 14:9496, 1998

  • 56

    Tugcu B, , Kepoglu U, , Gunal M, , Gunaldi O, , Karakaya B, & Demirgil BT: Two distinct primary brain tumors, in same region of the same patient: a case report. J Neurooncol 79:219220, 2006

    • Search Google Scholar
    • Export Citation
  • 57

    van Loon J, , Van Calenbergh F, , Goffin J, & Plets C: Controversies in the management of spontaneous cerebellar hemorrhage. A consecutive series of 49 cases and review of the literature. Acta Neurochir (Wien) 122:187193, 1993

    • Search Google Scholar
    • Export Citation
  • 58

    Vazquez E, , Ball WS Jr, , Prenger EC, , Castellote A, & Crone KR: Magnetic resonance imaging of fourth ventricular choroid plexus neoplasms in childhood. A report of two cases. Pediatr Neurosurg 17:4852, 1992

    • Search Google Scholar
    • Export Citation
  • 59

    Veeravagu A, , Bababeygy SR, , Kalani MY, , Hou LC, & Tse V: The cancer stem cell-vascular niche complex in brain tumor formation. Stem Cells Dev 17:859868, 2008

    • Search Google Scholar
    • Export Citation
  • 60

    Wolff JE, , Sajedi M, , Brant R, , Coppes MJ, & Egeler RM: Choroid plexus tumours. Br J Cancer 87:10861091, 2002

  • 61

    Wolff JE, , Sajedi M, , Coppes MJ, , Anderson RA, & Egeler RM: Radiation therapy and survival in choroid plexus carcinoma. Lancet 353:2126, 1999

    • Search Google Scholar
    • Export Citation
  • 62

    Wolff JE, , Wrede B, , Peters O, , Kebudi R, , Pietsch T, & Finlay J: Choroid plexus tumors in CPT-SIOP-2000: update March 2006. Pediatr Blood Cancer 47:382, 2006

    • Search Google Scholar
    • Export Citation
  • 63

    Wrede B, , Liu P, & Wolff JE: Chemotherapy improves the survival of patients with choroid plexus carcinoma: a meta-analysis of individual cases with choroid plexus tumors. J Neurooncol 85:345351, 2007

    • Search Google Scholar
    • Export Citation
  • 64

    Zülch KJ: Brain Tumors: Their Biology and Pathology New York, Springer, 1957. 7476

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