Parenrengi Muhammad Arifin, Aji Yunus Kuntawi
Department of Neurosurgery, Division of Pediatric Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Asian J Neurosurg. 2020 May 29;15(2):409-413. doi: 10.4103/ajns.AJNS_308_19. eCollection 2020 Apr-Jun.
Pilocytic astrocytoma is the most common primary brain tumor in the pediatric population and has a classic imaging manifestation of a solitary, cyst-like mass with a strong contrast-enhancing mural nodule. Here, we report a case of multiple lesions in pilocytic astrocytoma in a pediatric patient accompanied by postoperative spontaneous intracystic hemorrhage. We describe the case of a 14-year-old female patient with a history of surgery for right cerebellar tumor 6 years ago. Computed tomography (CT) and magnetic resonance imaging showed cystic lesion with a mural nodule in the cerebellum and right retrothalamic area, suggesting a pilocytic astrocytoma. Emergency surgery was done. Pathology confirmed a pilocytic astrocytoma World Health Organization Grade 1. During postoperative course, clinical outcomes of the patient did not improve. Follow-up CT showed cystic remnant compressing the brain stem with spontaneous intracystic hemorrhage. The second surgery was done to evacuate the hemorrhage and to remove the cyst. Serial CT was made after the second surgery with no cyst growth nor hemorrhage present. Only three other pediatric multiple pilocytic astrocytomas have been reported previously, and there were only 11 publications about spontaneous intracystic hemorrhage in pediatric pilocytic astrocytoma. Our review of all previously reported cases found that the patients were predominantly male, and some had a history of neurofibromatosis type 1.
毛细胞型星形细胞瘤是儿童最常见的原发性脑肿瘤，其典型影像学表现为孤立的、囊肿样肿块，伴有明显强化的壁结节。在此，我们报告一例儿童毛细胞型星形细胞瘤多发病变病例，伴有术后自发性囊内出血。我们描述了一名14岁女性患者的病例，该患者6年前有右小脑肿瘤手术史。计算机断层扫描（CT）和磁共振成像显示小脑及右丘脑后区域有一个伴有壁结节的囊性病变，提示为毛细胞型星形细胞瘤。遂进行了急诊手术。病理证实为世界卫生组织1级毛细胞型星形细胞瘤。在术后病程中，患者的临床症状并未改善。随访CT显示囊肿残余压迫脑干并伴有自发性囊内出血。于是进行了第二次手术以清除出血并切除囊肿。第二次手术后进行了系列CT检查，未见囊肿增大及出血。此前仅报道过另外3例儿童多发毛细胞型星形细胞瘤，关于儿童毛细胞型星形细胞瘤自发性囊内出血的文献仅有11篇。我们对所有既往报道病例的回顾发现，患者以男性为主，部分患者有1型神经纤维瘤病病史。
