Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 51, Num. 2, 2003, pp. 276-277

Neurology India, Vol. 51, No. 2, April-June, 2003, pp. 276-277

Short Report

Cytodiagnosis of anaplastic astrocytoma with metastasis to the cerebrospinal fluid in a neonate - A case report

S. Goel, K. Kapila, C. Sarkar, K. Verma

Department of Pathology, All India Institute of Medical Sciences, New Delhi-110029.
Chitra Sarkar
Professor, Department of Pathology, All India Institute of Medical Sciences, New Delhi-110029, India.
E-mail: sarkarcs@hotmail.com

Accepted on 13.02.2002.

Code Number: ni03088

ABSTRACT

A case of left cerebral hemispheric anaplastic astrocytoma with metastasis to the cerebrospinal fluid in a 50-day-old male child diagnosed on cytology and later confirmed by histological examination is reported.

Key Words: Anaplastic astrocytoma, Neonate, Metastasis, Cerebrospinal Fluid.

Neonatal brain tumors are those that present clinically within the first two months of life.¹ They are rare and represent only 0.5-1.9% of all pediatric (those individuals under the age of 15 years) brain tumors.² The metastatic spread of pediatric central nervous system tumors occurs most commonly with primitive neuroectodermal tumors and malignant gliomas.³ We present a case of anaplastic astrocytoma with dissemination to the cerebrospinal fluid in a neonate.

CASE REPORT

A 50-day-old male child, delivered by cesarean section, presented with complaints of generalized seizures, multiple vomiting, refusal to feed and progressively enlarging head size for 15 days. On examination, the head circumference was 39 cm and the anterior fontanellae was tense and bulging. The baby was emaciated and dehydrated. CT brain showed a mass in the left cerebral hemisphere with extension to the posterior third ventricle, posterior fossa and hydrocephalus. The cerebrospinal fluid (CSF) was sent for cytological examination. Millipore preparation was made by the standard Millipore technique.⁴ Microscopic examination of Papanicolaou stained smears showed irregular clusters of tumor cells. The tumor cells had oval to elongated hyperchromatic nuclei, scanty ill-defined cytoplasm and fibrillary processes. Mitotic figures could not be identified. A diagnosis of a glioma was considered. Later, a left frontal burr hole and biopsy of the tumor was done. Sections showed a highly cellular tumor with the tumor cells showing moderate pleomorphism and frequent mitosis. No necrosis was seen in the material examined. There was no evidence of ependymal differentiation. Tumor cells were positive for glial fibrillary acidic protein (GFAP, M/s Dako Path). Based on these features, the diagnosis of anaplastic astrocytoma was given. MIB-1 labeling index was 6%. Tumor cells were negative for p53 protein expression.

DISCUSSION

The percentage of childhood brain tumors occurring in children less than two years of age may approach 10%.⁵ A substantial number are found in infants and neonates. The reported incidence of brain tumor in children less than one year of age is 5.3%.⁶ Neonatal brain tumors are rare and represent 0.5-1.9% of all pediatric brain tumors. Brain tumors in young children are more commonly supratentorial and are quite large at the time of diagnosis. In a series of 45 congenital brain lesions⁷ diagnosed within the first 60 days of age, supratentorial astrocytomas represented 29% of the brain tumors and were the second most frequently identified histological group after teratoma and medulloblastoma having equal incidence. Two-thirds of the tumors were supratentorial in location and occupied more than one-third of intracranial volume. In this case the tumor was supratentorial and occupied almost the whole of the left cerebral hemisphere. Tumors in infants are widely disseminated throughout the subarachnoid space at diagnosis, particularly in patients with medulloblastoma and embryonal tumors.⁸ Cytological examination of CSF, although relatively specific, was not a sensitive test in the reported series of cases.^9,10, Cytology alone should not be relied upon to rule out CSF dissemination of supratentorial gliomas, especially if the CSF is obtained by lumbar puncture. Balhuizen et al¹¹ showed ventricular CSF to be more sensitive than lumbar CSF in detecting primary gliomas by cytological examination. In a review of CSF dissemination of tumors of the CNS in children, Packer et al⁹ found 18% incidence of ante mortem dissemination in children with cortical anaplastic gliomas. Among 50 children with supratentorial malignant glioma, Dropcho et al¹² found a similar incidence of 26% of CSF dissemination. The age range reported in all these cases was infants and young children.

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