Multiple lesions accompanied by postoperative spontaneous intracystic hemorrhage in a pediatric patient with pilocytic astrocytoma

Muhammad Parenrengi; Yunus Aji

doi:10.4103/ajns.AJNS_308_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 409-413
DOI: 10.4103/ajns.AJNS_308_19

Case Report

Multiple lesions accompanied by postoperative spontaneous intracystic hemorrhage in a pediatric patient with pilocytic astrocytoma

Muhammad Parenrengi

Department of Neurosurgery, Division of Pediatric Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya

,

Yunus Aji

¹Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya

› Author Affiliations

Abstract

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.

Key-words:

Intracystic hemorrhage - intratumoral hemorrhage - multiple lesion - pediatric neurosurgery - pilocytic astrocytoma

Full Text

References

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