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Holocord pilocytic astrocytoma in a young woman with intracranial extension: case report and review of the MRI characteristics

Abstract

Introduction

Pilocytic astrocytoma is a low-grade glioma more frequently seen in patients <20. It is pretty uncommon in the spinal cord. Rarely, astrocytoma may involve the most or total length of the spinal cord; in that case, they are called “holo-cord astrocytoma.” In this case report, we are reporting the third holo-cord pilocytic astrocytoma in an adult patient and the first with an extension to the Magendie foramen.

Case presentation

We presented a 24-year-old woman with complaints of progressively worsening neck and back pain since one year ago. The patient’s MRI showed a very large intradural and intramedullary cystic lesion with a solid component within the spinal cord extending from the medulla to the conus medullaris. Partial resection of the solid part of the cervical portion of the tumor was performed. Histopathological evaluation of the resected tumor segments was compatible with grade I pilocytic astrocytoma. After one year of follow-up, neck and back pain has reduced, and neurological functions have improved.

Conclusion

Spinal cord pilocytic astrocytoma may present as a holo-cord tumor and can rarely extend to the intracranial fossa. Although this tumor does not arise from the central canal, in this case, it was extended through the Magendie foramen. Symptoms could be subtle despite extensive cord involvement. On MRI, this tumor presents as an intramedullary holo-cord cystic lesion intermixed with a solid component with a variable enhancement of the solid component.

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Fig. 1: Whole spine MRI of holocord pilocytic astrocytoma.
Fig. 2: MRI of holocord pilocytic astrocytoma.
Fig. 3: Histopathological evaluation of the tumor.

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Data availability

Data sharing does not apply to this article as no datasets were generated or analyzed during the current study. The corresponding author makes the MRI and pathology images and reports available on reasonable request.

References

  1. Ostrom QT, Gittleman H, Liao P, Vecchione-Koval T, Wolinsky Y, Kruchko C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010–2014. Neuro-Oncol. 2017;19:v1–v88. https://doi.org/10.1093/neuonc/nox158

    Article  PubMed  PubMed Central  Google Scholar 

  2. Louis DN, Perry A, Reifenberger G, Von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathologica. 2016;131:803–20. https://doi.org/10.1007/s00401-016-1545-1

    Article  PubMed  Google Scholar 

  3. Goyal S, Puri T, Julka P. Holocord low grade astrocytoma–Role of radical irradiation and chemotherapy. J Egypt Natl Cancer Inst. 2015;27:105–8. https://doi.org/10.1016/j.jnci.2015.01.001

    Article  Google Scholar 

  4. Horger M, Ritz R, Beschorner R, Fenchel M, Nägele T, Danz S, et al. Spinal pilocytic astrocytoma: MR imaging findings at first presentation and following surgery. Eur J Radiol. 2011;79:389–99. https://doi.org/10.1016/j.ejrad.2010.04.024

    Article  CAS  PubMed  Google Scholar 

  5. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery. 2005;56:972–81.

    PubMed  Google Scholar 

  6. Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 2000;20:1721–49. https://doi.org/10.1148/radiographics.20.6.g00nv151721

    Article  CAS  PubMed  Google Scholar 

  7. Baran O, Kasimcan O, Sav A, Oruckaptan H. Holocord pilocytic astrocytoma in an adult: a rare case report and review of the literature. World Neurosurg. 2019;126:369–75. https://doi.org/10.1016/j.wneu.2019.03.103

    Article  PubMed  Google Scholar 

  8. Tobias ME, McGirt MJ, Chaichana KL, Goldstein IM, Kothbauer KF, Epstein F, et al. Surgical management of long intramedullary spinal cord tumors. Child’s Nerv Syst. 2008;24:219–23. https://doi.org/10.1007/s00381-007-0405-7

    Article  Google Scholar 

  9. Ebner FH, Schittenhelm J, Roser F, Scheel-Walter H, Tatagiba M, Schuhmann MU. Management of holocord pilocytic astrocytomas in children and adolescents: an update. Pediatr Neurosurg. 2013;48:133–40. https://doi.org/10.1159/000345593

    Article  Google Scholar 

  10. Arshad A, Hanif S, Yusuf I, Hussain K. First local case report of a holocord pilocytic astrocytoma–an uncommon entity with management challenges. Pak J Neurological Surg. 2021;25:437–42.

    Article  Google Scholar 

  11. McCunniff AJ, Liang MJ. Radiation tolerance of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 1989;16:675–8. https://doi.org/10.1016/0360-3016(89)90484-7

    Article  CAS  PubMed  Google Scholar 

  12. Vles J, Grubben C, Van Ooy A, Weil E. Holocord astrocytomas in childhood. Clin Neurol Neurosurg. 1990;92:361–4. https://doi.org/10.1016/0303-8467(90)90066-e

    Article  CAS  PubMed  Google Scholar 

  13. Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM. Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg. 1995;83:590–5. https://doi.org/10.3171/jns.1995.83.4.0590

    Article  CAS  PubMed  Google Scholar 

  14. Sandalcioglu IE, Gasser T, Wiedemayer H, Horsch S, Stolke D. Favourable outcome after biopsy and decompression of a holocord intramedullary spinal cord astrocytoma in a newborn. Eur J Paediatr Neurol. 2002;6:179–82. https://doi.org/10.1053/ejpn.2002.0587

    Article  PubMed  Google Scholar 

  15. Komotar RJ, Carson BS, Rao C, Chaffee S, Goldthwaite PT, Tihan T. Pilomyxoid astrocytoma of the spinal cord: report of three cases. Neurosurgery. 2005;56:191. https://doi.org/10.1227/01.NEU.0000146212.95421.B3

    Article  PubMed  Google Scholar 

  16. Schittenhelm J, Ebner FH, Tatagiba M, Wolff M, Nägele T, Meyermann R, et al. Holocord pilocytic astrocytoma—case report and review of the literature. Clin Neurol Neurosurg. 2009;111:203–7. https://doi.org/10.1016/j.clineuro.2008.09.014

    Article  PubMed  Google Scholar 

  17. Bansal S, Borkar S, Mahapatra A. Hydrocephalus associated with spinal intramedullary pilocytic astrocytoma. Asian J Neurosurg. 2017;12:217–9. https://doi.org/10.4103/1793-5482.144174

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank K. Eghbal M.D. at the Neurosurgery department of Shiraz University of Medical Sciences who put a lot of effort into the operation and follow-up of the patient.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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SKS was responsible for literature search, data acquisition, manuscript preparation, manuscript writing, editing, and manuscript review and approved the final version. AD was responsible for material preparation, manuscript preparation, manuscript writing, editing, and manuscript review and approved the final version. AT was responsible for material preparation, manuscript preparation, manuscript writing, editing, and manuscript review and approved the final version. AD was responsible for concept, design, data acquisition, manuscript preparation, manuscript writing, editing, and manuscript review and approved the final version.

Corresponding author

Correspondence to Alireza Dehghan.

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This study was approved by the Institutional Ethics Committee (IR.SUMS.MED.REC.1401.154). Written informed consent was obtained from the subject described in the publication.

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Kiani Salmi, S., Dehghanian, A., Taherifard, A. et al. Holocord pilocytic astrocytoma in a young woman with intracranial extension: case report and review of the MRI characteristics. Spinal Cord Ser Cases 10, 43 (2024). https://doi.org/10.1038/s41394-024-00656-z

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