Pilocytic astrocytoma is a low-grade central nervous system tumor most commonly seen in children. Dissemination from a primary intracranial tumor along the neuroaxis has been described at both presentation and disease progression. However, the development of an intradural extramedullary pilocytic astrocytoma independent of a primary intraparenchymal tumor in an adult patient with no history of pilocytic astrocytoma has rarely been reported.
A 69-year-old woman presented with progressive myelopathic symptoms and thoracic radicular pain. MRI imaging of the whole spine showed an enhancing intradural extramedullary lesion extending from the cervical cord to T11 causing cord compression. Laminectomies were performed for surgical decompression and histopathology was consistent with pilocytic astrocytoma. Complete staging was done that included imaging of the brain and cerebrospinal fluid cytology. No other tumor was found by these methods. Postoperatively the patient was treated with large field spinal radiation and concurrent chemotherapy followed by adjuvant chemotherapy. She has thus far been clinically and radiographically stable.
This is a rare case of an adult with multiple spinal pilocytic astrocytomas in an intradural extramedullary location, typically the result of cerebrospinal fluid dissemination of neoplastic cells from a primary intracranial tumor site (i.e. drop metastasis). No conventional primary tumor was identified in this patient, suggesting these tumors may arise from heterotopic gliomas.
Bond KM, Hughes JD, Porter AL, Orina J, Fang S, Parney IF. Adult pilocytic astrocytoma: an institutional series and systematic literature review for extent of resection and recurrence. World Neurosurg. 2018;110:276–83.
Munshey A, Moore J, Maclean C, Longano A, Goldschlager T. Cranial Pilocytic Astrocytoma With Spinal Drop Metastasis in an Adult: Case Report and Literature Review. World Neurosurg. 2017;98:883 e887–12. CrossRef
Shapiro K, Shulman K. Spinal cord seeding from cerebellar astrocytomas. Childs Brain. 1976;2(3):177–86. PubMed
Cooper IS, Craig WM, Kernohan JW. Tumors of the spinal cord; primary extramedullary gliomas. Surg Gynecol Obstet. 1951;92(2):183–90. PubMed
- An elderly patient presenting with a primary spinal multifocal intradural extramedullary pilocytic astrocytoma: a case report and review of the literature
Eyas M. Hattab
- BioMed Central
Neu im Fachgebiet Onkologie
MRI of cervical-thoracic intradural extramedullary pilocytic astrocytoma/© McBride et al., e.Med Kampagnen-Visual, Mail Icon II