M Suo-Palosaari1,2, H Rantala3,4, S Lehtinen3,4, T Kumpulainen5,6, N Salokorpi5,6. 1. Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, P.O. Box 50, 90029, OYS, Oulu, Finland. maria.suo-palosaari@fimnet.fi. 2. Medical Research Center, University of Oulu, Oulu, Finland. maria.suo-palosaari@fimnet.fi. 3. Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland. 4. PEDEGO Research Group, Medical Research Center, University of Oulu, Oulu, Finland. 5. Medical Research Center, University of Oulu, Oulu, Finland. 6. Department of Neurosurgery, Oulu University Hospital, P.O. Box 21, 90029, OYS, Oulu, Finland.
Abstract
BACKGROUND: We describe a unique case of expansive diffuse brainstem lesion diagnosed prenatally by magnetic resonance imaging (MRI) with long-term survival. Findings of fetal and postpartum MRI were highly consistent with the characteristics of diffuse brainstem glioma. METHODS: Diagnosis was based on the features of MRI, and histopathology was not confirmed by biopsy. Although the prognosis of diffuse brainstem tumor is usually poor, this child was asymptomatic at birth and the neurological condition is still normal at 4 years of age without any treatment. RESULTS: During routine imaging follow-up, diameters of the expansion have remained stable, while the size of the lesion compared to the posterior fossa size has diminished. In addition to brainstem tumor, a skin lesion of the back was observed and MRI of the thoracic spine showed a large asymptomatic extradural cystic lesion suggesting an arachnoid cyst. The pontine tumor of this infant, in agreement with a few previously reported cases, suggests a subgroup of beneficial outcome of expansive diffuse brainstem lesions, particularly in the neonatal period. DISCUSSION: In this article, we discuss the prognosis and characteristics of pediatric brainstem tumors and differential diagnosis of neonatal brainstem lesions.
BACKGROUND: We describe a unique case of expansive diffuse brainstem lesion diagnosed prenatally by magnetic resonance imaging (MRI) with long-term survival. Findings of fetal and postpartum MRI were highly consistent with the characteristics of diffuse brainstem glioma. METHODS: Diagnosis was based on the features of MRI, and histopathology was not confirmed by biopsy. Although the prognosis of diffuse brainstem tumor is usually poor, this child was asymptomatic at birth and the neurological condition is still normal at 4 years of age without any treatment. RESULTS: During routine imaging follow-up, diameters of the expansion have remained stable, while the size of the lesion compared to the posterior fossa size has diminished. In addition to brainstem tumor, a skin lesion of the back was observed and MRI of the thoracic spine showed a large asymptomatic extradural cystic lesion suggesting an arachnoid cyst. The pontine tumor of this infant, in agreement with a few previously reported cases, suggests a subgroup of beneficial outcome of expansive diffuse brainstem lesions, particularly in the neonatal period. DISCUSSION: In this article, we discuss the prognosis and characteristics of pediatric brainstem tumors and differential diagnosis of neonatal brainstem lesions.