DOI QR코드

DOI QR Code

Cerebellar Pilocytic Astrocytomas with Spontaneous Intratumoral Hemorrhage in Adult

  • Kim, Min-Su (Department of Neurosurgery, Yeungnam University College of Medicine) ;
  • Kim, Sang-Woo (Department of Neurosurgery, Yeungnam University College of Medicine) ;
  • Chang, Chul-Hoon (Department of Neurosurgery, Yeungnam University College of Medicine) ;
  • Kim, Oh-Lyong (Department of Neurosurgery, Yeungnam University College of Medicine)
  • Received : 2010.10.25
  • Accepted : 2011.05.30
  • Published : 2011.06.28

Abstract

Cerebellar pilocytic astrocytomas (PAs) are benign gliomas predominantly found in the pediatric population. Intracranial hemorrhages are extremely rare in initial presentations of cerebellar PAs. There are no reports in the medical literature of adult cerebellar PA cases presenting with intratumoral hemorrhage. We report 2 cases of adult cerebellar pilocytic astrocytomas with intratumoral hemorrhage. The first case is a 37-year-old woman presenting with severe headache, nausea, and vomitting. Computed tomography demonstrated an acute hemorrhage adjacent to the right cerebellar hemisphere and hydrocephalus. Magnetic resonance imaging (MRI) revealed a cerebellar vermian tumor with the hemorrhage as a mixed isoin-tense area in the T2-weighted image, and as a mixed hyperintense area in the contrast-enhanced T1-weighted image. The second case is a 53-year-old man presenting with headache for 3 weeks. MRI revealed a cerebellar hemispheric tumor with the hemorrhage as a mixed hyperintense area. It had a cystic mass with a heterogeneous enhanced mural nodule in the gadolinium-enhanced T1-weighted image and a fluid-fluid level within the cyst in the T2-weighted image. Both of them underwent radical resections of their respective lesions. Histological examination of the specimens revealed typical astrocytoma, including a hemorrhagic portion. Both patients recovered postoperatively and continue to do well at present. The medical literature on hemorrhagic cerebellar PAs is also reviewed.

References

  1. Aichholzer M, Gruber A, Haberler C, Bertalanffy A, Slavc I, Czech T :Intracranial hemorrhage from an aneurysm encased in a pilocytic astrocytoma--case report and review of the literature. Childs Nerv Syst 17 : 173-178, 2001 https://doi.org/10.1007/s003810000364
  2. Bell D, Chitnavis BP, Al-Sarraj S, Connor S, Sharr MM, Gullan RW : Pilocytic astrocytoma of the adult--clinical features, radiological features and management. Br J Neurosurg 18 : 613-616, 2004 https://doi.org/10.1080/02688690400022896
  3. Bitoh S, Hasegawa H, Ohtsuki H, Obashi J, Fujiwara M, Sakurai M : Cerebral neoplasms initially presenting with massive intracerebral hemorrhage. Surg Neurol 22 : 57-62, 1984 https://doi.org/10.1016/0090-3019(84)90230-1
  4. Brown PD, Buckner JC, O'Fallon JR, Iturria NL, Brown CA, O'Neill BP, et al. : Adult patients with supratentorial pilocytic astrocytomas : a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys 58 : 1153-1160, 2004 https://doi.org/10.1016/j.ijrobp.2003.09.020
  5. Burkhard C, Di Patre PL, Schuler D, Schuler G, Yasargil MG, Yonekawa Y, et al. : A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98 : 1170-1174, 2003 https://doi.org/10.3171/jns.2003.98.6.1170
  6. Fogelson MH, Oppenheim RE, McLaurin RL : Childhood cerebellar astrocytoma presenting with hemorrhage. Neurology 30 : 669-670, 1980 https://doi.org/10.1212/WNL.30.6.669
  7. Forsyth PA, Shaw EG, Scheithauer BW, O'Fallon JR, Layton DD Jr, Katzmann JA : Supratentorial pilocytic astrocytomas. A clinicopathologic, prognostic, and flow cytometric study of 51 patients. Cancer 72 : 1335-1342, 1993 https://doi.org/10.1002/1097-0142(19930815)72:4<1335::AID-CNCR2820720431>3.0.CO;2-E
  8. Koeller KK, Rushing EJ : From the archives of the AFIP : pilocytic astrocytoma : radiologic-pathologic correlation. Radiographics 24 : 1693-1708, 2004 https://doi.org/10.1148/rg.246045146
  9. Kondziolka D, Bernstein M, Resch L, Tator CH, Fleming JF, Vanderlinden RG, et al. : Significance of hemorrhage into brain tumors : clinicopathological study. J Neurosurg 67 : 852-857, 1987 https://doi.org/10.3171/jns.1987.67.6.0852
  10. Lee CS, Huh JS, Sim KB, Kim YW : Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma. Childs Nerv Syst 25 : 125-128, 2009 https://doi.org/10.1007/s00381-008-0678-5
  11. Li HM, Hsu SS, Wang JS, Weng MJ, Fu JH, Chen CK, et al. : Cerebral pilocytic astrocytoma with spontaneous intracranial hemorrhage in adults. J Chin Med Assoc 71 : 587-593, 2008 https://doi.org/10.1016/S1726-4901(08)70175-8
  12. Lieu AS, Hwang SL, Howng SL, Chai CY : Brain tumors with hemorrhage. J Formos Med Assoc 98 : 365-367, 1999
  13. Liwnicz BH, Wu SZ, Tew JM Jr : The relationship between the capillary structure and hemorrhage in gliomas. J Neurosurg 66 : 536-541, 1987 https://doi.org/10.3171/jns.1987.66.4.0536
  14. Lyons MK : Pilocytic astrocytoma with spontaneous intracranial hemorrhages in an elderly adult. Clin Neurol Neurosurg 109 : 76-80, 2007 https://doi.org/10.1016/j.clineuro.2006.03.002
  15. Mauersberger W, Cuevas-Solórzano JA : Spontaneous intracerebellar hematoma during childhood caused by spongioblastoma of the IVth ventricle. Neuropadiatrie 8 : 443-450, 1977 https://doi.org/10.1055/s-0028-1091539
  16. Mesiwala AH, Avellino AM, Roberts TS, Ellenbogen RG : Spontaneous cerebellar hemorrhage due to a juvenile pilocytic astrocytoma : case report and review of the literature. Pediatr Neurosurg 34 : 235-238, 2001 https://doi.org/10.1159/000056028
  17. Specht CS, Pinto-Lord C, Smith TW, DeGirolami U, Suran E, Marshall PC, et al. : Spontaneous hemorrhage in a mixed glioma of the cerebellum : case report. Neurosurgery 19 : 278-281, 1986 https://doi.org/10.1227/00006123-198608000-00019
  18. van Ouwerkerk WJ, Dirven CM : Hematoma in a low-grade medullary astrocytoma : report of an unusual case and literature review. Childs Nerv Syst 14 : 742-746, 1998 https://doi.org/10.1007/s003810050308
  19. Vincent FM, Bartone JR, Jones MZ : Cerebellar astrocytoma presenting as a cerebellar hemorrhage in a child. Neurology 30 : 91-93, 1980 https://doi.org/10.1212/WNL.30.1.91
  20. Wakai S, Yamakawa K, Manaka S, Takakura K : Spontaneous intracranial hemorrhage caused by brain tumor : its incidence and clinical significance. Neurosurgery 10 : 437-444, 1982 https://doi.org/10.1227/00006123-198204000-00004
  21. White JB, Piepgras DG, Scheithauer BW, Parisi JE : Rate of spontaneous hemorrhage in histologically proven cases of pilocytic astrocytoma. J Neurosurg 108 : 223-226, 2008 https://doi.org/10.3171/JNS/2008/108/2/0223