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Multiple intracranial juvenile xanthogranulomas. Case report
J Boström1, G Janssen, M Messing-Jünger
1Department of Neuropathology, Heinrich-Heine-University, Düsseldorf, Germany.
Insights
This case study details a rare instance of multiple intracranial juvenile xanthogranuloma (JXG) in a child without skin lesions. The study highlights the challenges in managing progressive JXG brain tumors.
Area of Science:
- Neuro-oncology
- Pediatric Neurology
- Dermatology
Background:
- Juvenile xanthogranuloma (JXG) is a rare, benign neoplastic proliferation of histiocytes.
- Intracranial involvement is uncommon, with fewer than 20 reported cases.
- JXG typically presents with cutaneous lesions, though extracutaneous and CNS manifestations can occur.
Observation:
- An 11-year-old boy presented with proptosis due to an orbital xanthofibroma at age 4.
- Bilateral papilledema developed, revealing multiple intracranial masses via MRI and CT.
- The patient developed behavioral changes and cognitive decline due to lesion growth.
Findings:
- Resected masses were histopathologically confirmed as juvenile xanthogranuloma (JXG).
- This is the first reported case of multiple intracranial JXGs without cutaneous manifestations.
- Surgical resection of intraventricular lesions led to vision loss, likely from optic neuropathy.
Implications:
- Multifocal intracranial JXG poses significant management challenges due to its rarity and potential for progression.
- The case underscores the need for vigilance in diagnosing and treating atypical JXG presentations.
- Further research is needed to establish optimal treatment strategies for progressive CNS JXG.
Abstract:
The authors report on an 11-year-old boy in whom proptosis of the eye caused by a benign intraosseous xanthofibroma of the left orbital wall became clinically apparent at the age of 4 years. Two years later he developed bilateral papilledema, at which time computerized tomography and magnetic resonance studies revealed multiple enhancing intracranial lesions. The largest mass was located in the left middle fossa; other lesions were located at the tentorium cerebelli, in both lateral ventricles, near the superior sagittal sinus, and extracranially near the left jugular vein. The mass in the left middle fossa was resected and diagnosed as juvenile xanthogranuloma (JXG). Thirty months later, the patient again became symptomatic, exhibiting behavioral abnormalities and a decrease in mental powers. At that time, the two remaining lesions in both lateral ventricles had grown enough to cause trapping of the temporal horns and raised intracranial pressure. These lesions were successively resected and histopathologically confirmed to be JXGs. However, resection of the second intraventricular lesion was complicated by postoperative bilateral amaurosis, presumably caused by postdecompression optic neuropathy. According to a review of the literature, fewer than 20 patients with JXG involving the central nervous system have been reported. The patient described in this report is the first in whom multiple intracranial JXGs developed in the absence of cutaneous manifestations. Although JXGs are biologically benign lesions, the treatment of patients with multifocal and/or progressive intracranial manifestations is problematic.