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Childhood brain tumors that occupy more than one compartment at presentation. Multiple compartment tumors
F H Gilles1, A Leviton, E T Hedley-Whyte
1Childrens Hospital of Los Angeles, CA.
Insights
Pediatric brain tumors affecting multiple compartments differ significantly from single-compartment tumors. Early presentation with multi-compartment involvement impacts survival and histology in children with brain tumors.
Area of Science:
- Pediatric neuro-oncology
- Brain tumor research
- Clinical oncology
Background:
- Pediatric brain tumors are a significant health concern.
- Tumor compartment involvement at diagnosis is a key factor in pediatric brain tumors.
- Understanding differences in tumor presentation is crucial for treatment and prognosis.
Purpose of the Study:
- To investigate the clinical and pathological differences between pediatric brain tumors confined to one compartment versus those involving multiple compartments at presentation.
- To identify specific tumor types and patient demographics associated with multi-compartment involvement.
- To analyze the impact of compartment involvement on survival and presenting symptoms.
Main Methods:
- Retrospective analysis of 3,291 pediatric brain tumor cases.
- Comparison of clinical presentation, pathology, and survival based on tumor compartment involvement (single vs. multiple).
- Statistical analysis to determine associations between tumor location, histology, patient age, and symptoms.
Main Results:
- At least 10% of pediatric brain tumors involved multiple compartments at initial diagnosis.
- Multi-compartment tumors were more common in younger children (1-3 years).
- Tumors confined to the infratentorial compartment had longer survival than those involving other compartments.
- Specific tumor types (ependymoma, astrocytoma) were overrepresented in multi-compartment infratentorial tumors.
- Distinct symptoms were associated with tumor location (seizures in supratentorial, nausea/vomiting/headache in infratentorial, bladder/pain symptoms in spinal canal).
Conclusions:
- Pediatric brain tumors involving multiple compartments at presentation exhibit distinct biological and structural characteristics compared to single-compartment tumors.
- Multi-compartment involvement is associated with specific tumor histologies and demographic factors.
- Tumor compartment involvement significantly influences clinical presentation and patient survival outcomes.
Abstract:
Children whose brain tumor involves two or more compartments at presentation differ clinically and pathologically from children whose brain tumor is confined to one compartment. In this study of 3,291 children with a brain tumor, at least 10% had a tumor that occupied two or three compartments at first hospitalization. Infratentorial tumors occupying multiple compartments were 1.7 times more likely to involve the cervicomedullary junction than the mesodiencephalic junction. Younger children (1-3 years) were more likely to have had multiple compartment tumors than older children. Children whose tumor was limited to the infratentorial compartment had a longer survival than children whose tumor also occupied other compartments. Ependymoma, anaplastic ependymoma, and astrocytoma (nos) were over represented among infratentorial multiple compartment tumors. Pilocytic astrocytoma, primitive neuroectodermal tumor (medulloblastoma), and desmoplastic medulloblastoma were less likely to have occupied multiple compartments at the time of the first surgical exploration. The distributions of histologic features in tumors at the cervicomedullary junction differed from those in tumors limited to the posterior fossa or to the spinal canal. Seizures were more likely if the tumor was confined to the supratentorial compartment, whereas nausea or vomiting and headache were more likely if the tumor was confined to the infratentorial compartment. Children whose tumor was confined to the spinal canal were significantly more likely to have bladder symptoms and back and/or abdominal pain than those whose tumor also involved compartments above the foramen magnum. We conclude that brain tumors apparently confined to one compartment at presentation are biologically and structurally different from tumors evident in two or more compartments.