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Published on: October 3, 2010
[Secondary metastatic neuromeningeal localization of neuroblastoma in children]
P Rohrlich1, O Hartmann, D Couanet
1Département de Pédiatrie, Institut Gustave-Roussy, Villejuif.
Insights
Central nervous system (CNS) metastases are rare in pediatric neuroblastoma, affecting 2.7% of patients. These metastases, particularly meningeal involvement, are associated with a poor prognosis and rapid disease progression.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Cancer Metastasis
Background:
- Neuroblastoma is a common pediatric malignancy.
- Central nervous system (CNS) metastases in neuroblastoma are infrequently studied.
- Understanding the characteristics of CNS metastases is crucial for prognosis.
Observation:
- A study of 258 children with neuroblastoma identified CNS metastases in 7 patients (2.7%).
- Parenchymal involvement occurred later (mean 21 months) and signaled relapse, even with local treatment.
- Meningeal involvement (3 cases) presented earlier (mean 12.7 months) and led to rapid mortality.
Findings:
- Clinical presentation in children differs from adults, with rapid symptom onset and frequent intracranial hypertension.
- Computed Tomography (CT) scans are valuable for diagnosing CNS metastases.
- Literature review of 30 reported cases indicates a worse prognosis for CNS neuroblastoma metastases.
Implications:
- Early detection and management strategies for CNS metastases are needed.
- The distinct clinical course in children warrants specific research focus.
- Improved understanding may lead to better therapeutic approaches and outcomes for pediatric neuroblastoma patients with CNS involvement.
Abstract:
In order to evaluate the frequency, clinical and radiological aspects and prognosis of central nervous system metastases in children's neuroblastoma, the 258 children presenting with neuroblastoma, and registered from January 1982 to August 1987, were studied. Among them, 7 patients (2.7%), of which 6 had an initially metastatic neuroblastoma, presented with a secondary neuro-meningeal involvement. Parenchyma involvement (4 cases) occurred after a mean period of time of 21 months and marked the relapses. The disease recurs later on, even when locally controlled by surgical excision and local irradiation. Meningeal involvements (3 cases) occurred after a mean delay of 12.7 months, in patients with full tumoral evolutivity, and were responsible for rapid death. The clinical presentation of these metastases differs from that in adults by the rapidity of setting up of the signs and the frequency of intracranial hypertension. CT scan allows approaching diagnosis in the majority of the cases. These data are compared with those in the literature, where 30 cases were reported: they show a high patients' average age and the worse prognosis.
