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Pediatric Thalamic Gliomas: An Updated Review
Insights
Pediatric thalamic tumors are rare but crucial to diagnose. Astrocytomas are the most common type, with high-grade forms being the largest subgroup, necessitating accurate tissue diagnosis for treatment.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Tumor pathology
Background:
- Thalamic neoplasms are rare overall but represent a significant portion of pediatric brain tumors.
- They constitute approximately 5% of pediatric intracranial tumors and up to 15% of malignant pediatric intracranial tumors in some studies.
Purpose of the Study:
- To provide an updated understanding of the diverse histology, biology, and behavior of pediatric thalamic tumors.
- To emphasize the critical role of histologic verification in treatment planning for these rare tumors.
Main Methods:
- A comprehensive PubMed search was conducted using keywords "pediatric + thalamic + glioma".
- Analysis included 445 cases of thalamic gliomas in patients under 18 years old from 45 publications.
- Data from 9 institutional series detailing various pediatric thalamic tumor histologies were reviewed.
Main Results:
- Astrocytomas constitute 81% of pediatric thalamic tumors, with diffuse astrocytomas being the most prevalent subtype.
- High-grade diffuse astrocytomas (World Health Organization grades III-IV) represent the largest single category of pediatric thalamic tumors.
- Oligodendrogliomas and ependymomas account for 10% and 3% of cases, respectively, often presenting as anaplastic.
Conclusions:
- Accurate tissue diagnosis is paramount for prognostication and guiding treatment strategies in pediatric thalamic tumors.
- The discovery of molecular targets further underscores the importance of precise histologic and molecular subtyping.
- Definitive diagnosis facilitates the identification of tumors amenable to surgical resection, improving patient outcomes.
Context:
- Neoplasms originating in the thalamus are rare overall (1% of all brain tumors); however, they comprise approximately 5% of pediatric intracranial tumors and approach 15% of all malignant pediatric intracranial tumors in some series.
Objective:
- To update readers about the current understanding of the diverse histology, biology, and behavior of pediatric thalamic tumors. Histologic verification is now thought to be critical for planning treatment, and, as a result, biopsy and total/subtotal resections are much more common today than in the past.
Data Sources:
- A PubMed search using the keywords "pediatric + thalamic + glioma" yielded 45 publications with a total of 445 cases of thalamic gliomas in patients less than 18 years of age. We found only 9 substantial institutional series tabulating all encountered thalamic histologic types in children. This survey confirmed a high proportion of astrocytomas, 81% (214 of 265), of which approximately two-thirds were diffuse astrocytomas (146 of 214) and one-third were pilocytic astrocytomas (68 of 214). Of the diffuse astrocytomas, 34% (49 of 146) were low grade (World Health Organization grade II) and 55% (81 of 146) were high grade (World Health Organization grade III or IV), making the latter subgroup the largest single category of all pediatric thalamic tumors. Oligodendrogliomas and ependymomas (mostly anaplastic in both cases) comprised 10% and 3% of all pediatric thalamic tumors, respectively.
Conclusions:
- Tissue diagnosis is now thought crucial for prognostication and treatment, particularly as more potentially therapeutic molecular targets are discovered. Secure diagnosis allows identification of tumors for which resection is more feasible and beneficial.
