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Pontine glioma with osteoblastic skeletal metastases in a child
Y Yanagawa1, T Miyazawa, S Ishihara
1Department of Neurosurgery and Laboratory Medicine, National Defense Medical College, Saitama, Japan.
Insights
Systemic metastases from pontine glioma are rare. This case report details a young boy with a pontine glioma who developed osteoblastic skeletal metastases, confirmed by GFAP-positive cells in bone biopsy.
Area of Science:
- Neuro-oncology
- Skeletal Metastasis Research
Background:
- Systemic metastases from primary intracranial gliomas are exceptionally rare.
- Pontine gliomas, a type of brainstem tumor, typically remain localized within the central nervous system.
Observation:
- A 12-year-old boy presented with symptoms including hoarseness, dysphagia, and ataxia.
- Imaging revealed a brainstem tumor diagnosed as a low-grade glioma.
- Following treatment, the patient developed widespread osteoblastic skeletal metastases in the skull, spine, pelvis, and long bones.
Findings:
- Biopsy of iliac bone metastases revealed cells positive for glial fibrillary acidic protein (GFAP), confirming glial origin.
- The metastases exhibited an osteoblastic phenotype, characterized by increased bone formation.
Implications:
- This case highlights an unusual pattern of spread for pontine gliomas.
- The findings suggest that infratentorial gliomas may possess the capacity to induce osteoblastic changes at metastatic sites, warranting further investigation into the underlying mechanisms.
Background:
The development of systemic metastases from primary intracranial gliomas is rare. We report here a rare case of pontine glioma with osteoblastic skeletal metastases.
Case:
This 12-year-old boy presented with a 4-month history of hoarseness, dysphagia, and a progressively ataxic gait. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) revealed a brain stem tumor that was diagnosed as a low grade glioma by stereotactic biopsy. Twelve months later following chemotherapy and radiotherapy, neurologic examination and neuroradiologic studies disclosed a recurrence of the pontine glioma. Skeletal roentgenograms revealed widespread osteoblastic metastases in the skull, vertebral bodies, pelvis, and long bones. A specimen from the iliac bone demonstrated cells that were immunoreactive glial fibrillary acidic protein (GFAP).
Discussion:
The mechanism of how glioma cells determine their biologic behavior at bony metastatic sites is not known. Infratentorial gliomas, which occur frequently in young patients and demonstrate active bony metabolism, may stimulate osteoblastic cells, and induce osteoblastic changes.