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Microscopic local leptomeningeal invasion at diagnosis of medulloblastoma
1University of Istanbul, Institute of Oncology, Department of Pediatric Oncology, Turkey.
Purpose:
To document the incidence and outcome of patients with microscopic local leptomeningeal invasion at presentation, children with medulloblastoma were reviewed.
Methods And Materials:
Nineteen patients (1-12 years of age), who had surgical resection (14 total, 5 subtotal) and were diagnosed as medulloblastoma, were evaluated for disease extent by pre- and postoperative computerized tomography/magnetic resonance imaging, histopathologic evaluation of leptomeninges adjacent to the resected tumor tissue, myelography/magnetic resonance of the entire spine, and analysis of cerebrospinal fluid cytology. Patients were also reviewed for disease outcome.
Results:
Staging revealed one T2, nine T3a, eight T3b, and one T4 disease. There were 10 M0, 2 M1, 2 M2, 2 M3, and 3 Mx patients according to Chang's classification. Ten out of 19 patients (52.6%) demonstrated microscopic local leptomeningeal invasion. When only the 10 patients with M0 disease were considered, three out of five patients with microscopic local leptomeningeal invasion was found to have one or more relapses. The five other M0 patients without microscopic local invasion were in complete remission at the time of analysis.
Conclusion:
The incidence of microscopic local leptomeningeal invasion in patients with medulloblastoma is high. Whereas the impact on survival remains to be determined in larger series, data suggests prognostic role for isolated microscopic local leptomeningeal invasion, thus validity for inclusion in the future staging system.
Insights
Microscopic local leptomeningeal invasion is common in pediatric medulloblastoma. This finding may indicate a higher risk of relapse, suggesting its importance for future staging systems.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Cancer Research
Background:
- Medulloblastoma is a common pediatric brain tumor.
- Leptomeningeal invasion is a known prognostic factor.
- The significance of microscopic local leptomeningeal invasion requires further investigation.
Purpose of the Study:
- To determine the incidence of microscopic local leptomeningeal invasion in children with medulloblastoma.
- To evaluate the outcome of patients with microscopic local leptomeningeal invasion.
- To assess the prognostic value of microscopic local leptomeningeal invasion.
Main Methods:
- Retrospective review of 19 pediatric medulloblastoma patients (1-12 years).
- Inclusion of surgical resection, imaging (CT/MRI), histopathology, and CSF cytology.
- Evaluation of disease extent and patient outcomes.
Main Results:
- 52.6% of patients (10/19) had microscopic local leptomeningeal invasion.
- Among M0 patients, those with microscopic local leptomeningeal invasion had a higher relapse rate (3/5) compared to those without (0/5).
- Tumor staging included T2-T4 and M0-Mx according to Chang's classification.
Conclusions:
- Microscopic local leptomeningeal invasion is frequently observed in pediatric medulloblastoma.
- This finding suggests a potential prognostic role for microscopic local leptomeningeal invasion.
- Inclusion in future medulloblastoma staging systems is warranted.