Characteristic analysis of diffuse leptomeningeal glioneuronal tumor misdiagnosed as cryptococcal meningitis in adolescent female

Diffuse leptomeningeal glioneuronal tumor(DLGNT)in adolescent female is rare and easy to be misdiagnosed due to its nonspecificity.This article described the characteristics of an adolescent female DLGNT patient with no history of tumor whose first symptoms are headache and vision loss,and analyzed the causes why DLGNT is easy to be misdiagnosed as cryptococcal meningitis.Treatment remedies:the adolescent female presented with progressive exacerbations of headache,vomiting and vision loss after general treatment.Dynamic monitoring of routine biochemical changes in cerebrospinal fluid(CSF)found abnormal high CSF pressure and protein,repeated examination of antibodies and acid-fast bacilli were negative,and high-throughput pathogen gene examination excluded viral meningitis,tuberculous meningitis and other diseases.To save the optic nerve,the Ommaya capsule was implanted to reduce the intracranial pressure.After diagnostic antifungal treatment,the patient’s condition did not improve.To identify the etiology,extensive meningeal enhancement was eventually detected by enhanced magnetic resonance imaging(MRI),and highly atypical tumor cells were identified by repeated examination of fresh CSF cytology.Post treatment evaluating:for DLGNT,consult oncology.Meningeal biopsy and PET-CT(positron emission tomographycomputed tomography)examination were recommended,and intrathecal chemotherapy and whole-brain radiotherapy were performed according to the examination results.But the patient’s family refused to have a meningeal biopsy and asked to be released from the hospital.Conclusions:the adolescent female without a history of tumor can not rule out the disease,and cryptococcal meningitis also has meningeal enhancement.The gold standard for the diagnosis of DLGNT is to find cancer cells.There is no effective cure for DLGNT,the timely placement of Ommaya sac can significantly improve the quality of the patient’s life,and the active adoption of targeted therapy is expected to extend the patient’s survival.

Manifestation of the malignant progression of glioma following initial intracerebral hemorrhage:A case report

BACKGROUND Intracranial hemorrhage is extremely rare during the initial stages of glioma.Here,we report a case of glioma with unclassified pathology and intracranial bleeding.CASE SUMMARY After the second surgery for intracerebral hemorrhage,the patient experienced weakness in the left arm and leg,but could walk unassisted.One month after discharge,the weakness in the left limbs had exacerbated and the patient also suffered from headaches and dizziness.A third surgery was ineffective against the rapidly growing tumor.Intracerebral hemorrhage may be the initial symptom of glioma in some rare cases,and atypical perihematomal edema can be used for diagnosis during an emergency.Certain histological and molecular features seen in our case were similar to that of glioblastoma with a primitive neuronal component,which is termed diffuse glioneuronal tumor with features similar to oligodendroglioma and nuclear clusters(DGONC).The patient underwent three surgeries to remove the tumor.The first tumor resection had been performed when the patient was 14-years-old.Resection of the hemorrhage and bone disc decompression were performed when the patient was 39-years-old.One month after the last discharge,the patient underwent neuronavigation-assisted resection of the right frontotemporal parietal lesion plus extended flap decompression.On the 50^(th)d after the third operation,computed tomography imaging showed rapid tumor growth accompanied by brain hernia.The patient was discharged and died 3 d later.CONCLUSION Glioma can present as bleeding in the initial stage and should be considered in such a setting.We have reported a case of DGONC,which is a rare molecular subtype of glioma with a unique methylation profile.

Epilepsy associated tumors: Review article

Long-term epilepsy associated tumors(LEAT) represent a well known cause of focal epilepsies. Glioneuronaltumors are the most frequent histological type consisting of a mixture of glial and neuronal elements and most commonly ariseing in the temporal lobe. Cortical dysplasia or other neuronal migration abnormalities often coexist. Epilepsy associated with LEAT is generally poorly controlled by antiepileptic drugs while, on the other hand, it is high responsive to surgical treatment. However the best management strategy of tumor-related focal epilepsies remains controversial representing a contemporary issues in epilepsy surgery. Temporo-mesial LEAT have a widespread epileptic networkwith complex epileptogenic mechanisms. By using an epilepsy surgery oriented strategy LEAT may have an excellent seizure outcome therefore surgical treatment should be offered early, irrespective of pharmacoresistance, avoiding both the consequences of uncontrolled seizures as well as the side effects of prolonged pharmacological therapy and the rare risk of malignant transformation.