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Child's Nervous System
Published in: Child's Nervous System 12/2017

01-12-2017 | Case Report

Malignant transformation of a conservatively managed incidental childhood cerebral mass lesion: controversy regarding management paradigm

Authors: Jehuda Soleman, Jonathan Roth, Zvi Ram, Michal Yalon, Shlomi Constantini

Published in: Child's Nervous System | Issue 12/2017

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Abstract

Background

Incidental findings on neuroimaging in the pediatric population are an emerging treatment challenge. Treatment options for these incidental childhood brain mass lesions, which radiologically may be assumed to be low-grade gliomas (LGG), vary, ranging from careful conservative “wait and scan” treatment to surgical biopsy, gross total resection, and upfront radiation and/or chemotherapy. As malignant transformation of LGG in children is extremely rare, some series advocate careful conservative management of these lesions; however, universal treatment protocols are not totally agreed upon.

Illustrative case

We present the case of a 10-year-old boy with a fronto-basal incidental cerebral mass lesion, suspected to be a low-grade glial neoplasm. Initially, magnetic resonance imaging (MRI) was done to rule out a pathology causing his growth to be delayed. A treatment with growth hormone was initiated. After close clinical and radiological follow-up of this asymptomatic lesion for 6 years, a minimal growth of the lesion was seen, which we decided to continue following. After 7 years, a clear growth with new contrast enhancement was seen on routine MRI. At this point, the lesion was surgically resected. The diagnosis was, surprisingly, glioblastoma multiforme (WHO grade IV, BRAF V-600E mutation).

Discussion

Malignant transformation of LGGs in children is a very rare phenomenon. This is to our knowledge the first well-documented case describing malignant transformation of a suspected benign pediatric cerebral mass lesion, which did not undergo radiation, in a patient without a cancer predisposition syndrome (e.g., neurofibromatosis), with the transformation occurring after such a long follow-up period. The management of these lesions is still controversial. Unfortunately, radiological risk factors for malignant transformation of such lesions in the pediatric age group are lacking.

Conclusion

Conservative treatment of incidental cerebral mass lesions in children seems a valid option. These lesions should probably be followed indefinitely, while carefully watching for changes in imaging characteristics.
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Metadata
Title
Malignant transformation of a conservatively managed incidental childhood cerebral mass lesion: controversy regarding management paradigm
Authors
Jehuda Soleman
Jonathan Roth
Zvi Ram
Michal Yalon
Shlomi Constantini
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 12/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3566-z

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