Abstract
Diencephalic syndrome (DS) is a rare pediatric condition associated with optic pathway gliomas (OPGs). Since they are slow-growing tumors, their diagnosis might be delayed, with consequences on long-term outcomes. We present a multicenter case series of nine children with DS associated with OPG, with the aim of providing relevant details about mortality and long-term sequelae. We retrospectively identified nine children (6 M) with DS (median age 14 months, range 3–26 months). Four patients had NF1-related OPGs. Children with NF1 were significantly older than sporadic cases (median (range) age in months: 21.2 (14–26) versus 10 (3–17); p = 0.015). Seven tumors were histologically confirmed as low-grade astrocytomas. All patients received upfront chemotherapy and nutritional support. Although no patient died, all of them experienced tumor progression within 5.67 years since diagnosis and were treated with several lines of chemotherapy and/or surgery. Long-term sequelae included visual, pituitary and neurological dysfunction. Despite an excellent overall survival, PFS rates are poor in OPGs with DS. These patients invariably present visual, neurological or endocrine sequelae. Therefore, functional outcomes and quality-of-life measures should be considered in prospective trials involving patients with OPGs, aiming to identify “high-risk” patients and to better individualize treatment.
Highlights
Diencephalic syndrome (DS) is a rare pediatric disorder characterized by failure to thrive, emaciation, hyperkinesia, despite normal or slightly decreased caloric intake, and normal linear growth
We describe a multicenter case series of nine young children with DS associated with optic pathway gliomas (OPGs), with the aim of providing relevant details about mortality and long-term sequelae associated with this rare condition
Children with neurofibromatosis type 1 (NF1)-related OPG were significantly older than sporadic cases (median age in months: 21.2 versus 10; p = 0.015)
Summary
Diencephalic syndrome (DS) is a rare pediatric disorder characterized by failure to thrive, emaciation, hyperkinesia, despite normal or slightly decreased caloric intake, and normal linear growth. DS commonly occurs in association with low-grade glioma (LGG) arising from the optic pathway, and involving the hypothalamus and the diencephalic structures [1].Optic pathway gliomas (OPG) account for approximately 3–5% of all pediatric brain tumors, and for 20% of brain tumors in very young children. They are more common in patients with neurofibromatosis type 1 (NF1) and represent one of the NF1 diagnostic criteria [2]. It is a rare occurrence, a more aggressive histopathological diagnosis (diffuse astrocytoma, anaplastic astrocytoma, glioblastoma) can be detected [4,5]
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