Abstract
For atypical brainstem lesions, histological diagnosis can have an impact on treatment, especially in cases where diffuse glioma is not found. Since radiotherapy is the only therapeutic modality that has shown clinical and radiographic improvement in patients with diffuse glioma, the misdiagnosis of diffuse glioma can have drastic consequences, particularly in patients with nontumorous lesions. Thus, the purpose of this study was to evaluate the impact of histological diagnosis on the treatment of atypical brainstem lesions. This was a retrospective study of 31 patients who underwent biopsy of atypical brainstem lesions. The procedures were performed between January 2008 and December 2018 at the Life Center Hospital and Santa Casa de Belo Horizonte, MG, Brazil. A diagnosis was obtained in 26 (83.9%) cases. Three patients presented complications: one presented bleeding with no clinical repercussions and two showed worsening of neurological deficit, only one of which was definitive. No mortality occurred due to the procedure. The histological diagnosis was diffuse glioma in seven cases (22.6%) and not diffuse glioma in 19 cases (61.3%). Thus, the histological diagnosis had an impact on the treatment of 19 patients (treatment impact rate: 61.3%). The histological diagnosis of intrinsic brainstem lesions is a safe, efficient procedure with a high diagnosis rate, and as such, it should be considered in the management of atypical lesions.
Highlights
For atypical brainstem lesions, histological diagnosis can have an impact on treatment, especially in cases where diffuse glioma is not found
The treatment of patients with brainstem lesions, which account for only 1.6% of central nervous system tumors, is complex and controversial, in cases in which surgical resection is not indicated[1,2]
The diagnosis of intrinsic brainstem tumors is based on imaging studies and clinical history, in cases of “typical” diffuse pontine lesions, due to the high frequency of diffuse gliomas in such c ases[3]
Summary
Histological diagnosis can have an impact on treatment, especially in cases where diffuse glioma is not found. The diagnosis of intrinsic brainstem tumors is based on imaging studies and clinical history, in cases of “typical” diffuse pontine lesions, due to the high frequency of diffuse gliomas in such c ases[3]. The imaging characteristics that are considered typical of diffuse pontine gliomas are as follows: (a) an intrinsic and central tumor involving more than 50% of the axial diameter of the pons; (b) poorly defined margins; (c) T1 hypointensity; (d) T2 hyperintensity; (e) heterogeneous contrast uptake, if any; and (f) the absence of cystic or exophytic c omponents[4,5] Based on these radiographic parameters, a patient presenting with a clinical syndrome that is consistent with typical diffuse glioma is submitted to radiotherapeutic treatment without histological confirmation[6]. The image shows the following characteristics: (a) T2 hyposignal; (b) diffusion restriction; (c) enhanced prominent c ontrast[10]; and (d) lesions outside the limits of the p ons[11]
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