Abstract
Primary bilateral thalamic tumors are extremely rare entity. We present a case of a 5-year-old child admitted with signs of raised intracranial pressure. Brain MRI showed huge bithalamic lesion with subsequent hydrocephalus. After ventriculo peritoneal shunt, direct operation was performed, and most of the right sided tumor mass was removed. Diagnosis was anaplastic astrocytoma. Although quarterly MRI did not show signs of tumor regrowth, twenty-one months after surgery child was referred to our department with acute consciousness deterioration, and hemorrhage in the region of the corpus callosum. After hematoma evacuation patient has recovered. Pathohistological examination showed glioblastoma, so after two weeks child was again operated, and gross tumor resection was performed. However, signs of leptomeningeal spread occurred, and patient died two months after the last operation.
Highlights
Pediatric thalamic tumors are rare, and their frequency is estimated between 0.84% to 5.2% of all intracranial tumors
Thalamic gliomas are rare tumors that make up about 1-5 % of pediatric intracranial tumors
After WHO classification from 2016, when diffuse midline glioma, H3 K27M-mutant was introduced as the new entity, specific for pediatric patients with midline gliomas and poor prognosis, it could have been expected that bithalamic gliomas will have this genetic pattern, but recent investigations excluded this possibility [5,10]
Summary
Pediatric thalamic tumors are rare, and their frequency is estimated between 0.84% to 5.2% of all intracranial tumors. Steinbok et al [2] reported review of seventy-two thalamic tumors of which 10 patients had bilateral lesion They are histologically benign, showing slow growth and reaching huge dimensions at the time of diagnosis, often causing CSF flow obstruction. Brain MRI showed huge bithalamic lesion, with some right sided predominance. It was uniformly isointense on T1 weighted and, hyperintense on T2 and FLAIR weighted images, with no contrast enhancement. Postoperative MRI showed residual tumor in the left thalamic region, and radiotherapy was performed, followed by chemotherapy. Brain CT scan showed tumor regrowth in the region of corpus callosum, so we again decided to operate the child (Figure 5). No further oncological therapy was conducted, and the child died two months after the last operation
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