Metastatic Diffuse Intrinsic Pontine Glioma to the Peritoneal Cavity Via Ventriculoperitoneal Shunt: Case Report and Literature Review

Abstract

Extraneural metastatic disease resulting from a primary central nervous system neoplasm is a rare clinical finding in the pediatric population. We report a case of peritoneal glioblastoma carcinomatosis following placement of a ventriculoperitoneal shunt and chemoradiotherapy in a 6-year-old female patient who initially presented with diffuse intrinsic pontine glioma. This case demonstrates the importance of evaluation of extraspinal structures when imaging for extension of disease. Additionally, this report highlights the cross-sectional imaging characteristics of glioblastoma peritoneal carcinomatosis and presents additional information that will facilitate the timely diagnosis of extraneural metastases of primary high-grade glial neoplasms in the pediatric population.

Keywords

pontine glioma - peritoneal metastasis - magnetic resonance imaging - pediatrics

Note

Ramon Francisco Barajas Jr. and Andrew Phelps contributed equally.

• References

• 1 Khatua S, Moore KR, Vats TS, Kestle JR. Diffuse intrinsic pontine glioma—current status and future strategies. Childs Nerv Syst 2011; 27 (9) 1391-1397
• 2 Cage TA, Samagh SP, Mueller S , et al. Feasibility, safety, and indications for surgical biopsy of intrinsic brainstem tumors in children. Childs Nerv Syst 2013; 29 (8) 1313-1319
• 3 Duffner PK, Cohen ME. Extraneural metastases in childhood brain tumors. Ann Neurol 1981; 10 (3) 261-265
• 4 Schuster H, Jellinger K, Gund A, Regele H. Extracranial metastases of anaplastic cerebral gliomas. Acta Neurochir (Wien) 1976; 35 (4) 247-259
• 5 Rickert CH. Extraneural metastases of paediatric brain tumours. Acta Neuropathol 2003; 105 (4) 309-327
• 6 Pollack IF, Hurtt M, Pang D, Albright AL. Dissemination of low grade intracranial astrocytomas in children. Cancer 1994; 73 (11) 2869-2878
• 7 Trigg ME, Swanson JD, Letellier MA. Metastasis of an optic glioma through a ventriculoperitoneal shunt. Cancer 1983; 52 (4) 599-601
• 8 Schweitzer T, Vince GH, Herbold C, Roosen K, Tonn JC. Extraneural metastases of primary brain tumors. J Neurooncol 2001; 53 (2) 107-114
• 9 Rickert CH. Abdominal metastases of pediatric brain tumors via ventriculo-peritoneal shunts. Childs Nerv Syst 1998; 14 (1-2) 10-14
• 10 Berger MS, Baumeister B, Geyer JR, Milstein J, Kanev PM, LeRoux PD. The risks of metastases from shunting in children with primary central nervous system tumors. J Neurosurg 1991; 74 (6) 872-877
• 11 Jiménez-Jiménez FJ, Garzo-Fernández C, De Inovencio-Arocena J, Pérez-Sotelo M, Castro-De Castro P, Salinero-Paniagua E. Extraneural metastases from brainstem astrocytoma through ventriculoperitoneal shunt. J Neurol Neurosurg Psychiatry 1991; 54 (3) 281-282
• 12 Liwnicz BH, Rubinstein LJ. The pathways of extraneural spread in metastasizing gliomas: a report of three cases and critical review of the literature. Hum Pathol 1979; 10 (4) 453-467
• 13 Weiss L. A metastasizing ependymoma of the cauda equina. Cancer 1955; 8 (1) 161-171
• 14 Fontanilla HP, Pinnix CC, Ketonen LM , et al. Palliative reirradiation for progressive diffuse intrinsic pontine glioma. Am J Clin Oncol 2012; 35 (1) 51-57
• 15 Jacques TS, Miller K, Rampling D, Gatscher S, Harding B. Peritoneal dissemination of a malignant glioma. Cytopathology 2008; 19 (4) 264-266
• 16 Kumar R, Jain R, Tandon V. Thalamic glioblastoma with cerebrospinal fluid dissemination in the peritoneal cavity. Pediatr Neurosurg 1999; 31 (5) 242-245
• 17 Newton HB, Rosenblum MK, Walker RW. Extraneural metastases of infratentorial glioblastoma multiforme to the peritoneal cavity. Cancer 1992; 69 (8) 2149-2153
• 18 Wakamatsu T, Matsuo T, Kawano S, Teramoto S, Matsumura H. Glioblastoma with extracranial metastasis through ventriculopleural shunt. Case report. J Neurosurg 1971; 34 (5) 697-701