FEDERAL AGENCY ON HEALTH AND SOCIAL DEVELOPMENT
FEDERAL SCIENTIFIC AND RESEARCH CENTER ON PEDIATRIC HEAMATOLOGY, ONCOLOGY AND IMMUNOLOGY
(FGU FNKC DGOI ROSZDRAVA)
117997, Moscow, GSP-7, Leninskiy prosp., h. 117 tel: (495) 936-93-76, fax: (495) 935-55-10, e-mail: info@niidg.ru
CONSULTATION
SavelovaSofia, age 1 year 5 months (born on 08.10.2005)
Diagnosis: aplastic ependymain the left frontal-temporal-parietal zone. The condition after several surgeries (09.02.06, 06.02.07).
Address: Ukraine, Ckarkiv oblast, Zmiyevsky region, village Sheludkovka, Lesnaya str., 5
From the age of 2 months the girl parents noticed frequent blinking, afterwards to this were added emesis, right eye lid ptosis. Later epileptic seizures appeared which repeated 1-2 times per week, as well as muscle weakness in the girl right arm and leg. MRI examination of brain on 07.02.06 revealed cystic solid tumour in the left frontal-temporal-parietal zone.
On 09.02.06 surgical operation 1 – tumor cyst draining with installation of prolonged permanent drainage. The local hospital morphologists diagnosed dermoid cyst.
Dynamic observation with brain MRI on 20.02.06, 03.03.06, 16.03.06, 10.05.06 and 05.09.06 revealed increase of cyst component of the tumour. The epileptic seizures continued; the girl regularly took finlepsin, which had no effect.
Brain MRI on 15.01.07 revealed significant growth of cystic solid tumor in the in the left frontal-temporal-parietal zone.
The patient was directed to Kyiv Neurosurgery Institute for surgery. On 06.02.07 surgical operation 2 - removal of the tumor of the mentioned localization. The local hospital morphologists diagnosed aplastic ependyma astrocytoma. Brain CT during post operational period on 07.02.07, 13.02.07 and 20.02.07 revealed post operational cyst 10x8x8 cm in size.
On 14.03.07 the girl histological preparations were reviewed in Moscow Burdenko Neurosurgery Institute. The diagnosis - aplastic ependyma.
MRI of the brain and spinal cord without CT post operational cyst in the left temporal lobe, which is connected with the lower cornu of the left cerebral ventricle (signs of porencephalia) without visible pathologic tissue inclusions. On the level of the left hemisphere is visible chronic subdural hemorrhage 3-4 mm in thickness. There is cyst of the transparent membrane: in the right subcortical zone we revealed cyst, which is situated closer to the back cornu of the right lateral ventricle and to the back thalamic lobes. The ventricles are moderately widened and shifted from left to right for about 3 mm.on 16.03.07 revealed the following:
Conclusion: considering the girl is younger than 3 years, histological variant of malignant tumor. At present we recommend PCT by HIT 2000 protocole, which includes application of high doses of Mtx in the first three blocks.
Вопрос о проведении лучевой терапии будет решен при динамическом обследовании на фоне ПХТ The possibility of radiotherapy will be considered during dynamic observation with PCT.
The girl will receive treatment at home.
We recommend:
1. Observation by pediatrician, oncologist, neuropathology specialist, neurosurgeon, and oculist at home.
2. PCT by HIT 2000 protocole, which includes application of high doses of Mtx in the first three blocks.
3. Brain MRI with contrastingafter the first block of PCT.
4. Repeated consultation, based on MRI results after the first block of PCT.
19.03.07
Director of neurooncology department, doctor of medical sciences, professor /Zheludkova О.G./
BURDENKO NEUROSURGERY INSTITUTE
of Academy of Medical Sciences of Russia
Neuromorphology laboratory
CONSULTATION RESULTS:
Patient: Savelova S.А.
Biopsy # … without marks
Pathological anatomical diagnosis after immunological-histological-chemical tests: aplastic ependyma, clearly pronounced positive GFAP expression, negative expression of neuronal, germinal, mesenchymal and epithelial markers.
Chief scientific collaborator Shishkina L.V.
Operation protocol
We made incision in the left frontal-temporal-parietal zone on the old scar. We put up bone flap in this zone. Cerebral membrane is very tight, it is open, and its basis is directed upwards. In upper temporal and parietal zone we revealed tumor of grey color. During the process of this tumor removal we opened up multiple cysts of yellow color. The tumor occupied temporal zone, therefore, we left narrow band of cerebral tissue in basal temporal zone. In the front the tumor is spread as far as Silius fissure, in medial direction the tumor is spread up to phalix. After the tumor removal we left narrow band of cerebral tissue over phalix. In the back the tumor is spread as far as occipital lobe. The general tumor size is 15 х 15 х 12 cm, we removed all the visible tumor. We stopped the blood with the help of haemostatic sponge. We stitched in hard cerebral membrane, which confines the zone 7 x 2 cm, and closed it with the help of haemostatic sponge. We fixed the skin flap with the help of knot stitch.
There were no complications during the operation.
Post operation diagnosis: Gigantic tumor in left temporal-parietal zone
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