Regresión espontánea de tumores cerebrales en niños: Reporte de caso y revisión de la literatura
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abr 11, 2024
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Resumen
Introducción: Se definen como lesiones ocupantes de espacio que presentan características radiológicas de tumores y que se resuelven espontáneamente durante el seguimiento radiológico. La regresión espontánea de tumores es un fenómeno raro, con una tasa de regresión en tumores malignos de 1/60.000 a 100.000 pacientes. Materiales y Métodos: Femenino de 11 años con polidipsia, poliuria, pérdida de peso de 5 kg, ataxia, cefalea, pérdida de visión y diabetes insípida. TC con tumor dependiente de quiasma que ocupa la cisterna interpenduncular desplazando el hipotálamo ventralmente. Resultados: Se realizó biopsia excisional mediante abordaje pterional y resección microquirúrgica, durante el procedimiento transquirúrgico se encontró engrosamiento del quiasma y nervios ópticos. Se notificó astocitoma pilocítico de grado I de la OMS. En el seguimiento de dos años con resonancia magnética cerebral, observamos una regresión completa del tumor. Discusión: La citorreducción parcial del tumor, biopsia, radioterapia o quimioterapia juegan un papel en el inicio de la apoptosis del tumor. El trauma quirúrgico altera favorablemente la actividad biológica del tumor y el estado inmunológico del huésped. Conclusiones: Los mecanismos de regresión espontánea e involución espontánea del tumor residual después de la cirugía no se conocen. La apoptosis puede ser el denominador común, los posibles mecanismos incluyen factores inmunológicos, genéticos y biológicos.
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Palabras clave
Regresión espontánea, Astrocitoma pilocítico, Tumores cerebrales, Apoptosis
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1. Fujimaki T, Mishima K, Asai A, Suzuki I, Kirino T. Spontaneous regression of a residual pineal tumor after resection of a cerebellar vermian germinoma. J Neurooncol. 1999;41(1):65–70. doi.org/10.1023/a:1006155120191.
2. Galloway L, Hayhurst C. Rapid regression of a symptomatic pineal region meningioma after presumed spontaneous central infarction. Acta Neurochir. 2016;158(8):1601–2. Doi: 10.1007/s00701-016-2859-4.
3. Gonzalez J, Gilbert MR. Treatment of astrocytomas. Curr Opin Neurol. 2005;18(6):632–8. Doi: 10.1097/01.wco.0000191510.14627.d2.
4. Gronych J, Korshunov A, Bageritz J, Milde T, Jugold M, Hambardzumyan D, et al. An activated mutant BRAF kinase domain is sufficient to induce pilocytic astrocytoma in mice. J Clin Invest. 2011;121(4):1344–8. Doi: 10.1172/JCI44656.
5. Gunny RS, Hayward RD, Phipps KP, Harding BN, Saunders DE. Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol. 2005;35(11):1086–91. Doi: 10.1007/s00247-005-1546-z.
6. Hoffman HJ, Soloniuk DS, Humphreys RP, Drake JM, Becker LE, De Lima BO, et al. Management and outcome of low-grade astrocytomas of the Midline in children. Neurosurgery. 1993;33(6):964–71. Doi: 10.1097/00006123-199312000-00002.
7. Lam KC, Ho JC, Yeung RT. Spontaneous regression of hepatocellular carcinoma: a case study. Cancer. 1982;50(2):332–6.
8. Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, et al. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys. 1996;36(3):549–56. Doi: 10.1016/s0360-3016(96)00352-5.
9. Kaye AH, Walker DG. Low grade astrocytomas: controversies in management. J Clin Neurosci. 2000;7(6):475–83. Doi: 10.1054/jocn.2000.0774.
10. Kheiri G, Habibi Z, Nejat F. Spontaneous regression of congenital brain tumors: a report of two cases. Childs Nerv Syst. 2021;37(12):3901–5. Doi: 10.1007/s00381-021-05172-1.
11. Schipmann S, Keurhorst D, Köchling M, Schwake M, Heß K, Sundermann B, et al. Regression of pineal lesions: Spontaneous or iatrogenic? A case report and systematic literature review. World Neurosurg. 2017;108:939-947.e1. doi: 10.1016/j.wneu.2017.08.106.
12. Schipmann S, Schwake M, Suero Molina E, Roeder N, Steudel W-I, Warneke N, et al. Quality indicators in cranial neurosurgery: Which are presently substantiated? A systematic review. World Neurosurg. 2017;104:104–12. Doi: 10.1016/j.wneu.2017.03.111.
13. Murai Y, Kobayashi S, Mizunari T, Ohaki Y, Adachi K, Teramoto A. Spontaneous regression of a germinoma in the pineal body after placement of a ventriculoperitoneal shunt: Case report. J Neurosurg. 2000;93(5):884–6. Doi: 10.3171/jns.2000.93.5.0884.
14. Sugita Y, Shigemori M, Yuge T, Iryo O, Kuramoto S, Nakamura Y, et al. Spontaneous regression of primary malignant intracranial lymphoma. Surg Neurol. 1988;30(2):148–52. Doi: 10.1016/0090-3019(88)90102-4.
15. Ono H, Shin M, Takai K, Oya S, Mukasa A, Saito N. Spontaneous regression of germinoma in the pineal region before endoscopic surgery: a pitfall of modern strategy for pineal germ cell tumors. J Neurooncol. 2011;103(3):755–8. Doi: 10.1007/s11060-010-0432-1.
16. Parsa CF. Spontaneous regression of optic gliomas: Thirteen cases documented by serial neuroimaging. Arch Ophthalmol. 2001;119(4):516. Doi: 10.1001/archopht.119.4.516.
17. Colosimo C, Cerase A, Maira G. Regression after biopsy of a pilocytic opticochiasmatic astrocytoma in a young adult without neurofibromatosis. Neuroradiology. 2000;42(5):352–6. Doi: 10.1007/s002340050897.
18. Leisti EL, Pyhtinen J, Poyhonen M. Spontaneous decrease of a pilocytic astrocytoma in neurofibromatosis type 1. AJNR Am J Neuroradiol. 1996;17(9):1691–4.
19. Rozen WM, Joseph S, Lo PA. Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 2008;44(4):324–8. Doi: 10.1159/000134925.
20. Schmandt SM, Packer RJ, Vezina LG, Jane J. Spontaneous regression of low-grade astrocytomas in childhood. Pediatr Neurosurg. 2000;32(3):132–6. Doi: 10.1159/000028917.
21. Omland H, Fosså SD. Spontaneous regression of cerebral and pulmonary metastases in renal cell carcinoma. Scand J Urol Nephrol. 1989;23(2):159–60. Doi: 10.3109/00365598909180834.
22. Alkhani AM, Boop FA, Rutka JT. Involution of enhancing intrinsic tectal tumors after endoscopic third ventriculostomy. Report of two cases: Report of two cases. J Neurosurg. 1999;91(5):863–6. Doi: 10.3171/jns.1999.91.5.0863.
23. Park SK, Wallace H, Brody J, Blakemore W. Immunosuppressive effect of surgery. Lancet. 1971;297(7689):53–5. Doi: 10.1016/s0140-6736(71)90777-x.
24. Dirven CM, Mooij JJ, Molenaar WM. Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst. 1997;13(1):17–23. Doi: 10.1007/s003810050033.
25. Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, et al. The 2021 WHO classification of tumors of the Central Nervous System: A summary. Neuro Oncol. 2021;23(8):1231–51. Doi: 10.1093/neuonc/noab106.
26. Loh J-K, Lieu A-S, Chai C-Y, Hwang S-L, Kwan A-L, Wang C-J, et al. Arrested growth and spontaneous tumor regression of partially resected low-grade cerebellar astrocytomas in children. Childs Nerv Syst. 2013;29(11):2051–5. Doi: 10.1007/s00381-013-2113-9.
27. Smoots DW, Geyer JR, Lieberman DM, Berger MS. Predicting disease progression in childhood cerebellar astrocytoma. Childs Nerv Syst. 1998;14(11):636–48. Doi: 10.1007/s003810050290.
28. Ogiwara H, Bowman RM, Tomita T. Long-term follow-up of pediatric benign cerebellar astrocytomas. Neurosurgery. 2012;70(1):40–7; discussion 47-8. Doi: 10.1227/NEU.0b013e31822ff0ed.
29. Steinbok P, Poskitt K, Hendson G. Spontaneous regression of cerebellar astrocytoma after subtotal resection. Childs Nerv Syst. 2006;22(6):572–6. Doi: 10.1007/s00381-006-0058-y.
30. Buder T, Deutsch A, Klink B, Voss-Böhme A. Model-based evaluation of spontaneous tumor regression in pilocytic astrocytoma. PLoS Comput Biol. 2015;11(12):e1004662. Doi: 10.1371/journal.pcbi.1004662.
31. Palma L, Celli P, Mariottini A. Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular reference to arrested growth or spontaneous tumour regression. Acta Neurochir. 2004;146(6):581–8; doi: 10.1007/s00701-004-0257-9.
32. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26(8):1338–45. Doi: 10.1200/JCO.2007.13.9337.
33. Venes JL, Latack J, Kandt RS. Postoperative regression of opticochiasmatic astrocytoma: A case for expectant therapy. Neurosurgery. 1984;15(3):421-3. Doi: 10.1097/00006123-198409000-00021.
34. Burzynski SR. Treatments for astrocytic tumors in children: Current and emerging strategies. Paediatr Drugs. 2006;8(3):167–78. Doi: 10.2165/00148581-200608030-00003.
35. Holmes AS, Klimberg IW, Stonesifer KJ, Kramer BS, Wajsman Z. Spontaneous regression of testicular seminoma: case report. J Urol. 1986;135(4):795–6. Doi: 10.1016/s0022-5347(17)45857-5.
36. Di Chirico A, Di Rocco F, Velardi F. Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst. 2001;17(1–2):42–6. Doi: 10.1007/pl00013724.
37. Masoudi A, Amini E, Wolff JE, Fuller GN, Ketonen L, Mahajan A. Shrinkage of germinoma by dexamethasone only. Pediatr Blood Cancer. 2008;50(5):1079. Doi: 10.1002/pbc.21421.
38. Si SJ, Khatua S, Dhall G, Nelson MD, Gonzalez-Gomez I, Finlay JL. Regression of primary central nervous system germinoma after dexamethasone administration: a case report. Pediatr Hematol Oncol. 2010;27(3):237–43. Doi: 10.3109/08880010903544866.
39. Sakai K, Miyahara T, Tsutsumi K, Kaneko T, Fukushima M, Tanaka Y, et al. Spontaneous regression of multicentric pilocytic astrocytoma with CSF dissemination in an adult. Brain Tumor Pathol. 2011;28(2):151–6. Doi: 10.1007/s10014-010-0015-z.
40. Mattogno PP, Frassanito P, Massimi L, Tamburrini G, Novello M, Lauriola L, et al. Spontaneous regression of pineal lesions: Ghost tumor or pineal apoplexy?. World Neurosurg. 2016;88:64–9. Doi: 10.1016/j.wneu.2015.12.080.
2. Galloway L, Hayhurst C. Rapid regression of a symptomatic pineal region meningioma after presumed spontaneous central infarction. Acta Neurochir. 2016;158(8):1601–2. Doi: 10.1007/s00701-016-2859-4.
3. Gonzalez J, Gilbert MR. Treatment of astrocytomas. Curr Opin Neurol. 2005;18(6):632–8. Doi: 10.1097/01.wco.0000191510.14627.d2.
4. Gronych J, Korshunov A, Bageritz J, Milde T, Jugold M, Hambardzumyan D, et al. An activated mutant BRAF kinase domain is sufficient to induce pilocytic astrocytoma in mice. J Clin Invest. 2011;121(4):1344–8. Doi: 10.1172/JCI44656.
5. Gunny RS, Hayward RD, Phipps KP, Harding BN, Saunders DE. Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol. 2005;35(11):1086–91. Doi: 10.1007/s00247-005-1546-z.
6. Hoffman HJ, Soloniuk DS, Humphreys RP, Drake JM, Becker LE, De Lima BO, et al. Management and outcome of low-grade astrocytomas of the Midline in children. Neurosurgery. 1993;33(6):964–71. Doi: 10.1097/00006123-199312000-00002.
7. Lam KC, Ho JC, Yeung RT. Spontaneous regression of hepatocellular carcinoma: a case study. Cancer. 1982;50(2):332–6.
8. Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, et al. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys. 1996;36(3):549–56. Doi: 10.1016/s0360-3016(96)00352-5.
9. Kaye AH, Walker DG. Low grade astrocytomas: controversies in management. J Clin Neurosci. 2000;7(6):475–83. Doi: 10.1054/jocn.2000.0774.
10. Kheiri G, Habibi Z, Nejat F. Spontaneous regression of congenital brain tumors: a report of two cases. Childs Nerv Syst. 2021;37(12):3901–5. Doi: 10.1007/s00381-021-05172-1.
11. Schipmann S, Keurhorst D, Köchling M, Schwake M, Heß K, Sundermann B, et al. Regression of pineal lesions: Spontaneous or iatrogenic? A case report and systematic literature review. World Neurosurg. 2017;108:939-947.e1. doi: 10.1016/j.wneu.2017.08.106.
12. Schipmann S, Schwake M, Suero Molina E, Roeder N, Steudel W-I, Warneke N, et al. Quality indicators in cranial neurosurgery: Which are presently substantiated? A systematic review. World Neurosurg. 2017;104:104–12. Doi: 10.1016/j.wneu.2017.03.111.
13. Murai Y, Kobayashi S, Mizunari T, Ohaki Y, Adachi K, Teramoto A. Spontaneous regression of a germinoma in the pineal body after placement of a ventriculoperitoneal shunt: Case report. J Neurosurg. 2000;93(5):884–6. Doi: 10.3171/jns.2000.93.5.0884.
14. Sugita Y, Shigemori M, Yuge T, Iryo O, Kuramoto S, Nakamura Y, et al. Spontaneous regression of primary malignant intracranial lymphoma. Surg Neurol. 1988;30(2):148–52. Doi: 10.1016/0090-3019(88)90102-4.
15. Ono H, Shin M, Takai K, Oya S, Mukasa A, Saito N. Spontaneous regression of germinoma in the pineal region before endoscopic surgery: a pitfall of modern strategy for pineal germ cell tumors. J Neurooncol. 2011;103(3):755–8. Doi: 10.1007/s11060-010-0432-1.
16. Parsa CF. Spontaneous regression of optic gliomas: Thirteen cases documented by serial neuroimaging. Arch Ophthalmol. 2001;119(4):516. Doi: 10.1001/archopht.119.4.516.
17. Colosimo C, Cerase A, Maira G. Regression after biopsy of a pilocytic opticochiasmatic astrocytoma in a young adult without neurofibromatosis. Neuroradiology. 2000;42(5):352–6. Doi: 10.1007/s002340050897.
18. Leisti EL, Pyhtinen J, Poyhonen M. Spontaneous decrease of a pilocytic astrocytoma in neurofibromatosis type 1. AJNR Am J Neuroradiol. 1996;17(9):1691–4.
19. Rozen WM, Joseph S, Lo PA. Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 2008;44(4):324–8. Doi: 10.1159/000134925.
20. Schmandt SM, Packer RJ, Vezina LG, Jane J. Spontaneous regression of low-grade astrocytomas in childhood. Pediatr Neurosurg. 2000;32(3):132–6. Doi: 10.1159/000028917.
21. Omland H, Fosså SD. Spontaneous regression of cerebral and pulmonary metastases in renal cell carcinoma. Scand J Urol Nephrol. 1989;23(2):159–60. Doi: 10.3109/00365598909180834.
22. Alkhani AM, Boop FA, Rutka JT. Involution of enhancing intrinsic tectal tumors after endoscopic third ventriculostomy. Report of two cases: Report of two cases. J Neurosurg. 1999;91(5):863–6. Doi: 10.3171/jns.1999.91.5.0863.
23. Park SK, Wallace H, Brody J, Blakemore W. Immunosuppressive effect of surgery. Lancet. 1971;297(7689):53–5. Doi: 10.1016/s0140-6736(71)90777-x.
24. Dirven CM, Mooij JJ, Molenaar WM. Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst. 1997;13(1):17–23. Doi: 10.1007/s003810050033.
25. Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, et al. The 2021 WHO classification of tumors of the Central Nervous System: A summary. Neuro Oncol. 2021;23(8):1231–51. Doi: 10.1093/neuonc/noab106.
26. Loh J-K, Lieu A-S, Chai C-Y, Hwang S-L, Kwan A-L, Wang C-J, et al. Arrested growth and spontaneous tumor regression of partially resected low-grade cerebellar astrocytomas in children. Childs Nerv Syst. 2013;29(11):2051–5. Doi: 10.1007/s00381-013-2113-9.
27. Smoots DW, Geyer JR, Lieberman DM, Berger MS. Predicting disease progression in childhood cerebellar astrocytoma. Childs Nerv Syst. 1998;14(11):636–48. Doi: 10.1007/s003810050290.
28. Ogiwara H, Bowman RM, Tomita T. Long-term follow-up of pediatric benign cerebellar astrocytomas. Neurosurgery. 2012;70(1):40–7; discussion 47-8. Doi: 10.1227/NEU.0b013e31822ff0ed.
29. Steinbok P, Poskitt K, Hendson G. Spontaneous regression of cerebellar astrocytoma after subtotal resection. Childs Nerv Syst. 2006;22(6):572–6. Doi: 10.1007/s00381-006-0058-y.
30. Buder T, Deutsch A, Klink B, Voss-Böhme A. Model-based evaluation of spontaneous tumor regression in pilocytic astrocytoma. PLoS Comput Biol. 2015;11(12):e1004662. Doi: 10.1371/journal.pcbi.1004662.
31. Palma L, Celli P, Mariottini A. Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular reference to arrested growth or spontaneous tumour regression. Acta Neurochir. 2004;146(6):581–8; doi: 10.1007/s00701-004-0257-9.
32. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26(8):1338–45. Doi: 10.1200/JCO.2007.13.9337.
33. Venes JL, Latack J, Kandt RS. Postoperative regression of opticochiasmatic astrocytoma: A case for expectant therapy. Neurosurgery. 1984;15(3):421-3. Doi: 10.1097/00006123-198409000-00021.
34. Burzynski SR. Treatments for astrocytic tumors in children: Current and emerging strategies. Paediatr Drugs. 2006;8(3):167–78. Doi: 10.2165/00148581-200608030-00003.
35. Holmes AS, Klimberg IW, Stonesifer KJ, Kramer BS, Wajsman Z. Spontaneous regression of testicular seminoma: case report. J Urol. 1986;135(4):795–6. Doi: 10.1016/s0022-5347(17)45857-5.
36. Di Chirico A, Di Rocco F, Velardi F. Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst. 2001;17(1–2):42–6. Doi: 10.1007/pl00013724.
37. Masoudi A, Amini E, Wolff JE, Fuller GN, Ketonen L, Mahajan A. Shrinkage of germinoma by dexamethasone only. Pediatr Blood Cancer. 2008;50(5):1079. Doi: 10.1002/pbc.21421.
38. Si SJ, Khatua S, Dhall G, Nelson MD, Gonzalez-Gomez I, Finlay JL. Regression of primary central nervous system germinoma after dexamethasone administration: a case report. Pediatr Hematol Oncol. 2010;27(3):237–43. Doi: 10.3109/08880010903544866.
39. Sakai K, Miyahara T, Tsutsumi K, Kaneko T, Fukushima M, Tanaka Y, et al. Spontaneous regression of multicentric pilocytic astrocytoma with CSF dissemination in an adult. Brain Tumor Pathol. 2011;28(2):151–6. Doi: 10.1007/s10014-010-0015-z.
40. Mattogno PP, Frassanito P, Massimi L, Tamburrini G, Novello M, Lauriola L, et al. Spontaneous regression of pineal lesions: Ghost tumor or pineal apoplexy?. World Neurosurg. 2016;88:64–9. Doi: 10.1016/j.wneu.2015.12.080.
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Franco-Jiménez, J. A., Tafur-Grandett, A. A., López-Orozco, R., & Sosa-Nájera, A. (2024). Regresión espontánea de tumores cerebrales en niños: Reporte de caso y revisión de la literatura. Revista Chilena De Neurocirugía, 49(3), 137–142. https://doi.org/10.36593/revchilneurocir.v49i3.414
