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Am J Med Genet A. 2016 Jun;170(6):1455-61. doi: 10.1002/ajmg.a.37622. Epub 2016 Mar 14.

Histologically benign, clinically aggressive: Progressive non-optic pathway pilocytic astrocytomas in adults with NF1.

Author information

1
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland.
2
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland.
3
Division of Neurology, Department of Pathology, Duke University Medical Center, Durham, North Carolina.
4
Division of Neurology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina.
5
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.

Abstract

Although optic pathway gliomas are the most common brain tumors associated with neurofibromatosis type 1 (NF1), extra-optic gliomas occur and may behave more aggressively with outcomes that differ by age. A retrospective case-control study was designed to describe the clinical course of adult NF1 patients with progressive extra-optic pilocytic astrocytomas (PAs) and compare to a pediatric cohort. Data for patients treated at the Johns Hopkins Comprehensive Neurofibromatosis Center from 2003 to 2013 were reviewed to identify cases (adults, age >18) and controls (pediatric, age <18) with clinically or radiographically progressive extra-optic PAs. Demographic, clinical, histologic, and radiographic data were collected. Three adult NF1 cases and four pediatric NF1 controls were identified. Mean age was 32.3 ± 9.5 years, 66% male (cases); 12.8 ± 4.2 years, 100% male (controls). Symptomatic progression occurred in two-of-three adults (67%) while the majority of pediatric patients presented with isolated radiographic progression (n = 3, 75%). Onset tended to be more rapid in adults (4 ± 1 vs. 14 ± 8.3 months, P = 0.10). Subtotal resection was the treatment for all pediatric patients. Radiotherapy (n = 2), chemotherapy (n = 2), and targeted, biologic agents (n = 2) were administered in adults. Although all pediatric patients are living, outcomes were universally poor in adults with progression to death in all (median survival 17.1 months, range 6.6-30.3). In conclusion, despite grade I histology, all three adult NF1 patients with progressive extra-optic PAs suffered an aggressive clinical course which was not seen in pediatric patients. Clinicians should be aware of this clinico-histologic discrepancy when counseling and managing adult NF1 patients with progressive extra-optic PAs.

KEYWORDS:

adult; brain tumor; extra-optic glioma; neurofibromatosis type 1; pediatric; pilocytic astrocytoma

PMID:
26992069
PMCID:
PMC4938896
DOI:
10.1002/ajmg.a.37622
[Indexed for MEDLINE]
Free PMC Article

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