title: Spontaneous complete regression of hypothalamic pilocytic astrocytoma after partial resection in a child, complicated with Stevens-Johnson syndrome: a case report and literature review.
abstract: Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor. The spontaneous regression that occurs after partial/subtotal resection is multifactorial, depending on multiple factors, as for the case of humoral and cell-mediated immune responses of the host to the implanted tumor. A 7-year-old boy was referred to a neurosurgery clinic with headache. Further imaging workup revealed hypothalamic PA. Partial resection of the lesions was performed with right-side pterional approach. The patient developed a severe panmucositis [Stevens-Johnson syndrome (SJS)] and respiratory failure plus conjunctivitis, due to phenytoin allergy. During the patient's 6-month follow-up, postoperative magnetic resonance imaging (MRI) revealed a residual tumor, and about 9 months later (at 15 months postoperatively), the MRI showed total regression of the tumor. Clinically, symptomatic PA may undergo spontaneous regression after partial resection. We report a well-documented case of spontaneous regression hypothalamic PA after partial resection that complicated with SJS. Immune system reaction in SJS may have a role in tumor behavior and spontaneous regression. Multiple studies confirmed spontaneous regression in PA after partial/subtotal resection. This phenomenon occurs due to humoral and cell-mediated host immune responses to the implanted tumor. The immune system reaction in SJS may have a role in tumor behavior and spontaneous regression.
authors.affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Kamali Avenue, Kargar Jonubi Street, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Samadian
authors.affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Kamali Avenue, Kargar Jonubi Street, Tehran, Iran. mhbakhtevari@yahoo.com.
authors.forename: Mehrdad Hosseinzadeh
authors.initials: MH
authors.lastname: Bakhtevari
authors.affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Kamali Avenue, Kargar Jonubi Street, Tehran, Iran.
authors.forename: Karim
authors.initials: K
authors.lastname: Haddadian
authors.affiliation: Department of Pathology, Day General Hospital, Tavanir Avenue, Vali Asr Street, Tehran, Iran.
authors.forename: Hossein Afshin
authors.initials: HA
authors.lastname: Alavi
authors.affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Kamali Avenue, Kargar Jonubi Street, Tehran, Iran.
authors.forename: Omidvar
authors.initials: O
authors.lastname: Rezaei
mesh_terms: D001254:Astrocytoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002648:Child; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D018365:Neoplasm, Residual / Q000601:surgery; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Hypothalamus; Pilocytic astrocytoma; Spontaneous neoplasm regression; Stevens-Johnson syndrome