title: Hypothalamic-Optochiasmatic Pilocytic Astrocytoma Associated with Occipital and Sacral Spinal Cavernomas: A Mere Coincidence or a True Association?
abstract: BACKGROUND
  The co-occurrence of cerebral gliomas and cavernous angiomas is rarely encountered in clinical practice. All reported cases with such association have occurred within the brain with none involving the spinal cord.
  
  
  METHODS
  The authors report the case of a hypothalamic-optochiasmatic pilocytic astrocytoma coexisting with right occipital and sacral spinal cavernomas. This 30-year-old man had an 8-year history of chronic lower back pain. Spinal magnetic resonance imaging (MRI) demonstrated an 8.2-cm expansile multilobulated heterogeneously enhancing intradural mass within the sacral spinal canal, extending into the bilateral S1 and left S2 foramina. Brain MRI depicted a 2.9-cm lobulated heterogeneously enhancing sellar-suprasellar solid and cystic mass expanding the sella and displacing the infundibulum to the right, with a normal-appearing pituitary gland inside the sella, and an extensive supratentorial and infratentorial superficial hemosiderosis. L5-S4 laminectomy and pterional craniotomy were performed for the resection of these lesions. Histopathologic examination revealed a sacral spinal cavernoma and a suprasellar hypothalamic-optochiasmatic pilocytic astrocytoma.
  
  
  CONCLUSIONS
  The coexistence of hypothalamic-optochiasmatic pilocytic astrocytoma and occipital and sacral spinal cavernomas has not been reported previously. Especially for radiologically atypical suprasellar lesions, hypothalamic-optochiasmatic glioma should be included in the differential diagnosis of masses that can expand the sella. Besides previously postulated hypotheses of viral-induced or angiogenic factor-induced glial growth, we hypothesize that neoplastic origins of hypothalamic-optochiasmatic glioma might be due to the irritative mechanisms resulting from the frequent bleeds occurring from the spinal or cranial cavernoma.
authors.affiliation: College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Hussam
authors.initials: H
authors.lastname: Abou Al-Shaar
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Amol
authors.initials: A
authors.lastname: Raheja
authors.affiliation: Department of Pathology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Palmer
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000000981:diagnostic imaging* / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D007796:Laminectomy / Q000379:methods; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D009778:Occipital Lobe / Q000000981:diagnostic imaging / Q000601:surgery; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome
keywords: Astrocytoma; Cavernoma; Cavernous angioma; Pilocytic astrocytoma; Spinal cord cavernoma