The Clinical Manifestations And Pathologic Features Of Gliomas In Children And Infants And Younger Children

Objective To investigate the specific clinical manifestations,histopathological spectrum,tumor locations,molecular pathologic abnormities and therapeutic characteristics of glioma in children and infants and younger children.Methods Children(<18 years old)with brain gliomas who underwent surgical treatment in our department from January 2012 to December 2018 were collected,and the histopathological results,tumor locations,and clinical manifestations were summarized and analyzed.Then the children were grouped according to the age when undergoing operations:the infant and younger children group(0-3 years old)and the older children group(4-18 years old).By comparing the two groups of children,the different clinical manifestations and pathologic characteristics of glioma in infants and young children were summarized and analyzed.Result A total of 172 children with gliomas were included in the study:138 children with low-grade glioma(WHOⅠ-Ⅱgrade)and 34 children with high-grade glioma(WHOⅢ-Ⅳgrade).There were 144 children in older children group,114 of them with low-grade glioma,and 30 of them with high-grade glioma.There were 28 cases in infant and younger children group,24 cases of low-grade glioma,and 4 cases of high-grade glioma.In the older children,gliomas were mainly distributed in the bilateral cerebral hemispheres and lateral ventricles,while in the infant and younger children,the majority of gliomas were subtentorial(χ~2=7.375,P=0.025).Among supratentorial gliomas,older children gliomas were mostly malignant(WHOⅡ-Ⅳgrade),while gliomas of the infant and younger children were mostly benign(WHOⅠgrade)(χ~2=4.617,P=0.032).Among the 172 cases,94 of them had tumor size descriptions,and there was no intergroup differences between the two groups(χ~2=0.714,P=0.803).In terms of the clinical manifestations,focal symptoms were more common in infants and young children(χ~2=14.243,P=0.000).Molecular pathological examination was performed in 14 cases,among which BRAF gene abnormities occurred most frequently,and all of them occurred in low-grade glioma,while the mutation burden of high-grade gliomas was low.The prognosis of children with low-grade glioma was good,and there was no difference of the survival time between the two group low-grade patients(χ2=0.019,P=0.889).Conclusion Glioma in the children were different from their adult counterparts in histopathological spectrum,clinical manifestations and molecular pathologic abnormities.While those of the gliomas in the infant and younger children were partly different from the older children counterparts.Low-grade glioma was the most common type of glioma in not only the infant and younger children but also the older children,especially the pilocytic astrocytoma,almost all the gliomas occurred in visual pathway in the infants and younger children were pilocytic astrocytoma.The molecular changes of glioma in the children were different from the adults,as well as the clinical manifestations and prognosis.DIPG,a special type of glioma in children,had very poor prognosis and still needs further in-depth study.Currently,biopsy as the relatively safe method for DIPG children to clarify the tissue and molecular pathological properties was advocated.The comprehensive treatment of low-grade glioma in children,especially in infants and young children,require more extensive multiple disciplinary cooperation.