Giant hemorrhagic and abscessed pediatric high-grade glioma with osteolysis and transcalvarial herniation: A unique presentation and literature review.

INTRODUCTION

High-grade gliomas (HGGs) in very young children are rare, with intratumoral abscess formation being exceptionally uncommon and primarily reported in adults. We present a unique pediatric case with this rare complication.

CASE REPORT: A 5-month-old female infant, born after a complicated pregnancy, presented with rapidly progressive intracranial pressure. Imaging revealed a large, hemorrhagic, left parieto-occipital lesion with osteolysis and subsequent transcalvarial herniation. Intraoperatively, a culture-negative abscess was found within the tumor. Initial biopsy suggested a low-grade glioma, but final histopathology confirmed a high-grade glioma.

DISCUSSION: The combination of a giant, abscessed, and osteolytic HGG leading to transcalvarial herniation in a young infant is unprecedented. Intratumoral abscesses in pediatric HGGs are not previously documented, making this case a significant addition to the literature. The sterile abscess may be linked to tumor necrosis or the patient's perinatal history. This atypical presentation underscores the diverse nature of pediatric HGGs.

CONCLUSION

This first reported case of a giant, hemorrhagic, osteolytic, and abscessed pediatric HGG with transcalvarial herniation highlights an exceptionally rare and aggressive presentation in a very young infant. It emphasizes the need for considering unusual features in pediatric brain tumors and warrants further investigation into the pathogenesis and management of such complex lesions.