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