Leptomeningeal spread of high grade glioma (HGG) has been rarely reported in literature, with an incidence of <5%. It is associated with dismal outcome with a median survival of <6 months. Here we present a series of three HGG patients who developed spinal cord metastasis and succumbed to it within three months of diagnosis

Background: Series on radiotherapy (RT) practice in pediatric malignancies are limited in India as only few centers practice pediatric RT, particularly under anesthesia. We aimed to study the clinical profile of pediatric cancer patients treated with RT and to assess various aspects of pediatric RT under anaesthesia. Procedure: The data was prospectively maintained in Microsoft Excel spreadsheets. Pediatric cancer patients aged 0–14 years, registered in the department between February 1, 2019, and July 30, 2021were analyzed. Results: A total of 193 pediatric cancer patients (non central nervous system) received radiation during above mentioned period. Median age at presentation was 5.2 years (range, 9 months to 14 years) with a male to female ratio of 1.8:1. Maximum population was in 0-4 years of age group (52.8%) followed by 5-9 years (29.5%) and ≥ 10 years (17.6%). Most common sites for RT included bone and soft tissue tumors (BST), retinoblastoma, wilms tumor, neuroblastoma, and hematological malignancies. Overall, BST constituted the most common malignancy among all age groups, followed by renal tumors in the 0-4 years and hematological malignancies in 5-14 years. One hundred and seventy-nine (92.7%) patients received RT with curative intent, while 14 (7.3%) patients received palliative RT. Thirty patients needed anaesthesia for RT. Thirty-four patients required RT interruption due to toxicities with a median gap of 7 days. Conclusions: RT is an important aspect of multi-disciplinary care in pediatric cancers. Establishing burden of pediatric cancer patients in RT department may help in resource development and prioritisation.

Background: Embryonal tumor with multilayered rosettes (ETMR) are a heterogenous group clinically, pathologically and topographically. Due to limited cases, data regarding its molecular genetics, pathology and prognostic factors is evolving. We retrospectively analysed our cohort of ETMR over last decade in order to study their clinicopathological characteristics and outcome. Methods: Our cohort consisted of patients diagnosed with Embryonal tumor with abundant neuropil and true rosettes (ETANTR)/Ependymoblastoma (EBL)/ Medulloepithelioma (MEPL) over the past decade. Clinical details, including outcome and imaging data was retrieved. Histological analysis including immunohistochemical work-up was performed. Results: Cohort included 15 patients with age range between 1-28 years and M:F ratio of 1.5:1. Supratentorial location predominated in comparison to tumors arising in posterior fossa. ETANTR and EBL patterns were equally distributed (40% each), followed by one case each of mixed pattern (EBL+ETANTR), MEPL and embryonal tumor, unclassified. All tumors readily expressed LIN 28A and INI-1 was retained. Recurrence with evidence of glial and rhabdoid differentiation was noted in a single patient 9 months following resection. Follow-up period ranged from 1-31 months, with overall median survival of 6.4 months. Eight patients were planned for adjuvant treatment following surgery, of which only four could complete it. All patients, except for one, succumbed to the disease. Conclusions: ETMR have a heterogenous morphology and gathers ETANTR, EBL, MEPL within its spectrum. Following treatment, the recurrent tumor may feature glial/rhabdoid differentiation. LIN28A is expressed in all cases, however should be interpreted in context of histology. Prognosis of ETMR remains dismal despite multimodal therapy.