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Case Reports
. 2017 Aug 18;9(8):e1580.
doi: 10.7759/cureus.1580.

Palliative Care Options for a Young Adult Patient with a Diffuse Intrinsic Pontine Glioma

Julian Sison  1 , Hung Tran  2 , Ashley Margol  2 , Nishant Tiwari  3 , Karla M Garcia  4 , Jennifer Cotter  5 , Erin Kiehna  6 , Arthur J Olch  7 , Kenneth Wong  7
Affiliations
Case Reports

Palliative Care Options for a Young Adult Patient with a Diffuse Intrinsic Pontine Glioma

Julian Sison et al. Cureus. .

Abstract

Diffuse intrinsic pontine gliomas (DIPGs) are rare but devastating brain tumors that occur primarily in children. These gliomas have poor prognoses and present options focus on palliation of symptoms and prolongation of life. Here, we present a case of a 16-year-old female diagnosed with a DIPG whose age group has been mostly left out of discussions regarding psychosocial support options. This report is meant to start a conversation about the different support options available at our institution that have shown promising results in the literature for palliative care applications. These options can include camps for patients with brain tumors, psychological counseling, the Ronald McDonald House, and other psychosocial programs. Many of these programs can be tailored to meet the specific needs of adolescent and young adult (AYA) patients and will hopefully be integrated into a comprehensive palliative care regimen in future studies.

Keywords: adolescent; aya; dipg; end-of-life; palliative care; psychosocial; support; young adult.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. High-grade diffuse intrinsic pontine glioma in a 16-year-old female
Sagittal (A), coronal (B), and axial (C) slices in T2-weighted magnetic resonance imaging showing a diffuse intrinsic brainstem hyperintense lesion (white arrows). (D) Magnetic resonance spectroscopy showing elevated choline and creatine peaks with a decreased n-acetylaspartate (NAA) peak.
Figure 2
Figure 2. Biopsy of a diffuse intrinsic pontine glioma
(A) Hematoxylin and eosin (H&E) stain showing neoplastic cells with nuclear atypia (black arrows) and intrinsic pontine neurons entrapped by neoplasm (red arrows). (B) H3K27me3 immunohistochemistry stain with wild type (black arrows) and mutant (red arrows) protein.
Figure 3
Figure 3. Treatment plan for a 16-year-old female with a diffuse intrinsic pontine glioma
Sagittal (A), coronal (B), and axial (C) slices of a dose color wash of a 10-beam non-coplanar intensity-modulated radiation therapy (IMRT) plan (white arrows) to 54 Gy in 30 fractions.
See this image and copyright information in PMC

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