Unusual Association of Multiple Cerebral and Orbital Tumors in a Two-Year-Old Child: A Case Report and Literature Review

Background The simultaneous occurrence of multiple primary brain tumors of differing histologies in a pediatric patient is extraordinarily rare. Established cancer-predisposition syndromes (NF1/NF2, Li–Fraumeni) or prior cranial irradiation can give rise to multiple lesions, but these were not apparent in our patient. Case Presentation: A previously healthy 2-year-old girl presented with chronic headache and progressive right-sided proptosis. MRI and CT revealed six separate lesions: (1) an intraocular retinoblastoma extending into the orbit; (2) two intra-conal right optic nerve sheath schwannomas; (3) a heterogeneous cystic sellar/suprasellar mass suggestive of craniopharyngioma; (4) a homogeneously enhancing olfactory groove meningioma; (5) a mixed cystic-solid right cerebellar mass consistent with pilocytic astrocytoma; and (6) multiple leptomeningeal and cortical enhancing nodules compatible with carcinomatous meningitis. The family was opposed to further genetic tests and elected serial imaging surveillance for all lesions. The child had no personal or family history of a cancer syndrome, no prior radiation exposure, and no systemic features of an inherited neoplasia predisposition. Conclusion The co-occurrence of six histologically distinct CNS tumors in one child, none of which fit a known genetic syndrome, appears unprecedented. This case underscores that multiple spatially and pathologically discrete brain tumors can arise in a pediatric patient without identifiable risk factors. It highlights the importance of thorough diagnostic evaluation (to distinguish multicentric primaries from metastases) and consideration of underlying germline or mosaic mutations. Further study is needed to understand the etiology of such multiple tumor formations and to guide surveillance and management in similarly complex cases.