Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review
Introduction. Synchronous multicentric cerebral gliomas are uncommon brain tumors, mostly malignant, with unknown pathogenesis, unfavorable prognosis and still controversial management. Preoperative differentiation from other multiple brain pathologies by conventional magnetic resonance imaging (MRI...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2018-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501600238P.pdf |
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| author | Perić Predrag Pavlićević Goran Ostojić Jelena Kostić Dejan Nikolajević Sanja Šupić Gordana Magić Zvonko Radovinović-Tasić Sanja |
| author_facet | Perić Predrag Pavlićević Goran Ostojić Jelena Kostić Dejan Nikolajević Sanja Šupić Gordana Magić Zvonko Radovinović-Tasić Sanja |
| author_sort | Perić Predrag |
| collection | DOAJ |
| description | Introduction. Synchronous multicentric cerebral gliomas are uncommon brain tumors, mostly malignant, with unknown pathogenesis, unfavorable prognosis and still controversial management. Preoperative differentiation from other multiple brain pathologies by conventional magnetic resonance imaging (MRI) is often difficult, but supplemental use of advanced magnetic resonance techniques should allow the tumor biology to be predicted and an appropriate treatment strategy planned. Case report. We reported a 59-yearold man with double synchronous multicentric cerebral lesions, which had initial MRI and diffusion-weighted imaging presentation as left parietal metastasis and ipsilateral amygdalo- hippocampal low-grade glioma. However, magnetic resonance spectroscopy (MRS) of both lesions showed different metabolite profiles of malignant glioma. En bloc resection of the easily accessible parietal lesion revealed glioblastoma with methylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter. Subsequently, the patient was treated with temozolomide (TMZ)-based chemoradiation according to Stupp’s protocol, with continuous standard (5/28) adjuvant TMZ in 12 courses. Despite prolonged stabilization of the disease with good life-quality during treatment, the patient died 19 months after diagnosis. The time to tumor progression estimated by MRI was 17 months. Conclusion. MRS significantly improved the differential diagnostic accuracy of conventional MRI in our patient. In accordance with reviewed literature data, the younger age, good initial performance status and methylated MGMT gene promoter were all favorable predictors of longer survival in the reported case. Resection of at least one easily accessible tumor lesion, followed by TMZ-based chemoradiation, with continuous adjuvant TMZ in more than 6 standard courses, seems currently to be the most beneficial therapeutic option for such cases. |
| format | Article |
| id | doaj-art-637ad7aa07a44e2fb4636283f273bfec |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-637ad7aa07a44e2fb4636283f273bfec2025-08-20T01:57:09ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202018-01-0175441442110.2298/VSP160605238P0042-84501600238PSynchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature reviewPerić Predrag0Pavlićević Goran1Ostojić Jelena2Kostić Dejan3Nikolajević Sanja4Šupić Gordana5Magić Zvonko6Radovinović-Tasić Sanja7Military Medical Academy, Clinic for Neurosurgery, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, BelgradeMilitary Medical Academy, Clinic for Neurosurgery, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, BelgradeClinical Center of Vojvodina, Center for Radiology, Novi Sad + Faculty of Medicine, Novi SadUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Radiology, BelgradeMilitary Medical Academy, Institute for Pathology and Forensic Medicine, BelgradeUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Medical Research, Belgrade University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Medical Research, Belgrade Military Medical Academy, Institute for Radiology, BelgradeIntroduction. Synchronous multicentric cerebral gliomas are uncommon brain tumors, mostly malignant, with unknown pathogenesis, unfavorable prognosis and still controversial management. Preoperative differentiation from other multiple brain pathologies by conventional magnetic resonance imaging (MRI) is often difficult, but supplemental use of advanced magnetic resonance techniques should allow the tumor biology to be predicted and an appropriate treatment strategy planned. Case report. We reported a 59-yearold man with double synchronous multicentric cerebral lesions, which had initial MRI and diffusion-weighted imaging presentation as left parietal metastasis and ipsilateral amygdalo- hippocampal low-grade glioma. However, magnetic resonance spectroscopy (MRS) of both lesions showed different metabolite profiles of malignant glioma. En bloc resection of the easily accessible parietal lesion revealed glioblastoma with methylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter. Subsequently, the patient was treated with temozolomide (TMZ)-based chemoradiation according to Stupp’s protocol, with continuous standard (5/28) adjuvant TMZ in 12 courses. Despite prolonged stabilization of the disease with good life-quality during treatment, the patient died 19 months after diagnosis. The time to tumor progression estimated by MRI was 17 months. Conclusion. MRS significantly improved the differential diagnostic accuracy of conventional MRI in our patient. In accordance with reviewed literature data, the younger age, good initial performance status and methylated MGMT gene promoter were all favorable predictors of longer survival in the reported case. Resection of at least one easily accessible tumor lesion, followed by TMZ-based chemoradiation, with continuous adjuvant TMZ in more than 6 standard courses, seems currently to be the most beneficial therapeutic option for such cases.http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501600238P.pdfgliomaglioblastomadiagnosismagnetic resonance imagingmagnetic resonance spectroscopymgmt protein, humantemozolomideprognosistreatment outcome |
| spellingShingle | Perić Predrag Pavlićević Goran Ostojić Jelena Kostić Dejan Nikolajević Sanja Šupić Gordana Magić Zvonko Radovinović-Tasić Sanja Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review Vojnosanitetski Pregled glioma glioblastoma diagnosis magnetic resonance imaging magnetic resonance spectroscopy mgmt protein, human temozolomide prognosis treatment outcome |
| title | Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review |
| title_full | Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review |
| title_fullStr | Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review |
| title_full_unstemmed | Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review |
| title_short | Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review |
| title_sort | synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival case report and literature review |
| topic | glioma glioblastoma diagnosis magnetic resonance imaging magnetic resonance spectroscopy mgmt protein, human temozolomide prognosis treatment outcome |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501600238P.pdf |
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