Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review
2016
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 report the case of a 59-year-old
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.
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