5-ALA fluorescence in a WHO grade I papillary glioneuronal tumour: a case report

Abstract

Abstract5-ALA is proven to be effective in high-grade glioma operative resection. The use of 5-ALA in WHO grade I lesions is still controversial. A 49-year-old lady was diagnosed in 2004 with a left temporal lobe lesion as an incidental finding; she was followed up clinically and radiologically. In 2016, the lesion showed contrast enhancement and she was offered surgical resection but given she is asymptomatic, she refused. In 2018, the lesion showed signs of transformation with ring contrast enhancement, increased vasogenic oedema and perfusion; the patient accepted surgery at that point. She had preoperative mapping by navigated transcranial magnetic stimulation and she had operative resection with 5-ALA. The tumour was bright fluorescent under Blue 400 filter—Zeiss Pentero 900©(Carl Zeiss Meditec)—and both bright fluorescence and pale fluorescence were resected. Postoperative MRI showed complete resection and histopathology revealed WHO grade I papillary glioneuronal tumour, negative for BRAF V600 mutation. WHO grade I papillary glioneuronal tumour may present as 5-ALA fluorescent lesions. From a clinical perspective, 5-ALA can be used to achieve complete resections in these lesions which, in most cases, can be curative.

Papillary Glioneuronal Tumor Masquerading as Malignant Brain Tumors: A Case Report

“…Other than the MRI findings mentioned above, the present case could also have been misdiagnosed as a malignant brain tumor based on the following intraoperative findings: (1) the solid component emitted red fluorescence during the intraoperative photodynamic diagnosis, and (2) the results of the rapid intraoperative diagnosis using only one sample from one site indicated a malignant glioma. To the best of our knowledge, only one case of intraoperative fluorescence in PGNT has been reported in the relevant literature (Labrador et al) 10 ; therefore, the former finding was extremely rare. Additionally, Labrador et al reported intraoperative fluorescence in other cases of benign brain tumors.…”

Papillary Glioneuronal Tumor of Third Ventricle Endoscopically Treated: Case Report and Review of Literature

“…After radical excision, prognosis with free survival and overall survival is very good, with follow-up free of disease for up to 7 years after total resection as reported by Bouvier-Labit et al in their article in 2000 [6,14]. Lavrador et al propose the use of 5-ALA fluorescent in the lesion to achieve complete removal of PGNT [19].…”

PAPILLARY GLIONEURONAL TUMOR: A CASE REPORT & REVIEW OF LITERATURE

“…The close association between the ventricular system and the tumors, as was noted in our case, has been commented on by several authors, and it is thought to be due to the possible origin of these tumors from the neuroglial progenitor cells in the subependymal plate as postulated by Komori et al 3 These tumors need to be followed up for a long time since enlargement of the lesion has been reported as late as 10 years after the initial diagnosis. 20,21…”