A Mistaken Diagnosis of Secondary Glioblastoma as Parasitosis

Abstract

Background: Glioblastoma is a malignant brain tumor with poor prognosis requiring early diagnosis. Secondary glioblastoma refers to cases that progressed from low-grade glioma. Evidence shows that timely resection correlates with increased survival.Case presentation: We describe a case of a patient with secondary glioblastoma who was mistakenly diagnosed with Angiostrongylus cantonensis infection until 7 years after disease onset. The patient presented with non-specific clinical manifestations at disease onset. A conventional magnetic resonance imaging (MRI) in the primary survey provided insufficient information, and thus failed to identify the malignancy. During follow-up, unfortunately, clinicians were misled by the patient's raw food diet, a positive serum parasite antibody and a result of low glucose metabolism on Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT). The patient was diagnosed with parasitosis. However, his condition kept getting worse under antiparasitic treatment. Preoperative magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) failed to reverse the mistaken impression. Final diagnosis was confirmed until intraoperative and postoperative pathological findings indicated glioblastoma.Conclusion: We ascribe the incorrect diagnosis to insufficient understanding on imaging manifestations of brain neoplasm as well as clinical features of parasitosis. Thus, we review the MRI, FDG-PET-CT, MRS, and DTI data of this case according to the timeline, refer to relevant studies, and point out the pitfalls. With a long course of slowly progressing, this was a rare case of secondary glioblastoma with the absence of isocitrate dehydrogenase 1 (IDH1) gene mutation.

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“…Early diagnosis and appropriate intervention are required to ensure prolonged survival and minimize the possibility of transformation into malignancy [6]. One of the major challenges against properly timed diagnosis and intervention of low-grade astrocytoma is the diffi culty to ascertain and diff erentiate them from other non-enhancing intraaxial lesions including those arising from infections or acute and subacute traumatic brain injuries [8][9][10]. Also, traumatic brain injury itself is thought to carry a potential of inducing astrocytic malignant transformation [11].…”

Incidental IDH1 Mutant Low-grade Astrocytoma Mimicking TBI Later Transforming into Aggressive Glioblastoma: Diagnostic and Serial Surgical Challenges in Gliomas

“…Early diagnosis and appropriate intervention are required to ensure prolonged survival and minimize the possibility of transformation into malignancy [6]. One of the major challenges against properly timed diagnosis and intervention of low-grade astrocytoma is the diffi culty to ascertain and diff erentiate them from other non-enhancing intraaxial lesions including those arising from infections or acute and subacute traumatic brain injuries [8][9][10]. Also, traumatic brain injury itself is thought to carry a potential of inducing astrocytic malignant transformation [11].…”

Aptamer Generated by Cell-SELEX for Specific Targeting of Human Glioma Cells

“…7,8 These clinical manifestations can be misdiagnosed as noncancerous diseases, resulting in diagnostic delay. 9,10 The present imaging systems, including computed tomography, transcranial sonography, and magnetic resonance imaging, are employed in the routine diagnosis of brain tumors. 11,12 Such systems can accurately detect anatomical changes between different tissue types.…”

“…Gliomas are the most common primary brain tumors, and they originate from normal glial cells, including oligodendrocytes, astrocytes, and ependymal cells. − Most gliomas are characterized by highly infiltrative capacities and variant tumor heterogeneity, which greatly complicate glioma therapy. − The clinical symptoms and signs of malignant gliomas are normally nonspecific in the early stage, including headaches associated with increased intracranial pressure and neurologic deficits related to the functions of the affected brain regions. , These clinical manifestations can be misdiagnosed as noncancerous diseases, resulting in diagnostic delay. , The present imaging systems, including computed tomography, transcranial sonography, and magnetic resonance imaging, are employed in the routine diagnosis of brain tumors. , Such systems can accurately detect anatomical changes between different tissue types. , Nevertheless, the imaging examinations are limited by their poor sensitivity for identifying the molecular and cellular changes in the earliest process of cancer, when no histological alterations have occurred. , …”