H3G34-mutant diffuse hemispheric glioma with osseous metastases: a case report and literature review

Abstract

Aim: H3G34 diffuse hemispheric glioma is a CNS tumor that is difficult to diagnose and treat and accompanied with poor prognosis. It is becoming clear that extra CNS metastasis may present in a subset of patients with H3G34 gliomas, further complicating diagnosis and treatment. Materials & methods: We present a case of a 19-year-old female with a H3G34 mutant diffuse hemispheric glioma with osseous metastases. We then provide a literature review of the most recent understanding of H3G34 mutant malignancies. Conclusion: Given the stress that patients with H3G34 can experience and the poor prognosis, it is imperative to expand our knowledge and ascertain accurate diagnostic methodologies and targeted therapeutic approaches.

H3G34-Mutant Gliomas—A Review of Molecular Pathogenesis and Therapeutic Options

“…Reasons for initial presentation were most frequently signs and symptoms of high intracranial pressure (headache, nausea, vomiting, blurred vision, or somnolence), focal neurologic deficits, and seizures. Metastasis was uncommon but did occur in four cases, with the most common patterns being osseous metastasis and a leptomeningeal spread [69,109,110,114].…”

“…A number of studies reported on clinical presentation and/or survival [66][67][68][69][70][71][72][73][74][75][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123]. Survival is discussed below with treatment regimens in a separate section.…”

“…It is important to note that a large portion of DHGs were subtotally resected given the size, deep infiltration, and multifocal nature (such as gliomatosis [134,136]) of the tumors. The most common chemotherapeutic agents utilized included temozolomide [3,119], vincristine [71,72], lomustine [63,74,120], cisplastin [3,51], bevacizumab [62,79,123,124], and procarbazine [63,74], although other drugs, such as methotrexate, etoposide, and carboplatin or thiotepa, carboplatin, and cyclophosphamide [72]; doxorubicin, mesna, and ifosfamide [69]; irinotecan [62]; nimustine [76]; isotretinoin [71]; and dianhydrodulcitol [51], were also utilized. A standard chemotherapeutic regimen does not exist, and regimens are extrapolated from other studies.…”