Multicentric gliomas misdiagnosed as metastatic tumors: One case report and literature review

Wang, Peng; Wu, Mingcan; Chen, Shijie; Yang, Yong; Zhao, Guang-rui

doi:10.1007/s11805-010-0538-4

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…13,14 A CT scan of the chest and abdomen is standard practice, and in the absence of a primary tumor, a stereotactic biopsy will establish the correct diagnosis and provide adequate tissue for further molecular tests. 15 The differential diagnosis also includes central nervous system lymphoma and inflammatory diseases such as tumefactive multiple sclerosis. 16,17 Such demyelinating lesions can mimic tumors, 18 and among misdiagnoses, a low-grade astrocytoma is the most frequent.…”

Section: Discussionmentioning

confidence: 99%

Multifocal low-grade astrocytoma successfully treated with volumetric modulated arc therapy and concurrent temozolomide

Kamperis¹,

Dionysopoulos²,

Efthymiadis³

et al. 2021

JCPCR

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Multifocal gliomas comprise an uncommon clinical entity with challenging diagnostic and therapeutic ramifications. In this article, we present the case of a young man with progressive memory loss that was found to have numerous space-occupying lesions masquerading as secondary metastases in his brain MRI. Histopathological examination revealed a diffuse low-grade astrocytoma. The patient was successfully treated with radical chemoradiotherapy and adjuvant temozolomide and has been recurrence-free during three years of regular follow-up. While we review the contemporary diagnostic and therapeutic options, we emphasize the necessity of stereotactic biopsy to 1. exclude brain metastases, 2. provide tissue for further molecular characterization, which is helpful for prognostication, and 3. guide an individualized treatment plan. We also contend against using whole-brain radiotherapy based on its well-recognized detrimental neurocognitive effects and its inability to allow dose escalation. Instead, targeted radiotherapy with IMRT/VMAT should be the preferred irradiation technique. As our imaging technology advances, so does our ability to diagnose multifocal lesions that would have been classified as unifocal in the past. Hence, we expect that we will, more often, be finding ourselves confronted with this clinical scenario in the future.

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Section: Discussionmentioning

confidence: 99%

Multifocal low-grade astrocytoma successfully treated with volumetric modulated arc therapy and concurrent temozolomide

Kamperis¹,

Dionysopoulos²,

Efthymiadis³

et al. 2021

JCPCR

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“…[ 10 24 ] Next, multicentric tumours (MCGBM) are multiple separate lesions without any clear microscopic or macroscopic connection. [ 25 31 ] The incidence of MLGBM has a wide range from 0.5% to 20%,[ 1 4 9 14 17 24 32 ] and most of them are found in the supratentorial component, especially in the frontal and parietal lobes. [ 1 ] Overall, it is difficult to differentiate between MFGBM and MCGBM with available imaging technology or their histological features.…”

Section: Discussionmentioning

confidence: 99%

Synchronous multicentric glioblastoma with PNET and O subtypes: Possible pathogenesis

Wan¹,

King²,

Low³

et al. 2014

Surg Neurol Int

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Background:Glioblastomas (GBM) are highly infiltrative, cellular and mitotically active tumors with large histologic variations within and between tumours. Several subtypes have been described including the GBM with oligodendroglial differentiation (GBM-O) and primitive neuroectodermal tumour components (GBM-PNET). We report the first described case of a patient with synchronous multi-centric GBM-O and GBM-PNET components.Case Description:A patient, who presented with a short history of progressive headache and difficulty with memory recall, was found on MRI imaging to have two intracranial lesions. These showed heterogeneous enhancement and were found in the left frontal and left temporal regions. The patient underwent gross total resection of these two lesions which were found to show GBM-O and GBM-PNET differentiations.Conclusion:Although tumour cell migration in the context of GBM is a well-recognized phenomenon, the traditional hypothesis is not able to satisfactorily explain this case of multicentric GBM whereby the two lesions demonstrate different cell origins. More current understanding of the migratory pathways from the subventricular zone provide an alternate and plausible pathway that fits our patient's unusual diagnosis.

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“…Despite the undoubted advantages of conventional contrast-enhanced MRI in diagnosing McGs, their differentiation from other multiple cerebral pathologies such as metastases, lymphoma, infections and vascular or demyelinating diseases may prove difficult or even impossible 8,9,24 . Conventional MRI has a limited capacity to differentiate McGs from multiple brain metastases, because their neuroimaging appearance is often similar, equivocal, or indistinguishable 8,24,25 , as was the case with the parietal lesion in our patient. An additional difficulty in distinguishing these intracerebral lesions is posed by the possibility of the simultaneous presence of brain metastasis in patients affected by glioma, even multicentric 6,18 .…”

Section: Discusionmentioning

confidence: 99%

Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review

et al. 2018

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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.

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Multicentric gliomas misdiagnosed as metastatic tumors: One case report and literature review

Cited by 3 publications

References 19 publications

Multifocal low-grade astrocytoma successfully treated with volumetric modulated arc therapy and concurrent temozolomide

Multifocal low-grade astrocytoma successfully treated with volumetric modulated arc therapy and concurrent temozolomide

Synchronous multicentric glioblastoma with PNET and O subtypes: Possible pathogenesis

Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review

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