Abstract
Background
The term of low-grade glioma addresses a favorable clinical outcome with indolent histological features in general consideration; however, recent studies underline the inconsistency, which originates from the accumulation of different histologic subtypes in this terminology. The malignant transformation of a low-grade glioma is unusual but presents a poor prognosis.
Case history
We report a case of a 12-year-old boy, who was referred for complaints of recurrent seizures. His physical examination was unremarkable, but it was learned that a peripheral mass lesion located on the left posterior parietal lobe—which had been thought to be a low-grade glioma—had been detected on a magnetic resonance imaging 2 years ago at a different hospital. The patient was then treated with valproate and carbamazepine for the seizures and advised to be followed up without any additional diagnostic and therapeutic studies for his suspected low-grade glioma. A recent magnetic resonance imaging study showed enlargements of the mass and surrounding edema with additional necrosis. Surgical excision of the tumor was performed. After the diagnosis of glioblastoma multiforme, the patient received radiation therapy and chemotherapy with a good clinical recovery without any evidence of residue or recurrence at 12-month follow-up.
Conclusion
The first line treatment modality in the management of low-grade glioma—especially in suitable patients—is clearly surgery. The gross total resection guarantees the distinguishing of the histological types of the low-grade gliomas and reflects the biologic behavior of these tumors. Observation without surgery must be reserved for selected unoperable cases.
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References
Broniscer A, Baker SJ, West AN, Fraser MM, Proko E, Kocak M, Dalton J, Zambetti GP, Ellison DW, Kun LE, Gajjar A, Gilbertson RJ, Fuller CE (2006) Clinical and molecular characteristics of malignant transformation of low-grade glioma in children. J Clin Oncol 25:682–629
Perry A (2003) Pathology of low-grade gliomas: an update of emerging concepts. Neurooncology 5:168–178
Pouratian N, Asthagiri A, Jagannathan J, Shaffrey ME, Schiff D (2007) Surgery insight: the role of surgery in the management of low-grade gliomas. Nat Clin Pract Neurol 3:628–639
Kocaeli H, Yakut T, Bekar A, Taşkapilioğlu O, Tolunay S (2006) Glioblastomatous recurrence of oligodendroglioma remote from the original site: a case report. Surg Neurol 66:627–631
Jay V, Squire J, Becker LE, Humphreys R (1994) Malignant transformation in a ganglioglioma with anaplastic neuronal and astrocytic components. Report of a case with flow cytometric and cytogenetic analysis. Cancer 73:2862–2868
Mittelbronn M, Schittenhelm J, Lemke D, Ritz R, Nägele T, Weller M, Meyermann R, Beschorner R (2007) Low grade ganglioglioma rapidly progressing to a WHO grade IV tumor showing malignant transformation in both astroglial and neuronal cell components. Neuropathology 27:463–467
Kim NR, Wang KC, Bang JS, Choe G, Park Y, Kim SK, Cho BK, Chi JG (2003) Glioblastomatous transformation of ganglioglioma: case report with reference to molecular genetic and flow cytometric analysis. Pathol Int 53:874–882
Rumana CS, Valadka AB (1998) Radiation therapy and malignant degeneration of benign supratentorial gangliogliomas. Neurosurgery 42:1038–1043
Brown PD (2006) Low-grade gliomas: the debate continues. Curr Oncol Rep 8:71–77
Tarnaris A, O'Brien C, Redfern RM (2006) Ganglioglioma with anaplastic recurrence of the neuronal element following radiotherapy. Clin Neurol Neurosurg 108:761–767
Unal E, Koksal Y, Vajtai I, Toy H, Kocaogullar Y, Paksoy Y (2008) Astroblastoma in a child. Childs Nerv Syst 24:165–168
Deorah S, Lynch CF, Sibenaller ZA, Ryken TC (2006) Trends in brain cancer incidence and survival in the United States: surveillance, epidemiology, and end results program, 1973 to 2001. Neurosurg Focus 20:E1
McCormack BM, Miller DC, Budzilovich GN, Voorhees GJ, Ransohoff J (1992) Treatment and survival of low-grade astrocytoma in adults—1977–1988. Neurosurgery 31:636–642
Cairncross JG, Laperriere NJ (1989) Low-grade glioma. To treat or not to treat? Arch Neurol 46:1238–1239
Cavaliere R, Lopes MB, Schiff D (2005) Low-grade gliomas: an update on pathology and therapy. Lancet Neurol 4:760–770
Kondziolka D, Lunsford LD, Martinez AJ (1993) Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg 79:533–536
Jenkinson MD, Smith TS, Brodbelt AR, Joyce KA, Warnke PC, Walker C (2007) Apparent diffusion coefficients in oligodendroglial tumors characterized by genotype. J Magn Reson Imaging 26:1405–1412
Hakyemez B, Erdogan C, Ercan I, Ergin N, Uysal S, Atahan S (2005) High-grade and low-grade gliomas: differentiation by using perfusion MR imaging. Clin Radiol 60:493–502
Keles GE, Lamborn KR, Berger MS (2001) Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735–745
van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmström PO, Collette L, Piérart M, Mirimanoff R, Karim AB, EORTC Radiotherapy and Brain Tumor Groups and the UK Medical Research Council (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:985–990
Khaw SL, Coleman LT, Downie PA, Heath JA, Ashley DM (2007) Temozolomide in pediatric low-grade glioma. Pediatr Blood Cancer 49:808–811
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Unal, E., Koksal, Y., Cimen, O. et al. Malignant glioblastomatous transformation of a low-grade glioma in a child. Childs Nerv Syst 24, 1385–1389 (2008). https://doi.org/10.1007/s00381-008-0716-3
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DOI: https://doi.org/10.1007/s00381-008-0716-3