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Epithelioid glioblastoma changed to typical glioblastoma: the methylation status of MGMT promoter and 5-ALA fluorescence

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Abstract

A 55-year-old man was admitted to our hospital complaining of left hemiparesis. Magnetic resonance imaging (MRI) showed a smooth ring-like enhanced cystic tumor in the right parietal lobe. He underwent gross total resection of the tumor under neuronavigation and 5-aminolevulinic acid (5-ALA) fluorescence guiding method. Histopathological examination of the tumor showed small cells formed epithelioid solid nests with some focus of duct-like structure. On the basis of the MRI and operative and histological findings, this tumor was diagnosed as a metastatic poorly differentiated carcinoma, although the primary cancer could not be detected by metastatic work-ups. Afterward, this tumor recurred repeatedly. Histopathological examination of specimen from the fourth surgery indicated that the tumor was a glioblastoma (GBM). In the review of the histology and immunohistochemistry of the first tumor, atypical fibrillary cells were seen between solid nests and positive for glial fibrillary acidic protein, therefore the tumor was retrospectively diagnosed as epithelioid GBM. We assessed whether the changes in histopathology were accompanied by changes in the methylation status of O6-methylguanine methyltransferase (MGMT) promoter and the status of 5-ALA fluorescence. The methylation status of the MGMT promoter was found to have changed from methylated to unmethylated and 5-ALA fluorescence became positive along with the histological change.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

GBM:

Glioblastoma

5-ALA:

5-Aminolevulinic acid

PPIX:

Protoporphyrin IX

MGMT:

O6-Methylguanine methyltransferase

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Authors and Affiliations

  1. Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Shingo Tanaka, Mitsutoshi Nakada, Yutaka Hayashi, Natsuki Furuyama, Tomohide Suzuki, Tomoya Kamide, Yasuhiko Hayashi & Jun-ichiro Hamada

  2. Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan

    Satoko Nakada

  3. Pathology Section, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Seiko Sawada-Kitamura

  4. Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan

    Seiji Yano

Authors
  1. Shingo Tanaka
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  2. Mitsutoshi Nakada
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  3. Yutaka Hayashi
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  4. Satoko Nakada
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  5. Seiko Sawada-Kitamura
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  6. Natsuki Furuyama
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  7. Tomohide Suzuki
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  8. Tomoya Kamide
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  9. Yasuhiko Hayashi
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  10. Seiji Yano
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  11. Jun-ichiro Hamada
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Correspondence to Mitsutoshi Nakada.

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Tanaka, S., Nakada, M., Hayashi, Y. et al. Epithelioid glioblastoma changed to typical glioblastoma: the methylation status of MGMT promoter and 5-ALA fluorescence. Brain Tumor Pathol 28, 59–64 (2011). https://doi.org/10.1007/s10014-010-0009-x

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  • DOI: https://doi.org/10.1007/s10014-010-0009-x

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