4th Quadrennial Meeting of the World Federation of Neuro-Oncology

NO-114

A case of malignant gemistocytic astrocytoma with synchronous glioblastoma

Mimi Lee, Augustus Perez, John Norton, Hartmut Uschmann, Andrea Chamczuck, Majid Khan, Jonathan
Fratkin University of Mississippi Medical Center, Jackson,MS, USA

INTRODUTION: Gemistocytic astrocytomas (GA) are typically indolent CNS
lesions defined under the WHO classification as grade II neoplasia.  The natural
course of this disease includes a predilection for malignant transformation and,
to date, limited analyses of these tumors have yielded evidence for differential
genetic and pathological profiles that may underlie this behavior. We submit
here a case of biopsy-proven GA and synchronous GBM.  Antedating reviews
have speculated an occurrence rate of 2.4% for multi-focal gliomas and rates for
histopathologically distinct, multi-centric lesions are exceedingly lower.  The
contemporary literature is sparse for cases of either that involve GA.
PRESENTATION: A fifty-five year old Caucasian male presented with a six-month
history of dysphagia followed by weakness and neck pain.  Examination revealed a
weak gag, quadriparesis, and a C3-4 sensory level.  MRI of the brain and spine
demonstrated T2 signal changes with white matter in the right frontal lobe,
cervico-medullary junction (CMJ), and at C3-4.  MRS of the frontal mass
demonstrated an elevated choline peak. Infectious, autoimmune, and metastatic
workup was negative. SURGICAL INTERVENTION AND PATHOLOGY: This patient underwent
stereotactic biopsy of the supratentorial lesion and histological analysis
revealed globoid cells.  Autopsy confirmed the presence of a frontal GA, WHO
grade III, and a WHO grade IV glioma at the CMJ based on high MIB-1 labeling
index, necrosis, and microvascular proliferation. CONCLUSION: We propose a case
of a synchronous, malignant, multi-centric glioma based on radiographic and
pathologic appearance per se as well as lack of demonstration of
continuity between these two white matter lesions.  However, previous theories
have suggested a role for micro-migration of neoplastic cells, and more in depth
genetic profiling could help to delineate either similar clonal populations that
would indicate a multi-focal lesion in different stages of malignant progression
or disparate populations that would espouse our working theory.

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