Acute progression of untreated incidental WHO Grade II glioma to glioblastoma in an asymptomatic patient
| العنوان: | Acute progression of untreated incidental WHO Grade II glioma to glioblastoma in an asymptomatic patient |
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| المؤلفون: | Valérie Rigau, Jérôme Cochereau, Hugues Duffau, Guillaume Herbet |
| المساهمون: | Service de Neurochirurgie [Montpellier], CHU Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de Biopathologie [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) |
| المصدر: | Journal of Neurosurgery Journal of Neurosurgery, American Association of Neurological Surgeons, 2016, 124 (1), pp.141-145. ⟨10.3171/2014.12.JNS141851⟩ |
| بيانات النشر: | HAL CCSD, 2016. |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, malignant transformation, medicine.medical_treatment, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Neuropsychological Tests, Fluid-attenuated inversion recovery, Asymptomatic, Neurosurgical Procedures, Malignant transformation, surgery, 03 medical and health sciences, 0302 clinical medicine, Glioma, medicine, Humans, incidental tumor, Watchful Waiting, EOR = extent of resection, iLGG = incidental LGG, Chemotherapy, low-grade glioma, Brain Neoplasms, business.industry, Headache, General Medicine, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Surgery, Radiation therapy, WHO = World Health Organization, Treatment Outcome, LGG = low-grade glioma, 030220 oncology & carcinogenesis, Concomitant, oncology, Disease Progression, Female, FLAIR = fluid attenuation inversion recovery, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Radiology, medicine.symptom, Headaches, Glioblastoma, business, 030217 neurology & neurosurgery |
| الوصف: | International audience; WHO Grade II glioma (low-grade glioma [LGG]) is increasingly diagnosed as an incidental finding in patients undergoing MRI for many conditions. Recent data have demonstrated that such incidental LGGs are progressive tumors that undergo clinical transformation and ultimately become malignant. Although asymptomatic LGG seems to represent an earlier step in the natural course of a glioma than the symptomatic LGG, it is nonetheless impossible to predict at the individual level when the tumor will become malignant. The authors report the case of a 43-year-old woman with a right operculo-insular LGG that was incidentally diagnosed because of headaches. No treatment was proposed, and repeated MRI scans were performed for 6 years in another institution. Due to a slow but continuous growth of the lesion, the patient was finally referred to our center to undergo surgery. Interestingly, objective calculation of the velocity of the tumor's diametric expansion demonstrated a sudden acceleration of the growth rate within the 5 months preceding surgery, with the development of contrast enhancement. Remarkably, the patient was still asymptomatic. An awake resection was performed with intraoperative electrical mapping. There was no functional worsening following surgery, as assessed on postoperative neuropsychological examination. Removal of 92% of signal abnormality on FLAIR MRI was achieved, with complete resection of the area of contrast enhancement. Neuropathological examination revealed a glioblastoma, and the patient was subsequently treated with concomitant radiotherapy and chemotherapy. Although a "wait and see" attitude has been advocated by some authors with respect to incidental LGG, our original case demonstrates that acute transformation to glioblastoma may nonetheless occur, even before the onset of any symptoms. Therefore, because the lack of symptoms does not protect from malignant transformation, we propose consideration of earlier resection in a more systematic manner in cases of incidental LGG. |
| اللغة: | English |
| تدمد: | 0022-3085 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6f64610df4396992d29b5ea77a1e0f8e https://hal.archives-ouvertes.fr/hal-01890368 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....6f64610df4396992d29b5ea77a1e0f8e |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00223085 |
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