PMC9800515_01
Case report 1: (A) preoperative axial MRI (postcontrast T1 weighted image) showing an intra-axial contrast-enhancing lesion in the left parietal lobe with perilesional edema extending to the central region, (B) histopathological finding of hypercellular pleomorphic glial neoplasia with multiple palisading necroses and glomeruloid microvascular proliferations (H&E, original magnification 100x), (C) postoperative MRI showing subtotal tumor resection, (D) GBM recurrence 5 months after primary tumor resection, (E) 2 years follow-up MRI, and (F) MRI with second tumor recurrence (arrow) 61 months after the first GBM recurrence.
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A 45-year old female suffering from right hemiparesis and tactile hemi-hypesthesia was referred to our neurosurgery department with an intra-axial contrast-enhancing lesion in the left parietal lobe with perilesional edema extending to the central region ( Figure 1A ). The patient underwent 5-ALA fluorescence-guided subtotal tumor resection with electrophysiological monitoring and the histopathological diagnosis of GBM IDH-wildtype, WHO grade IV MGMT promotor methylated ( Figures 1B, C ). Her clinical status started to improve; however, the follow-up MRI in 3 months after concurrent chemoradiotherapy and adjuvant chemotherapy according to the original Stupp's protocol revealed an early GBM progression ( Figure 1D ). December 2020 (disease-free survival of 61 months after the second resection of initial GBM recurrence), when the second GBM recurrence was detected by regular MRI ( Figure 1F ) and its further progression was confirmed by subsequent MRI scan 3 months later. Despite the radiotherapy treatment, the recurrence further progressed based on the latest MRI.
PMC9800515_02
Case report 2: (A) preoperative postcontrast CT showing an intra-axial contrast-enhancing lesion in the left frontal lobe with perilesional edema, (B) histopathological finding of diffusely infiltrating astrocytoma with significant mitotic activity and cellular atypia classified as AA, IDH-mutant, WHO grade III (H&E, original magnification 100x), (C) postoperative MRI showing radical tumor resection, (D) AA recurrence 6 years after primary tumor resection, (E) 3 years follow-up MRI and (F) the last MRI with no signs of tumor recurrence.
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A 53-year-old female patient with a history of epileptic seizures and the finding of a contrast-enhancing lesion in the left frontal lobe with perilesional edema on CT ( Figure 2A ) underwent radical tumor resection in 2003 with the histopathological result of AA, WHO grade III ( Figures 2B, C ). Despite incomplete oncological treatment, she was without any signs of tumor relapse on CT and subsequently MRI (available from 2004) for 6 years when MRI revealed a small enhancing lesion suspected to be a tumor recurrence ( Figure 2D ). A second surgery was performed and classified as a gross total resection ( Figure 2E ) with a histopathological diagnosis of AA IDH-mutant, WHO grade III. Despite no tumor relapse on MRI ( Figure 2F ), the patient died of a respiratory infection 14 years (152 months) after the initial diagnosis of AA.