PMC7550879_01
Main medical imaging and histopathology information of the pregnant GBM patient. (A) MRI images of the primary GBM prior to the first right parietal craniotomy that demonstrated a heterogeneous cystic and solid mass in the right parietal lobe with marked surrounding edema and a shift of the midline structures to the left side (01/11/2017). (B) MRI images on the 3rd day after the first right parietal craniotomy that demonstrated a total resection of the mass, the marked surrounding edema and a shift of the midline structures to the left side remained (01/21/2017). (C) Histopathological features of the primary GBM. Hematoxylin and eosin (H & E) staining of the primary revealed the hyper-cellular astrocytic neoplasm. The features such as mitotic activity, microvascular proliferation, and pseudopalisading presented. The histopathological features indicated the primary tumor to be GBM. (D) Emergency CT scan when the patient was diagnosed with a recurrent tumor, prior to the second right parietal craniotomy which demonstrated a huge fresh mass of low density in the right parietal lobe surrounded by extensive edema, accompanied with a shift of midline structure and distortion of the right lateral ventricle (03/28/2017). (E) MRI images on the 3rd day after the second right parietal craniotomy which demonstrated a total resection of the recurrent tumor, the marked surrounding edema and a shift of the midline structures to the left side still remained (03/30/2018). (F) Histopathological features of the recurrent GBM. Hematoxylin and eosin (H & E) staining of the primary revealed the similar histopathological features with the primary tumor. (G) MRI images of the latest follow-up after multidisciplinary therapy (12/08/2018). The images demonstrated no signs of recurrence and smaller volume of the surrounding edema. The region of the tumor transformed into a capsule without enhancement. The disease remained stable.
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GBM was highly suspected (Figure 1A). Total resection of the tumor was performed (Figure 1B) with histopathological diagnose of GBM (Figure 1C). An emergency CT scan supported tumor recurrence (Figure 1D). After emergent dehydration treatment, cesarean section and second craniotomy (Figure 1E) were performed contemporarily. Once again, the pathological diagnosis was GBM (Figure 1F), but ki67 was more than 30%, suggesting the recurrent tumor was more aggressive and contained a higher risk of relapse than the primary tumor. Follow-up MRI showed stable disease with no recurrence in the right parietal area (Figure 1G). The regular follow-up information is exhibited as supplementary data (Supplementary Figures 1-4).
Overview of the patient's course of disease, treatment regimen and genetic analysis.
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The regular follow-up information is exhibited as supplementary data (Supplementary Figures 1-4).