PMC6345719_01
(A,B) Pre and post-operative MRI. Red arrow: chemoradiation associated with cannabidiol in a dosage ranging from 300 to 450 mg/day. (C) Control MRI after 1 month of the end of the chemoradiation was characterized an exacerbated and ultra-precocious phenomenon of pseudoprogression with increased edema and inflammatory disease. (D,E) MRI controls demonstrated progressive reduction of these findings.
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F1
MRI (Figure 1) was characterized by exacerbation and the ultra-precocious phenomenon of PSD with increased edema and inflammatory disease characterized by extensive areas of contrast enhancement associated with tissue hypoperfusion (not shown). MRI controls demonstrated the progressive reduction of these findings.
(A) First surgery: June/2010-1A.HE; 2A. GFAP; 3A. ATRX; 4A. IDH-1 ; 5A.Ki67:4,5%. (B) Second surgery: May/2016-1 B and 2 B (micronecrosis). HE; 3B. GFAP; 4B. EGFR; 5B. IDH-1 ; 6B. Ki67: 30%; 7B: MGMT methylated.
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F2
After the second surgery, he progressed to GBM grade IV (Figure 2), related to increased cellularity, frequent mitosis, presence of micronecrosis, microvascular proliferation/endothelial, Ki67 staining of 30%, and loss of ATRX expression.
PMC6345719_02
(A) MRI showed expansive infiltrative lesion predominantly subcortical of poorly defined contours, located in the left temporal lobe, involving the upper, middle and lower temporal gyrus, with increase of the left temporal gyrus cortex. The lesion compromises a large part of the temporal lobe and extends to the temporal isthmus, posterior aspect of the insula, and deeply to the trigeminal effigy of the left lateral ventricle. There is diffuse erasure of the regional cortical sulci and the Sylvian fissure, as well as slight compression over the atrium of the left lateral ventricle. (B) Intraoperative MRI. Red arrow: chemoradiation associated with cannabidiol in a dosage ranging from 100 to 200 mg/day. (C) MRI control right after chemoradiation was characterized post-operative changes associated with a significant reduction of the infiltrative components of the tumor. (D) Magnetic resonance control after 1 year characterized no evidence of disease progression.
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F3
MRI control immediately after chemoradiation (Figure 3) was used to characterize post-operative changes and showed a significant reduction of the infiltrative components of the tumor.
1 C. HE; 2C. GFAP; 3C. P53; 4C. Retained ATRX expression; 5C. IDH-mutated; 6C. Ki67: 9%; 7C. 1 p19q I Co-deleted.
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F4
The result of the pathological study after the first surgery (Figure 4) was oligodendroglioma grade II.