Fabien Rech1, Valerie Rigau2, Michel Fabbro3, Christine Kerr3, Guillaume Gauchotte4, Luc Taillandier5, Hugues Duffau6. 1. Department of Neurosurgery, CHU Nancy, Nancy, France. 2. Department of Neuropathology, CHU de Montpellier, Montpellier, France. 3. Department of Neurooncology, ICM, Montpellier, France. 4. Department of Neuropathology, CHU Nancy, Nancy, France. 5. Department of Neurooncology, CHU Poitiers, Poitiers, France. 6. Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France.
Abstract
BACKGROUND: Secondary gliosarcomas are rare tumors, especially those arising from a World Health Organization (WHO) grade II glioma not irradiated. We report a case with subtotal resection for a WHO grade II oligoastrocytoma, without adjuvant treatment, whose metaplastic transformation into gliosarcoma suddenly occurred 4 years later with meningeal dissemination. We show a favorable outcome after therapeutic management of this rare entity. PATIENT: A 46 year-old woman underwent surgery for a right premotor WHO grade II oligoastrocytoma discovered incidentally. Because of a subtotal resection with only 1 cc of residue, no complementary therapy was given, and the patient enjoyed a normal life for 4 years. In the meantime, the magnetic resonance images performed every 6 months showed a very low growth rate. Suddenly, the tumor switched toward a gliosarcoma profile with meningeal dissemination. RESULTS: Reoperation, radiotherapy, and chemotherapy were performed, enabling a control of the disease with 15 months of follow-up (i.e., with radiologic shrinkage of the multiple lesions and preservation of quality of life). CONCLUSION: A delayed sarcomatous transformation can acutely occur with a low proliferation index in a nonirradiated WHO grade II oligoastrocytoma. Furthermore, an aggressive therapeutic strategy can allow control of secondary gliosarcomas, even in cases of leptomeningeal spreading. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Secondary gliosarcomas are rare tumors, especially those arising from a World Health Organization (WHO) grade II glioma not irradiated. We report a case with subtotal resection for a WHO grade II oligoastrocytoma, without adjuvant treatment, whose metaplastic transformation into gliosarcoma suddenly occurred 4 years later with meningeal dissemination. We show a favorable outcome after therapeutic management of this rare entity. PATIENT: A 46 year-old woman underwent surgery for a right premotor WHO grade II oligoastrocytoma discovered incidentally. Because of a subtotal resection with only 1 cc of residue, no complementary therapy was given, and the patient enjoyed a normal life for 4 years. In the meantime, the magnetic resonance images performed every 6 months showed a very low growth rate. Suddenly, the tumor switched toward a gliosarcoma profile with meningeal dissemination. RESULTS: Reoperation, radiotherapy, and chemotherapy were performed, enabling a control of the disease with 15 months of follow-up (i.e., with radiologic shrinkage of the multiple lesions and preservation of quality of life). CONCLUSION: A delayed sarcomatous transformation can acutely occur with a low proliferation index in a nonirradiated WHO grade II oligoastrocytoma. Furthermore, an aggressive therapeutic strategy can allow control of secondary gliosarcomas, even in cases of leptomeningeal spreading. Georg Thieme Verlag KG Stuttgart · New York.
Authors: R Michael Meyer; Charles A Miller; Daniel J Coughlin; George Rymarczuk; Nicholas S Szuflita; Michael J Cirivello; Brett J Theeler; Michael S Dirks Journal: J Neurooncol Date: 2017-03-13 Impact factor: 4.130