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Vojnosanitetski pregled
2018, vol. 75, br. 4, str. 414-421
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.2298/VSP160605238P

Creative Commons License 4.0
Sinhroni maligni multicentrični gliom mozga sa atipičnom neuroradiološkom prezentacijom i komparativno dugim preživljavanjem - prikaz bolesnika i pregled literature
aMilitary Medical Academy, Clinic for Neurosurgery, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
bClinical Center of Vojvodina, Center for Radiology, Novi Sad + University of Novi Sad, Faculty of Medicine, Novi Sad
cUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Institute for Radiology,Belgrade
dInstitute for Pathology and Forensic Medicine, Belgrade
eUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Institute for Medical Research, Belgrade
fInstitute for Radiology,Belgrade

e-adresa: drpavlicevic@gmail.com

Sažetak

Sinhroni multicentrični maligni gliomi mozga su retki moždani tumori koji su uglavnom maligni, sa nepoznatom patogenezom, nepovoljnom prognozom i još uvek spornim dijagnostičko-terapijskim pristupom. Preoperativna diferencijacija u odnosu na druge multiple moždane lezije uz pomoć konvencionalne magnetne rezonance (MR) je često teška, tako da bi dodatna primena naprednih MR tehnika trebala da omogući predikciju biologije tumora i planiranje odgovarajuće strategije lečenja. Prikaz bolesnika. Prikazali smo muškarca starosti 59 godine, sa dve sinhrone multicentrične moždane lezije, koje su na inicijalnoj MR mozga sa difuzionom sekvencom izgledale kao parijetalna cerebralna metastaza sa leve strane i ipsilsteralni amigdalohipokampalni niskogradusni gliom. Medjutim, magnetnorezonantna spektroskopija (MRS) obe lezije pokazala je prisustvo metaboličkih profila malignog glioma. Lako dostupna parijetalna lezija koja je resecirana u potpunosti, potvrdjena je kao glioblastom, sa metilisanim promotorskim genom za O6-metilguanin-DNK-metiltransferazu (MGMT). Postoperativno, bolesnik je lečen hemioradioterapijom baziranoj na temozolomidu (TMZ) prema Stupp-ovom protokolu, uz kontinuiranu standardnu (5/28) adjuvantnu monohemioterapiju TMZ u 12 ciklusa. Uprkos prolongiranoj stabilizaciji bolesti sa dobrim kvalitetom života tokom lečenja, bolesnik je preminuo 19 meseci nakon dijagnostikovanja bolesti. Vreme do progresije bolesti koje je procenjivano MR pregledom iznosilo je 17 meseci. Zaključak. Tehnika MRS je značajno poboljšala diferencijalnodijagnostičku preciznost konvencionalne MR kod našeg bolesnika. U odnosu na prikazane literaturne podatke, mlado životno doba, inicijalno dobro opšte stanje i metilisani promotorski gen za MGMT bili su povoljni prediktori dužeg preživljavanja kod prikazanog bolesnika. Resekcija bar jedne lako dostupne tumorske lezije, uz postoperativnu hemioradioterapiju baziranu na TMZ i kontinuiranu adjuvantnu hemioterapiju TMZ sa više od 6 standardnih ciklusa, čini se kao trenutno najpovoljnija terapijska opcija kod ovakvih bolesnika.

Ključne reči

gliom; glioblastom; dijagnoza; magnetna rezonanca snimanje; magnetna rezonanca; spektroskopija; mgmt protein; humani; temozolomid; prognoza; lečenje; ishod

Reference

Akimoto, J., Sasaki, H., Haraoka, R., Nakajima, N., Fukami, S., Kohno, M. (2014) A case of radiologically multicentric but genetically identical multiple glioblastomas. Brain Tumor Pathology, 31(2): 113-117
Ampil, F., Burton, G.V., Gonzalez-Toledo, E., Nanda, A. (2007) Do we need whole brain irradiation in multifocal or multicentric high-grade cerebral gliomas? Review of cases and the literature. Journal of Neuro-Oncology, 85(3): 353-355
Arcos, A., Romero, L., Serramito, R., Santín, J.M., Prieto, A., Gelabert, M., Arráez, M.Á. (2012) Multicentric glioblastoma multiforme. Report of 3 cases, clinical and pathological study and literature review. Neurocirugía, 23(5): 211-215
Batzdorf, U., Malamud, N. (1963) The Problem of Multicentric Gliomas. Journal of Neurosurgery, 20(2): 122-136
Bowen, B.C. (2003) Glial neoplasms without elevated choline-creatine ratios. AJNR Am J Neuroradiol, 24(5): 782-4
Bulakbasi, N., Kocaoglu, M., Ors, F., Tayfun, C., Uçöz, T. (2003) Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol, 24(2): 225-33
Bulik, M., Jancalek, R., Vanicek, J., Skoch, A., Mechl, M. (2013) Potential of MR spectroscopy for assessment of glioma grading. Clinical Neurology and Neurosurgery, 115(2): 146-153
Cage, T.A., Pekmezci, M., Prados, M., Berger, M.S. (2013) Subependymal spread of recurrent glioblastoma detected with the intraoperative use of 5-aminolevulinic acid. Journal of Neurosurgery, 118(6): 1220-1223
Castillo, M., Kwock, L. (1998) Proton MR spectroscopy of common brain tumors. Neuroimaging Clin N Am, 8(4): 733-52
Cianfoni, A., Law, M., Re, T.J., Dubowitz, D.J., Rumboldt, Z., Imbesi, S.G. (2011) Clinical pitfalls related to short and long echo times in cerebral MR spectroscopy. Journal of Neuroradiology, 38(2): 69-75
di Russo, P., Perrini, P., Pasqualetti, F., Meola, A., Vannozzi, R. (2013) Management and outcome of high-grade multicentric gliomas: a contemporary single-institution series and review of the literature. Acta Neurochirurgica, 155(12): 2245-2251
Dresemann, G. (2010) Temozolomide in malignant glioma. OncoTargets and Therapy, str. 139
Faehndrich, J., Weidauer, S., Pilatus, U., Oszvald, A., Zanella, F. E., Hattingen, E. (2011) Neuroradiological viewpoint on the diagnostics of spaceoccupying brain lesions. Clinical Neuroradiology, 21(3): 123-139
Franceschi, E., Tosoni, A., Brandes, A.A. (2008) Adjuvant temozolomide: how long and how much?. Expert Review of Anticancer Therapy, 8(5): 663-665
Hassaneen, W., Levine, N.B., Suki, D., Salaskar, A.L., de Moura, L.A., McCutcheon, I.E., Prabhu, S.S., Lang, F.F., de Monte, F., Rao, G., Weinberg, J.S., Wildrick, D.M., Aldape, K.D., Saway (2011) Multiple craniotomies in the management of multifocal and multicentric glioblastoma. Journal of Neurosurgery, 114(3): 576-584
Hau, P., Stupp, R., Hegi, M.E. (2007) MGMT Methylation Status: The Advent of Stratified Therapy in Glioblastoma?. Disease Markers, 23(1-2): 97-104
Hefti, M., Campe, G. von, Schneider, C., Roelcke, U. (2010) Multicentric Tumor Manifestations of High Grade Gliomas: Independent Proliferation or Hallmark of Extensive Disease?. Central European Neurosurgery, 71(01): 20-25
Hegi, M.E., Diserens, A., Gorlia, T., Hamou, M., de Tribolet, N., Weller, M., Kros, J.M., Hainfellner, J.A., Mason, W., Mariani, L., Bromberg, J.E.C., Hau, P., Mirimanoff, R.O., Cairn (2005) MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma. New England Journal of Medicine, 352(10): 997-1003
Juliano, J., Nakhl, F., Chang, E., Shiau, J., Alastra, A., Wrzolek, M., Odaimi, M., Raden, M. (2010) A patient with multiple synchronous gliomas of distinctly different grades and correlative radiographic findings. Surgical Neurology International, 1(1): 48
Li, Z., Tian, Y., Hu, G., Yu, X. (2007) Multiple gliomas. Chinese Journal of Clinical Oncology, 4(6): 379-383
Liu, Q., Liu, Y., Li, W., Wang, X., Sawaya, R., Lang, F.F., Yung, W. K. A., Chen, K., Fuller, G.N., Zhang, W. (2015) Genetic, epigenetic, and molecular landscapes of multifocal and multicentric glioblastoma. Acta Neuropathologica, 130(4): 587-597
Patil, C.G., Yi, A., Elramsisy, A., Hu, J., Mukherjee, D., Irvin, D.K., Yu, J.S., Bannykh, S.I., Black, K.L., Nuño, M. (2012) Prognosis of patients with multifocal glioblastoma: a case-control study. Journal of Neurosurgery, 117(4): 705-711
Paulsson, A.K., Holmes, J.A., Peiffer, A.M., Miller, L.D., Liu, W., Xu, J., Hinson, W.H., Lesser, G.J., Laxton, A.W., Tatter, S.B., Debinski, W., Chan, M.D. (2014) Comparison of clinical outcomes and genomic characteristics of single focus and multifocal glioblastoma. Journal of Neuro-Oncology, 119(2): 429-435
Pejsa, V., Grgurevic, I., Pazanin, L., Lang, N., Grgurevic, L., Jaksic, O. (2005) Multicentric glial brain tumors of a varying degree of differentiation in patient with chronic lymphocytic leukemia. American Journal of Hematology, 79(1): 50-53
Salunke, P., Badhe, P., Sharma, A. (2010) Cerebellar glioblastoma multiforme with non-contiguous grade 2 astrocytoma of the temporal lobe in the same individual. Neurology India, 58(4): 651
Salvati, M., Caroli, E., Orlando, E.R., Frati, A., Artizzu, S., Ferrante, L. (2003) Multicentric glioma: our experience in 25 patients and critical review of the literature. Neurosurgical Review, 26(4): 275-279
Schroeder, B., Shah, N., Rostad, S., McCullough, B., Aguedan, B., Foltz, G., Cobbs, C. (2016) Genetic investigation of multicentric glioblastoma multiforme: case report. Journal of Neurosurgery, 124(5): 1353-1358
See, S.J., Gilbert, M.R. (2007) Chemotherapy in adults with gliomas. Ann Acad Med Singapore, 36(5): 364-6
Server, A., Josefsen, R., Kulle, B., Mæhlen, J., Schellhorn, T., Gadmar, Ø., Kumar, T., Haakonsen, M., Langberg, C.W., Nakstad, P.H. (2010) Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors. Acta Radiologica, 51(3): 316-325
Shakur, S.F., Bit-Ivan, E., Watkin, W.G., Merrell, R.T., Farhat, H.I. (2013) Multifocal and Multicentric Glioblastoma with Leptomeningeal Gliomatosis: A Case Report and Review of the Literature. Case Reports in Medicine, 2013: 1-8
Showalter, T.N., Andrel, J., Andrews, D.W., Curran, W.J., Daskalakis, C., Werner-Wasik, M. (2007) Multifocal Glioblastoma Multiforme: Prognostic Factors and Patterns of Progression. International Journal of Radiation Oncology*Biology*Physics, 69(3): 820-824
Stupp, R., Hegi, M.E., Mason, W.P., Bent, M.J., Taphoorn, M.J.B., Janzer, R.C., Ludwin, S.K., Allgeier, A., Fisher, B., Belanger, K., Hau, P., Brandes, A.A., Gijtenbeek, J., Marosi, C., Vecht, C. (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. lancet oncology, 10(5): 459-66
Stupp, R., Mason, W.P., Bent, M.J., Weller, M., Fisher, B., Taphoorn, M.J.B., Belanger, K., Brandes, A.A., Marosi, C., Bogdahn, U., Curschmann, J., Janzer, R.C., Ludwin, S.K., Gorlia, T., Allgeier (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England journal of medicine, 352(10): 987-96
Terakawa, Y., Yordanova, Y.N., Tate, M.C., Duffau, H. (2013) Surgical management of multicentric diffuse low-grade gliomas: functional and oncological outcomes. Journal of Neurosurgery, 118(6): 1169-1175
Thomas, R.P., Xu, L.W., Lober, R.M., Li, G., Nagpal, S. (2013) The incidence and significance of multiple lesions in glioblastoma. Journal of Neuro-Oncology, 112(1): 91-97
Thon, N., Kreth, S., Kreth, F.W. (2013) Personalized treatment strategies in glioblastoma: MGMT promoter methylation status. OncoTargets and Therapy, str. 1363
Tinchon, A., Oberndorfer, S., Marosi, C., Rudà, R., Sax, C., Calabek, B., Grisold, W. (2012) Malignant spinal cord compression in cerebral glioblastoma multiforme: a multicenter case series and review of the literature. Journal of Neuro-Oncology, 110(2): 221-226
Wan, K., King, N., Low, S., Sitoh, Y., Lee, H., Wong, C., Ng, W. (2014) Synchronous multicentric glioblastoma with PNET and O subtypes: Possible pathogenesis. Surgical Neurology International, 5(1): 31
Wang, P., Wu, M., Chen, S., Yang, Y., Zhao, G. (2010) Multicentric gliomas misdiagnosed as metastatic tumors: One case report and literature review. Clinical Oncology and Cancer Research, 7(5): 317-321
Wilson, T., Karajannis, M., Harter, D. (2014) Glioblastoma multiforme: State of the art and future therapeutics. Surgical Neurology International, 5(1): 64
Zamponi, N., Rychlicki, F., Ducati, A., Regnicolo, L., Salvolini, U., Ricciuti, R. A. (2001) Multicentric glioma with unusual clinical presentation. Child's Nervous System, 17(1-2): 101-105