Gandhi Puneet, Khare Richa, Garg Nitin, Sorte Sandeep
Puneet Gandhi, Richa Khare, Department of Research, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India.
World J Clin Cases. 2017 Jun 16;5(6):247-253. doi: 10.12998/wjcc.v5.i6.247.
Glioblastoma-multiforme (GBM), the most aggressive glial tumor, has a worldwide age-adjusted incidence ranging from 0.59-3.69/100000 persons. Despite current multimodal-treatment approach, median-survival time and progression-free survival (PFS) remains short. Glioblastomas display a variety of molecular alterations, which necessitates determining which of these have a prognostic significance. This is a case of a 45-year-old patient who presented with progressive slurring of speech and features of raised intracranial pressure. Computed tomography (CT) scan revealed a large heterogeneously enhancing lesion in the left front-temporal-perisylvian region with solid, cystic areas, suggestive of malignant glioma. Partial tumor-excision was followed by concurrent chemo-radiotherapy. Histopathologically, the tumor was astrocytoma grade-IV. Patient had an extended PFS of 12 mo, with an overall survival of 26 mo. Primary-GBM was confirmed using molecular markers and the immunophenotypic signature was defined by evaluating systemic expression of human telomerase reverse transcriptase, interleukin-6, neutrophil-lymphocyte ratio, tissue inhibitor of metalloproteinases-1, human chitinase-3-like-protein-1 (YKL-40) and high mobility group-A1. Current findings suggest that this signature can identify worst outcomes, independent of clinical criteria.
多形性胶质母细胞瘤（GBM）是最具侵袭性的胶质肿瘤，全球年龄调整发病率为0.59 - 3.69/100000人。尽管目前采用多模式治疗方法，但中位生存时间和无进展生存期（PFS）仍然较短。胶质母细胞瘤表现出多种分子改变，因此有必要确定其中哪些具有预后意义。这是一例45岁患者，表现为进行性言语不清和颅内压升高的症状。计算机断层扫描（CT）显示左额颞叶-岛周区域有一个大的不均匀强化病变，有实性和囊性区域，提示为恶性胶质瘤。部分肿瘤切除后进行同步放化疗。组织病理学检查显示肿瘤为IV级星形细胞瘤。患者的无进展生存期延长至12个月，总生存期为26个月。使用分子标志物确诊为原发性GBM，并通过评估人类端粒酶逆转录酶、白细胞介素-6、中性粒细胞与淋巴细胞比值、金属蛋白酶组织抑制剂-1、人几丁质酶-3样蛋白-1（YKL-40）和高迁移率族蛋白A1的全身表达来确定免疫表型特征。目前的研究结果表明，这种特征可以独立于临床标准识别最差的预后情况。
