Woo Byungjun, Han Nayoung, Kim Jeong Hoon, Gwak Ho-Shin
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Pathology, National Cancer Center, Goyang, Korea.
Brain Tumor Res Treat. 2024 Jul;12(3):186-191. doi: 10.14791/btrt.2024.0022.
High-grade transformation of low-grade gliomas has long been a poor prognostic factor during therapy. In 2016, the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS) adopted isocitrate dehydrogenase (IDH) mutation status in the classification of diffuse astrocytomas. The 2021 classification denoted glioblastomas as IDH-wildtype and graded IDH-mutant astrocytomas as 2, 3, or 4. Gemistocytic morphology, a large proportion of residual tumor, the patient's age, and recurrence after radiotherapy were previously mentioned as risk factors for high-grade transformation of low-grade gliomas. We report a 34-year-old male patient initially diagnosed with IDH-mutant grade 2 astrocytoma according to the 2021 WHO classification of CNS tumors. As the first surgical resection achieved gross total resection on postoperative MRI, no adjuvant therapy was given and regular follow-up was planned. On 1-year follow-up MRI, two new enhancing nodular lesions appeared at the ipsilateral brain parenchyma abutting the surgical resection cavity. Salvage craniotomy achieved gross total resection, and the pathologic diagnosis was IDH-mutant WHO grade 4 astrocytoma. We describe this tumor in terms of the previous WHO classification to evaluate the risk of high-grade transformation and discuss possible risk factors leading to high-grade transformation of low-grade astrocytoma.
低级别胶质瘤的高级别转化长期以来一直是治疗过程中预后不良的因素。2016年，世界卫生组织（WHO）中枢神经系统（CNS）肿瘤分类在弥漫性星形细胞瘤分类中采用了异柠檬酸脱氢酶（IDH）突变状态。2021年的分类将胶质母细胞瘤定义为IDH野生型，将IDH突变型星形细胞瘤分为2级、3级或4级。肥胖细胞形态、大部分残留肿瘤、患者年龄以及放疗后的复发此前被提及为低级别胶质瘤高级别转化的危险因素。我们报告一名34岁男性患者，根据2021年WHO中枢神经系统肿瘤分类最初被诊断为IDH突变型2级星形细胞瘤。由于首次手术切除在术后MRI上实现了大体全切，未给予辅助治疗并计划进行定期随访。在1年的随访MRI检查中，在紧邻手术切除腔的同侧脑实质出现了两个新的强化结节性病变。挽救性开颅手术实现了大体全切，病理诊断为IDH突变型WHO 4级星形细胞瘤。我们根据先前的WHO分类描述该肿瘤，以评估高级别转化的风险，并讨论导致低级别星形细胞瘤高级别转化的可能危险因素。
