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Ma Q, Liu L, Sun N, Gao L, Chen Y, Liu L, Guo W, Yang X. Glioblastoma with a primitive neuronal component: A case report. Oncol Lett 2023; 26:341. [PMID: 37427343 PMCID: PMC10326655 DOI: 10.3892/ol.2023.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
The present study describes a rare case of glioblastoma with a primitive neuronal component (GBM-PNC), and provides an in-depth analysis of the clinical, pathological and differential diagnostic findings. A comprehensive literature review was conducted to enhance the understanding of GBM-PNC, revealing its distinct characteristics and prognostic implications. A 57-year-old woman presented with acute onset headache, nausea and vomiting, leading to the identification of an intracranial mass through magnetic resonance imaging. Surgical resection revealed the coexistence of a glial component and a PNC within the tumor. Immunohistochemical analysis detected the expression of glial fibrillary acidic protein in the glial component and synaptin in the PNC. The pathological diagnosis confirmed the presence of GBM-PNC. Gene detection analysis revealed no mutations in isocitrate dehydrogenase (IDH)1 and IDH2, and neurotrophic tyrosine kinase receptor-1 (NTRK1), NTRK2 and NTRK3 genes. GBM-PNC is characterized by a propensity for recurrence and metastasis, with a low 5-year survival rate. The present case report highlights the importance of accurate diagnosis and comprehensive characterization of GBM-PNC to guide treatment decisions and improve patient outcomes.
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Affiliation(s)
- Qiang Ma
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Limin Liu
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Naiying Sun
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Lixiang Gao
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Ying Chen
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Li Liu
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Wenjun Guo
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Xingjie Yang
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
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Munjapara V, Heumann T, Schreck KC, Gross JM, Perez-Heydrich C, Gujar SK, Eberhart CG, Holdhoff M. BRAF V600E-Mutant Glioblastoma with Extracranial Metastases Responsive to Combined BRAF and MEK Targeted Inhibition: A Case Report. Case Rep Oncol 2022; 15:909-917. [PMID: 36825105 PMCID: PMC9941771 DOI: 10.1159/000525660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Recent advancements in understanding the biology of glioblastomas (GBM) and increasing adoption of genomic sequencing in oncology practice have led to the discovery of several targetable mutations in these cancers. Among them, the BRAF V600E mutation can be found in approximately 3% of GBM. Despite the aggressive nature of GBM, metastatic disease is rarely observed. While there are growing data utilizing BRAF-targeting strategies in patients with GBM, data examining their efficacy in cases of metastatic GBM are lacking. We present the case of a 46-year-old female with GBM, isocitrate dehydrogenase (IDH)-wildtype and O6-methylguanine-DNA methyltransferase promoter (MGMT) unmethylated, BRAF V600E-mutant, and MYC amplified with extra-central nervous system spread to the spine and lung. Four months after completion of treatment with standard chemoradiation and temozolomide, the patient developed severe back pain, leading to the eventual discovery of her metastatic disease. Based on the presence of the BRAF V600E mutation, the patient was treated with and achieved an intracranial and systemic response to combination BRAF-MEK targeted inhibition for 9 months before evidence of progression.
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Affiliation(s)
- Vasu Munjapara
- aDepartment of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thatcher Heumann
- aDepartment of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karisa C. Schreck
- aDepartment of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,bDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John M. Gross
- cDepartment of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carlos Perez-Heydrich
- aDepartment of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sachin K. Gujar
- dDepartment of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles G. Eberhart
- cDepartment of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthias Holdhoff
- aDepartment of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,bDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,*Matthias Holdhoff,
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Rong T, Zou W, Qiu X, Cui W, Zhang D, Wu B, Kang Z, Li W, Liu B. A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components. Front Oncol 2021; 11:760697. [PMID: 34796114 PMCID: PMC8593252 DOI: 10.3389/fonc.2021.760697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) is the most common malignant tumor of the central nervous system. GBM with primitive neuronal component (GBM-PNC) is an aggressive variant identified in 0.5% of GBMs. Extracranial metastasis from GBM-PNC is a rare and challenging situation. Methods A special case of early-onset GBM with systemic bone metastasis was enrolled. Clinical data, including patient characteristics, disease course, and serial radiological images were retrieved and analyzed. Tumor tissues were obtained by surgical resections and were made into formalin-fixed paraffin-embedded sections. Histopathological examinations and genetic testing were performed for both the primary and metastatic tumor specimens. Results A 20-year-old man suffered from GBM with acute intratumoral hemorrhage of the left temporal lobe. He was treated by gross total resection and chemoradiotherapy following the Stupp protocol. Seven months later, he returned with a five-week history of progressive neck pain and unsteady gait. The radiographic examinations identified vertebral collapse at C4 and C6. Similar osteolytic lesions were also observed at the thoracolumbar spine, pelvic, and left femur. Anterior spondylectomy of C4 and C6 was performed. The resected vertebral bodies were infiltrated with greyish, soft, and ill-defined tumor tissue. One month later, he developed mechanical low-back pain and paraplegia caused by thoracolumbar metastases. Another spine surgery was performed, including T10 total en-bloc spondylectomy, T7-9, L2-3, and L5-S1 laminectomy. After the operation, the patient’s neurological function and spinal stability remained stable. However, he finally succumbed to the rapidly increased tumor burden and died 15 months from onset because of cachexia and multiple organ failure. In addition to typical GBM morphology, the histological examinations identified monomorphic small-round cells with positive immunohistochemical staining of synaptophysin and CD99, indicating the coexistence of PNC. The next-generation sequencing detected pathogenic mutations in TP53 and DNMT3A. Based on above findings, a confirmed diagnosis of systemic metastases from GBM-PNC (IDH-wild type, WHO grade IV) was made. Conclusions The present case highlights the occurrence and severity of extensive axial skeletal metastases from GBM-PNC. This rare variant of GBM requires aggressive multimodal treatment including surgery and chemoradiotherapy targeting PNC. The pathological screening of PNC is recommended in patients with early-onset GBM and intratumoral hemorrhage. Surgery for spinal metastasis is appropriate in patients with chemoradioresistance and relatively good general status, with the objectives of restoring spinal stability and relieving spinal cord compression.
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Affiliation(s)
- Tianhua Rong
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanjing Zou
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Duo Zhang
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Bingxuan Wu
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhuang Kang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
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