Brain Tumor Res Treat.  2014 Oct;2(2):119-123. 10.14791/btrt.2014.2.2.119.

Hemorrhagic Recurrence in Diffuse Astrocytoma without Malignant Transformation

• Baek HJ
• Kim SM
• Chung SY
• Park MS

• KMID: 2134283
• DOI: http://doi.org/10.14791/btrt.2014.2.2.119

Abstract

Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

Keyword

Astrocytoma; Glioma; Recurrence

MeSH Terms

Astrocytoma*
Craniotomy
Drug Therapy
Follow-Up Studies
Glioma
Hemorrhage
Humans
Magnetic Resonance Imaging
Prognosis
Recurrence*
Seizures
World Health Organization

Figure

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  Fig. 1 Series of annual MRI follow-up from immediate post operation since 2003 to 2010, before the hemorrhagic event. In series of MRI fluid attenuation inversion recovery, circled lesion shows slow changes in most medial portion of the tumor boundary.

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  Fig. 2 Initial MRI after dysarthria and headache. A and B: The images show T1-, T2-weighted image of acute onset hemorrhage with surrounding gliotic changes from the previous operation. C and D: Flair and T1 enhancement image shows peripheral thin rim enhancing lesion about 32×28×24 mm at the left perisylvian posterior insula, subinsula, posterior external capsule white matter area, with surrounding mild edema. E and F: MR diffusion and regional cerebral blood volume (rCBV) image of the patient. Note that increase in rCBV from the peripheral enhancing thin rim of the Lt. perisylvian superior temporal hemorrhagic lesion.

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  Fig. 3 Histopathology. A: Histology of 1st operation (hematoxylin-eosin stain, ×200).Tumor cells with mild nuclear atypia are present in fibrillary background, diagnosed as diffuse astrocytoma. B: Histology of main lesion of 2nd operation (hematoxylin-eosin stain, ×200). The neoplastic astrocytes with occasional nuclear atypia and glomeruloid vessels are present in the background of a loosely structured or microcystic tumor matrix, diagnosed as astrocytoma. C: Main lesion 2nd operation (hematoxylin-eosin stain, ×100). Evidence of hemorrhage and vascular proliferation of the main lesion is present. D: Main lesion 2nd operation (hematoxylin-eosin stain, ×200). Neovascularization is identified along the edge of tumor periphery. E: There is 1-2% stain of tumor cells in Ki-67 immunohistochemical staining (×200).

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