Malignant glioblastomatous transformation of a low-grade glioma in a child

Department of Pediatrics, Meram Faculty of Medicine, Selcuk University, 42080, Meram, Konya, Turkey.
Child s Nervous System (Impact Factor: 1.11). 11/2008; 24(12):1385-9. DOI: 10.1007/s00381-008-0716-3
Source: PubMed

ABSTRACT The term of low-grade glioma addresses a favorable clinical outcome with indolent histological features in general consideration; however, recent studies underline the inconsistency, which originates from the accumulation of different histologic subtypes in this terminology. The malignant transformation of a low-grade glioma is unusual but presents a poor prognosis.
We report a case of a 12-year-old boy, who was referred for complaints of recurrent seizures. His physical examination was unremarkable, but it was learned that a peripheral mass lesion located on the left posterior parietal lobe--which had been thought to be a low-grade glioma--had been detected on a magnetic resonance imaging 2 years ago at a different hospital. The patient was then treated with valproate and carbamazepine for the seizures and advised to be followed up without any additional diagnostic and therapeutic studies for his suspected low-grade glioma. A recent magnetic resonance imaging study showed enlargements of the mass and surrounding edema with additional necrosis. Surgical excision of the tumor was performed. After the diagnosis of glioblastoma multiforme, the patient received radiation therapy and chemotherapy with a good clinical recovery without any evidence of residue or recurrence at 12-month follow-up.
The first line treatment modality in the management of low-grade glioma--especially in suitable patients--is clearly surgery. The gross total resection guarantees the distinguishing of the histological types of the low-grade gliomas and reflects the biologic behavior of these tumors. Observation without surgery must be reserved for selected inoperable cases.

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    • "Treatment of pediatric gliomas is subject to a different set of considerations and standards as toxicity of therapy has a greater impact on the developing nervous and skeletal system. Surgery with GTR is the primary mode of therapy as this has been shown to be the most effective method for cure (Fisher et al., 2008, Unal et al., 2008). While rare, malignant transformation does occur so observation is not recommended with lesions that are amenable to surgery. "
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