High-Grade Glioma: Refined Diagnostics Steering Stratified Therapy
A 30-year-old female presented at our clinic with moderate aphasia of a few weeks’ duration 14 days after she had been diagnosed with anaplastic astrocytoma based on an open biopsy of her left temporal lobe at an external hospital. She had a 2-year history of complex focal epileptic seizures prior to diagnosis. Due to a substantial mass effect of the remaining tumor, an interdisciplinary consensus was followed, and part of the remaining tumor was resected with a substantial relief of the mass effect (fig. ) and almost complete recovery of aphasia, with a Karnofsky performance score of 90%. The diagnosis of anaplastic astrocytoma was confirmed by the local neuropathologist, taking into consideration that some of the reactive and regressive changes (fig. ) were attributable to the preceding biopsy. The presence of a mutation of isocitrate dehydrogenase (IDH1), a marker of grade II and III gliomas and secondary glioblastomas, substantiated the diagnosis []. After central review of the histology by 2 reference neuropathologists, randomization into an international clinical trial for anaplastic gliomas was rejected due to the fact that necrosis in the histological samples obtained during the second surgery qualified, in the view of the reference neuropathologists, as glioblastoma. At that point, considering the size of the residual tumor mass and in view of the clinical history and an MRI suggestive of a rather aggressive high-grade glioma, we decided to start the patient on radiochemotherapy with temozolomide according to the Stupp protocol [].