A Husband and a Wife with Simultaneous Presentation of Glioblastoma Multiforme: A Case Report
The wife was a 72-year-old woman who presented in March 2012 with ingravescent, vague balance difficulties. A brain MRI (fig. ) showed a large, inhomogeneous, irregularly gadolinium-enhancing, right, paratrigonal, intra-axial mass. Additional findings included a macroadenoma and a small left frontal meningioma. The patient grew up in the same small town as her spouse, had always worked as a nurse and was retired at the time of diagnosis. She had been married for 46 years, with no evidence of possible consanguinity with her husband. Her family history was negative for tumors. She reported that use of cell phones had occurred only within the last 10 years, with a very moderate frequency and only upon need. The patient underwent subtotal resection of the intracranial mass. Pathologic evaluation showed a GBM tumor cell proliferation index – as evaluated by anti-ki-67 MIB1 antibody (rabbit monoclonal antibody, diluted 1:100; NeoMarkers, Inc., Fremont, Calif., USA) – of about 45–55%; EGFR and p53 were negative. A diagnosis of grade IV GBM according to the WHO 2007 grading system was rendered. A follow-up brain MRI 1 month after surgery showed a volumetric increase of the right temporoparietal intra-axial mass with a mass effect on the ventricular system and midbrain, causing subfalcine herniation and a midline shift. Therefore, a second palliative surgery was performed. In May 2012, the patient started treatment with temozolomide (TMZ) in combination with adjuvant radiation therapy and corticosteroids. After she had finished radiotherapy, she was started on a 6-month TMZ treatment. However, after only two cycles of TMZ, our patient went into a coma and died in July 2012.