A Husband and a Wife with Simultaneous Presentation of Glioblastoma Multiforme: A Case Report
The husband was a 76-year-old man who presented with headache, vague balance difficulties, left hemisensory and hemiparetic deficits in February 2012. He was admitted to another institution before he came to our institution, from which he was discharged with a clinical and neuroimaging diagnosis of hemorrhagic stroke (fig. ). Over the next 2 months, the patient did not complain about any discomfort except for mild-to-moderate left hemidysesthesia. In April 2012, a brain MRI showed resorption of the bleeding and clear evidence of a large, right parietal, extra-axial mass (fig. ). Platelet counts, prothrombin time and activated partial thromboplastin time were within normal ranges. The patient had no history of diabetes, hypertension or coagulation disorders and no history of trauma. He was a retired goldsmith living in a small town. His family history was negative for tumors and his two children were healthy. He pointed to his use of cell phones, which had started only a few years earlier, however, and occurred with moderate frequency. The patient underwent a subtotal resection of the intracranial mass through a right temporoparietal approach. 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 55–65%, an EGFR of about 65% and p53 was negative. The final pathologic diagnosis was grade IV GBM according to the WHO 2007 grading system. In May 2012, a brain MRI confirmed the lesion mass with a further bleeding. Considering the patient's clinical conditions and neuroimaging findings, we opted for supportive care and therapy with corticosteroids. No irradiation was performed. The patient continued supportive care waiting for the clinical conditions to allow treatment, but unfortunately, he died of his primary brain tumor in July 2012.