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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(02): 351-355
DOI: 10.1055/s-0043-1777012
Case Report

Unusual Extra-Axial and Extracranial Recurrence in an IDH Mutant Astrocytoma: A Case Report

Swetha M. Nair 
1   Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Arpita Sahu 
1   Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Apurva Prasad
2   Department of Neurosurgery, Bhatia General Hospital, Mumbai, Maharashtra, India
,
Asha Mary George
3   Department of Pathology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
,
Atul Goel
4   Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
,
Tejpal Gupta
5   Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
› Author Affiliations Funding None.
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Abstract

Isocitrate dehydrogenase mutant gliomas generally have a better prognosis than their wild-type counterpart. Recurrences are generally within the radiation field in the primary tumoral bed. Remote recurrence is uncommon and is usually intraparenchymal. Transformation to a higher grade has been observed with TP53 mutants. Presentation of glioma as an extra-axial lesion is extremely uncommon. No such cases of remote intracranial extra-axial recurrence have been reported in the literature. We describe the unique imaging findings in this case and attempt to formulate possible diagnoses. Intraoperative and pathological findings confirmed this unusual recurrence pattern.

Keywords

extra-axial - extracranial - recurrence - IDH mutant - glioma - metastases - astrocytoma

Informed Consent

Informed consent has been obtained from the patient for using clinical details and imaging.




Publication History

Article published online:
04 December 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Torp SH, Solheim O, Skjulsvik AJ. The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview. Acta Neurochir (Wien) 2022; 164 (09) 2453-2464
    CrossrefPubMedGoogle Scholar
  • 2 Sun Q, Xu R, Xu H, Wang G, Shen X, Jiang H. Extracranial metastases of high-grade glioma: the clinical characteristics and mechanism. World J Surg Oncol 2017; 15 (01) 181
    CrossrefPubMedGoogle Scholar
  • 3 Umphlett M, Bilal KH, Martini ML. et al. IDH-mutant astrocytoma with EGFR amplification-genomic profiling in four cases and review of literature. Neurooncol Adv 2022; 4 (01) vdac067
    PubMedGoogle Scholar
  • 4 Nakae S, Kato T, Murayama K. et al. Remote intracranial recurrence of IDH mutant gliomas is associated with TP53 mutations and an 8q gain. Oncotarget 2017; 8 (49) 84729-84742
    CrossrefPubMedGoogle Scholar
  • 5 Im JH, Hong JB, Kim SH. et al. Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification. Sci Rep 2018; 8 (01) 777
    CrossrefPubMedGoogle Scholar
  • 6 Stewart J, Sahgal A, Chan AKM. et al. Pattern of recurrence of glioblastoma versus grade 4 IDH-mutant astrocytoma following chemoradiation: a retrospective matched-cohort analysis. Technol Cancer Res Treat 2022;21
    Google Scholar
  • 7 Miller JJ, Loebel F, Juratli TA. et al. Accelerated progression of IDH mutant glioma after first recurrence. Neuro-oncol 2019; 21 (05) 669-677
    CrossrefPubMedGoogle Scholar
  • 8 Hong CS, Hsieh JK, Edwards NA, Ray-Chaudhury A, Zaghloul KA. IDH mutations may not preclude distant, trans-tentorial spread in gliomas: a case report and review of the literature. World J Surg Oncol 2016; 14: 53
    CrossrefPubMedGoogle Scholar
  • 9 Sotoudeh H, Yazdi HR. A review on dural tail sign. World J Radiol 2010; 2 (05) 188-192
    CrossrefPubMedGoogle Scholar
  • 10 Patel M, Nguyen HS, Doan N, Gelsomino M, Shabani S, Mueller W. Glioblastoma mimicking meningioma: report of 2 cases. World Neurosurg 2016; 95: 624.e9-624.e13
    CrossrefPubMedGoogle Scholar
  • 11 Dabboucy B, Younes P, Rahbani A, Fahed E, Abadjian G. Primary extra-axial glioblastoma: case report and literature review. Brazil Neurosurg 2021; 40 (04) e368-e373
    Google Scholar
  • 12 Kim J, Hong CK, Suh SH, Jung WS, Ahn SJ. The added value of the CSF cleft on ADC in distinguishing extra-axial from intra-axial tumors. Clin Imaging 2017; 45: 81-85
    CrossrefPubMedGoogle Scholar
  • 13 Katsuhara T, Moro N, Ohta T, Homma T, Yoshino A. Solitary primary intracranial leptomeningeal glioblastoma invading the normal cortex: case report. Mol Clin Oncol 2018; 8 (03) 466-470
    PubMedGoogle Scholar
  • 14 Karthigeyan M, Ahuja CK, Chatterjee D, Salunke P. Radiologic dilemma in an extra-axial petroclival lesion: low grade versus high grade. World Neurosurg 2017; 100: 713.e1-713.e3
    CrossrefPubMedGoogle Scholar
  • 15 Bradley Jr WG. MR appearance of hemorrhage in the brain. Radiology 1993; 189 (01) 15-26
    CrossrefPubMedGoogle Scholar
  • 16 Canedo-Antelo M, Baleato-González S, Mosqueira AJ. et al. Radiologic clues to cerebral venous thrombosis. Radiographics 2019; 39 (06) 1611-1628
    CrossrefPubMedGoogle Scholar
  • 17 Roth P, Happold C, Eisele G, Nägele T, Weller M, Luft AR. A series of patients with subpial hemorrhage: clinical manifestation, neuroradiological presentation and therapeutic implications. J Neurol 2008; 255 (07) 1018-1022
    CrossrefPubMedGoogle Scholar
  • 18 Bhatt SH, Kodankandath TV. Subpial hemorrhage in an adult male. Cureus 2022; 14 (08) e28404 . Accessed May 2, 2023 at: https://www.cureus.com/articles/101441-subpial-hemorrhage-in-an-adult-male
    PubMedGoogle Scholar
  • 19 Zhang D, Yu J, Guo Y, Zhao S, Shao G, Huang H. An intraventricular meningioma and recurrent astrocytoma collision tumor: a case report and literature review. World J Surg Oncol 2015; 13 (01) 37
    CrossrefPubMedGoogle Scholar
  • 20 Martínez-Lage J, Ros de San Pedro J, Martínez-Pérez M, Poza M. Meningiomas after radiation-therapy for benign astrocytomas. Neurocirugia (Astur) 2005; 16 (03) 266-270 , discussion 270
    CrossrefPubMedGoogle Scholar
  • 21 Lee J, Kim MS, Kim YZ. Extensive pachymeningeal dissemination of glioblastoma mimicking chronic subdural hematoma: a case report. Brain Tumor Res Treat 2019; 7 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 22 Sudarsan RT, Ramanujan V, Rajendran A. et al. Rare Case of Extracranial Metastases in a Patient with IDH-Mutant Glioblastoma. South Asian J Cancer [Internet]. 2022 Dec 31 [cited 2023 May 1]; Accessed November 4, 2023 at: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757425
    Google Scholar
  • 23 Li ZG, Mu HY. Extracranial bone metastases from recurrent anaplastic astrocytoma on FDG PET/CT: a case report a care-compliant article. Medicine (Baltimore) 2017; 96 (23) e7123
    CrossrefPubMedGoogle Scholar
  • 24 Piccirilli M, Brunetto GMF, Rocchi G, Giangaspero F, Salvati M. Extra central nervous system metastases from cerebral glioblastoma multiforme in elderly patients. Clinico-pathological remarks on our series of seven cases and critical review of the literature. Tumori 2008; 94 (01) 40-51
    CrossrefPubMedGoogle Scholar
  • 25 Dotson J, Nijim A, Denning KL, Shweihat Y, Lebowicz Y. A rare case of metastases from a high-grade astrocytoma to the pleura, bones, and liver within six months of diagnosis. Cureus 2018; 10 (08) e3234 . Available at: https://www.cureus.com/articles/14068-a-rare-case-of-metastases-from-a-high-grade-astrocytoma-to-the-pleura-bones-and-liver-within-six-months-of-diagnosis
    PubMedGoogle Scholar