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World Neurosurg. 2010 Jan;73(1):53-62; discussion e5. doi: 10.1016/j.surneu.2009.05.010. Epub 2009 Aug 7.

Rapid malignant transformation of low-grade astrocytomas: report of 2 cases and review of the literature.

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  • 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA.

Abstract

BACKGROUND:

Low-grade gliomas have been documented to undergo transformation into high-grade astrocytomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients harboring these low-grade lesions. Several studies have investigated the evolution of low-grade gliomas into malignant gliomas by CT and MRI characteristics, but many have not documented the timing of these transformation processes.

CASE DESCRIPTION:

The authors discuss the cases of 2 patients with histopathologically confirmed grade II astrocytomas after craniotomies that underwent rapid evolution into malignant gliomas within 13 weeks. Interestingly, both low-grade astrocytomas were positive with immunostaining for the epidermal growth factor receptor, in which its amplification has been implicated as a molecular marker of malignant gliomas. In addition, the grade II astrocytomas were negative for p53 in both patients but were found to be positive upon transformation into malignant gliomas.

CONCLUSIONS:

To our knowledge, this is the first report of rapid malignant transformation of low-grade gliomas, which were proven by histology, within 13 weeks. There may be patients with a subtype of low-grade astrocytomas that may warrant molecular characterization to determine if aggressive adjuvant therapy would be of benefit.

Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID:
20452869
[PubMed - indexed for MEDLINE]
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