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

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 investi...

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Bibliographic Details
Published in:World neurosurgery 2010, Vol.73 (1), p.53-62
Main Authors: Frazier, James L., MD, Johnson, Michael W., MD, PhD, Burger, Peter C., MD, Weingart, Jon D., MD, Quinones-Hinojosa, Alfredo, MD
Format: Article
Language:English
Subjects:
Astrocytoma - metabolism
Astrocytoma - pathology
Astrocytoma - surgery
Biological and medical sciences
Brain Neoplasms - metabolism
Brain Neoplasms - pathology
Brain Neoplasms - surgery
Cell Transformation, Neoplastic
Female
Glioblastoma
Grade II astrocytoma
High-grade glioma
Histopathology
Humans
Low-grade glioma
Male
Malignant transformation
Medical sciences
Middle Aged
Neurosurgery
Receptor, Epidermal Growth Factor - metabolism
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Tumor Suppressor Protein p53 - metabolism
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Summary: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.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.surneu.2009.05.010