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Received Feb 26, 2018; Accepted May 23, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Glioblastoma multiforme (GBM) is the most malignant form of astrocytoma and the most frequent primary tumor of the brain in adults. Its prognosis is poor, with a median survival of 12.1–14.6 months despite current multimodal treatment [1]. GBM shows a great degree of histological variability and numerous morphologic subtypes, some of which may be associated with specific genetic alterations or clinical behaviors [2]. Glioblastoma with primitive neuronal component, which has been referred to as glioblastoma with the primitive neuroectodermal tumor-like component (GBM-PNET) in the literature and which is one of the emerging GBM subtypes, is a rare tumor with the combined features of malignant glioma and PNET. Here, we report a long-term survival patient who presented not only this rare collision tumor but also different histopathological components in the disease course.
2. Case Presentation
A 23-year-old woman presented with progressive headache, nausea, and vomiting for 1 week. Right-side weakness, ptosis, and diplopia were also found. Due to acute onset conscious disturbance (Glasgow Coma Scale of E3VaM5) in the hospital, brain computed tomography was arranged and revealed an enhanced brain tumor with necrotic cystic change. This tumor was located at the left temporal lobe with upward extension to the left basal ganglion and periventricular region, causing perifocal edema and midline shift (Figure 1). We performed emergent craniectomy for tumor removal in December 2006.
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Pathology revealed pleomorphic, hyperchromatic cells with glassy, astrocytic cytoplasm, as well as hypercellularity, microvascular proliferation, and necrosis, consistent with the diagnosis of classic GBM (Figure 2).
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The patient underwent radiotherapy 1 month later and followed by chemotherapy with temozolomide for 6 months. Her performance status improved to a Karnofsky Grade of 70, and her clinical condition was stable thereafter. However, follow-up brain magnetic resonance imaging (MRI) in June 2014 revealed a new enhanced nodular lesion, approximately 1.1 cm in diameter, at the left temporal base. The brain MRI in October 2014 revealed a progressive change of lesions, maximum 3.0 cm in diameter (Figure 1). Thus,...