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2017 ; 6
(3
): 321-326
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Anaplastic astrocytoma cells not detectable on autopsy following long-term
temozolomide treatment: A case report
#MMPMID28451406
Hirano H
; Kawahara T
; Niiro M
; Yonezawa H
; Takajyou T
; Ohi Y
; Kitazono I
; Sakae K
; Arita K
Mol Clin Oncol
2017[Mar]; 6
(3
): 321-326
PMID28451406
show ga
We herein present an autopsy case of a glioma patient who received long-term
treatment with temozolomide (TMZ). The patient, a 35-year-old man with a
hypointense tumor of the left frontal lobe, without contrast enhancement
following gadolinium (Gd) administration on T1-weighted images, underwent tumor
removal surgery, after which the tumor was diagnosed as anaplastic astrocytoma.
By the third round of surgery, the tumor had progressed to anaplastic astrocytoma
with contrast enhancement following Gd administration, and the patient received
60 Gy of external beam radiotherapy and nimustine hydrochloride (ACNU)-based
chemotherapy. After the fifth tumor removal surgery, TMZ was substituted with
ACNU chemotherapy, which suppressed tumor progression. Following the 41st TMZ
treatment, hemorrhage was observed in the residual tumor, and the hematoma had
been replaced by a hemangioma. The hemangioma and surrounding brain tissue was
removed during the sixth surgery. The patient survived for 14 years and 9 months
after the initial surgery, but succumbed to hydrocephalus due to bleeding from
hemangiomas. The histopathological specimens of the first to the sixth surgeries
revealed mutant isocitrate dehydrogenase 1 (IDH1; R132H point mutation) and
p53-positive tumor cells, but cells positive for the R132H mutation or p53 could
not be detected by immunohistochemistry in the autopsy specimens of the brain
after 108 courses of TMZ treatment. Mutant IDH1 (R132H) cells were also not
detected in the autopsy specimens of the brain by polymerase chain reaction
analysis.