Sinhroni maligni multicentrični gliom mozga sa atipičnom neuroradiološkom prezentacijom i komparativno dugim preživljavanjem: prikaz bolesnika i pregled literature
Sažetak
Uvod. Sinhroni multicentrični maligni gliomi mozga su retki moždani tumori koji su uglavnom maligni, sa nepoznatom patogenezom, nepovoljnom prognozom i još uvek spornim dijagnostičko-terapijskim pristupom. Preoperativna diferencijacija u odnosu na druge multiple moždane lezije uz pomoć konvencionalne magnetne rezonance (MR) je često teška, tako da bi dodatna primena naprednih MR tehnika trebala da omogući predikciju biologije tumora i planiranje odgovarajuće strategije lečenja. Prikaz bolesnika. Prikazali smo muškarca starosti 59 godine, sa dve sinhrone multicentrične moždane lezije, koje su na inicijalnoj MR mozga sa difuzionom sekvencom izgledale kao parijetalna cerebralna metastaza sa leve strane i ipsilsteralni amigdalo-hipokampalni niskogradusni gliom. Medjutim, magnetno-rezonantna spektroskopija (MRS) obe lezije pokazala je prisustvo metaboličkih profila malignog glioma. Lako dostupna parijetalna lezija koja je resecirana u potpunosti, potvrdjena je kao glioblastom, sa metilisanim promotorskim genom za O6-metilguanin-DNK-metiltransferazu (MGMT). Postoperativno, bolesnik je lečen hemioradioterapijom baziranoj na temozolomidu (TMZ) prema Stupp-ovom protokolu, uz kontinuiranu standardnu (5/28) adjuvantnu monohemioterapiju TMZ u 12 ciklusa. Uprkos prolongiranoj stabilizaciji bolesti sa dobrim kvalitetom života tokom lečenja, bolesnik je preminuo 19 meseci nakon dijagnostikovanja bolesti. Vreme do progresije bolesti koje je procenjivano MR pregledom iznosilo je 17 meseci. Zaključak. Tehnika MRS je značajno poboljšala diferencijalno-dijagnostičku preciznost konvencionalne MR kod našeg bolesnika. U odnosu na prikazane literaturne podatke, mlado životno doba, inicijalno dobro opšte stanje i metilisani promotorski gen za MGMT bili su povoljni prediktori dužeg preživljavanja kod prikazanog bolesnika. Resekcija bar jedne lako dostupne tumorske lezije, uz postoperativnu hemioradioterapiju baziranu na TMZ i kontinuiranu adjuvantnu hemioterapiju TMZ sa više od 6 standardnih ciklusa, čini se kao trenutno najpovoljnija terapijska opcija kod ovakvih bolesnika.
Reference
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