Author(s) :

Bianca, Miruna, Andrada , Daniel, Zsolt.

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Abstract :

Gliomas account for the great majority of primary tumors that arise within the central nervous system (CNS). The term "glioma" refers to tumors that have histologic features similar to normal glial cells (ie, astrocytes, oligodendrocytes, and ependymal cells). Each of these types of gliomas contains neoplasms spanning a broad spectrum of biologic aggressiveness. Historically, the slower-growing lesions, corresponding to World Health Organization (WHO) grades 1 and 2, have been commonly referred to as "low-grade gliomas," while the more rapidly progressive, grade 3 and 4 tumors are referred to as "high-grade gliomas." The WHO classification recommends avoiding these terms since they lump together heterogenous groups of tumors, many of which have significantly different biologic properties, prognoses, and treatment approaches . Grade 4 gliomas are the most common primary malignant brain tumors in adults. They are characterized by their aggressive and invasive nature and exhibit high inter- and intratumoral heterogeneity .They commonly arise de novo, meaning they begin as a grade 4 tumor with no evidence of a lower-grade precursor. In 2021 the World Health Organization (WHO) updated CNS tumor classifications. We present the case of a 47 year old male, with the diagnosis of frontal grade III anaplastic oligoastrocytoma in 2007, who undergoes surgery and who presents a local recurrence after 4 years. After the second surgical intervention with complete removal of the tumor, the histopathological examination reveals the diagnosis of grade IV astrocytoma. Postoperatively, the patient undergoes 2 cycles of chemotherapy with Temozolomide and considering the histology, age and the patient’s comorbidities, conformal radiotherapy with curative purpose is decided, along with chemotherapy. In 2023 he has a second relapse for which he undergoes surgery. Histopathological report shows that the tumor has transformed into a grade IV astrocytoma. Following surgery, concurrent radio-chemotherapy is instituted for 6 weeks. After the completion of the radio-chemotherapy, he undergoes chemotherapy and follow-up through brain MRI.

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