Dados do Trabalho

Título

Adult diffuse high-grade brainstem glioma induced by brain radiotherapy in childhood, a case report

RESUMO

Case report
33-year-old female, in 2002, at age 13, was diagnosed with pineal dysgerminoma. The patient underwent surgical resection of the lesion, followed by chemotherapy and radiotherapy. In 2003, this patient had tumor recurrence and was submitted to a new surgical resection followed by chemotherapy and reirradiation. After achieving complete response, the patient remained in clinical follow-up for 18 years. In May 2020, she evolved with altered mental status associated with diplopia and oculomotor nerve paresis. Cranial MRI was performed and showed an expansive lesion in the right thalamo-mesencephalic region with contrast enhancement. In July 2020, a biopsy of the midbrain lesion was performed and confirmed the diagnosis of high-grade glioma. Immunohistochemical analysis demonstrated positivity for expression of GFAP, ATRX and Ki67 (40% of the tumor cells), while the expression of IDH1, CD34, neurofilament, synaptophysin, p53 and H3K27M were negative. Diffuse high-grade glioma, H3-wildtype and IDH-wildtype was the definitive diagnosis. Radiotherapy was performed initially and later this patient had disease progression and received temozolamide. Currently, this patient is in palliative care.
Discussion
Aside from genetic factors, the main risk factor already established for the development of glioma is previous exposure to ionizing radiation of the central nervous system (CNS), as occurs from therapeutic radiation therapy for childhood brain tumors or leukemia. The interval between irradiation and glioma development varies from five years to several decades. In this clinical case, the etiology of the glioma is probably related to the brain radiotherapy that this patient underwent for the treatment of pineal dysgerminoma during childhood.
Conclusion
Radiation induced glioma is relatively rare but well described in the literature. Unfortunately, radiation-induced gliomas promote high morbidity and mortality in patients. In this way, the rational use of brain radiotherapy especially in children and the development of new technologies that reduce the risk of second brain neoplasms induced by radiotherapy is extremely important.

Palavras Chave

Adult Diffuse Glioma ; Child Pineal Dysgerminoma