Malignant glioma-primitive neuroectodermal tumor recurring as PNET-like only subdural collection: Case report

Abstract

Background:Histologic variants of conventional glioblastoma are rare clinical entities. In recent years, an aggressive variant termed malignant glioma with primitive neuroectodermal tumor components (MG-PNET) has been described in adults. In addition to the rarity of supratentorial primitive neuroectdoermal tumors (sPNET) in adults, MG-PNET can present with unique radiographic features.Case Description:We report the case of a 42-year-old male who presented with headaches and vision changes. Magnetic resonance imaging (MRI) of the brain revealed a large right frontal lesion. He underwent craniotomy with pathology demonstrating glioblastoma WHO grade IV, with primitive neuroectodermal tumor-like components (MG-PNET). Seven weeks later the patient represented with worsening headaches and left-hand weakness. MRI brain revealed a diffusion restricting subdural collection overlying the prior craniotomy site. Biopsy revealed PNET-like recurrence of the previously treated MG-PNET.Conclusion:In addition to histologic deviation, MG-PNET can present with variable radiographic findings on MRI and a clinical course distinctive from traditional glioblastoma. The hypercellular nature of this lesion can present as a diffusion-restricting lesion.

Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

“…Nerve roots enhancement can be seen in some cases (57%) as well as cranial nerve infiltration (11%–19%) [1, 34, 78]. Exceptional presentation mimicking chronic subdural hematoma or empyema has been reported [116, 117].…”

“…Antiangiogenic drugs (e.g., bevacizumab) alone [1, 44, 117, 142] or combined with cytotoxic agents (e.g., irinotecan) were used with inconsistent clinical benefit [15, 55, 64, 85, 110, 134, 143]. Concurrent radiochemotherapy can be proposed in selected cases, eventually in association with antiangiogenic agents [15, 31, 55, 134].…”