Supratentorial Primitive Neuroectodermal Tumor in an Aged Patient-Case Report-

Abstract

An 88-year-old woman presented with a supratentorial primitive neuroectodermal tumor (PNET) manifesting as disturbance of consciousness and left hemiplegia. Magnetic resonance imaging showed a large mass lesion in the right frontotemporal region. She underwent biopsy of the lesion that confirmed the diagnosis of PNET. Her poor condition only allowed chemotherapy with methyl 6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-a-D-glucopyranoside (MCNU), vincristine, and prednisolone to be performed. The patient died approximately 6 months after diagnosis due to enlargement of the tumor. Supratentorial PNET is a rare tumor, especially in adults. Multimodal therapy consisting of gross total or subtotal resection, radiation therapy, and chemotherapy is generally considered necessary for patients with supratentorial PNET. However, the condition of each patient should be considered in determining the therapeutic plan, especially in the case of extremely aged patients, since supratentorial PNET is malignant and long-term survival is rare despite aggressive treatment.

Epilepsy due to a temporal ganglioglioma and its subsequent malignant transformation into a primitive neuroectodermal tumor

“…Usually, the proliferation index is high, as in our patient, who, moreover, had a very early recurrence even after complete resection. [1524] Supratentorial PNETs on MRI are hypo and hyperintense on T1 and T2-weighted sequences, respectively, and in most of the cases there is heterogeneous contrast enhancement after gadolinium administration. Some areas of decreased diffusion within the lesion are common findings, due to the high cell density.…”

Case of a miniature dachshund with a primitive neuroectodermal tumor confined to the forebrain region treated with a combination of surgery and chemotherapy

“…In humans, lesions have been observed to be hypointense and hyperintense on T1W and T2W MR imaging, respectively, and were heterogeneously enhanced by the contrast medium according to the extent of vascularity [12,13,14]. In addition, a ring-like contrast enhancement was present, and brain edema around the tumor varied from slight to marked [12, 13].…”

“…The optimal treatment regimen for non-cerebellar origin PNET has not yet been established in humans. In humans, long-term survivors are rare among both adults and children, despite aggressive therapy with surgery, radiation therapy and chemotherapy, with outcomes possibly being worse for aged patients than for young adults [14]. Sufficient reduction of tumor volume before chemotherapy and additional therapeutic modalities may be needed to improve outcome [14].…”

“…In humans, long-term survivors are rare among both adults and children, despite aggressive therapy with surgery, radiation therapy and chemotherapy, with outcomes possibly being worse for aged patients than for young adults [14]. Sufficient reduction of tumor volume before chemotherapy and additional therapeutic modalities may be needed to improve outcome [14]. In the present case, the dog returned to clinical normal after surgery; however, the tumor had increased in size during chemotherapy treatment using lomustine.…”

“…The surgery was therefore regarded as effective, but it is difficult to judge the curative effect of the chemotherapy because it commenced after a recurrence of the tumor. In humans, chemotherapy with nitorosourea and/or a platinum-based agent and/or vincristine was given to long-term survivors [14]. A combination of some of the above agents may be expected to be effective in veterinary medicine.…”