Rapid malignant transformation of low-grade astrocytomas: report of 2 cases and review of the literature

Frazier, James L.; Johnson, Michael W.; Burger, Peter C.; Weingart, Jon D.; Quinones-Hinojosa, Alfredo

doi:10.1016/j.surneu.2009.05.010

« Previous Next »World Neurosurgery
Volume 73, Issue 1 , Pages 53-62, January 2010

Rapid malignant transformation of low-grade astrocytomas: report of 2 cases and review of the literature

James L. Frazier, MD
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, MD
Michael W. Johnson, MD, PhD
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
Peter C. Burger, MD
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
Jon D. Weingart, MD
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
Alfredo Quinones-Hinojosa, MD
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, MD
- Corresponding author. Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and Oncology, Baltimore, MD 21231, USA. Tel.: +1 410 502 2906; fax: +1 410 502 5559.

Received 9 January 2009; accepted 7 May 2009. published online 10 August 2009.

Abstract

Background

Low-grade gliomas have been documented to undergo transformation into high-grade astrocytomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients harboring these low-grade lesions. Several studies have investigated the evolution of low-grade gliomas into malignant gliomas by CT and MRI characteristics, but many have not documented the timing of these transformation processes.

Case Description

The authors discuss the cases of 2 patients with histopathologically confirmed grade II astrocytomas after craniotomies that underwent rapid evolution into malignant gliomas within 13 weeks. Interestingly, both low-grade astrocytomas were positive with immunostaining for the epidermal growth factor receptor, in which its amplification has been implicated as a molecular marker of malignant gliomas. In addition, the grade II astrocytomas were negative for p53 in both patients but were found to be positive upon transformation into malignant gliomas.

Conclusions

To our knowledge, this is the first report of rapid malignant transformation of low-grade gliomas, which were proven by histology, within 13 weeks. There may be patients with a subtype of low-grade astrocytomas that may warrant molecular characterization to determine if aggressive adjuvant therapy would be of benefit.

Abbreviations: CT, computed tomography, EGFR, epidermal growth factor receptor, FLAIR, fluid-attenuated inversion recovery, GBM, glioblastoma multiforme, MRI, magnetic resonance imaging