• Review Article
  • |
  • Open Access

A Case Report of Cerebellar Glioblastoma

  • Ting Chen;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Xiao Qi Xie;
    • Department of Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, PR China
  • Wei Min Li*;
    • Precision Medicine Center, West China Hospital, Sichuan University, Sichuan, PR China
  • Xin Wu;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Qing Ding;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Xue Yang;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Ping Ai;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Feng Wang*;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Chen Yi;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Yong Luo;
    • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China
  • Deng Bing Wu;
    • Cancer Hospital, Ansteel Group Hospital, Anshan, Liao Ning, PR China
  • Yuan Zhao Liu;
    • Department of Radiotherapy, Beijing Hospital, Beijing, PR China
  • Jing Bo Kang;
    • Department of Radiotherapy, The Fifth Medical Center of PLA General Hospital, Beijing, PR China
  • Ruo Yu Wang;
    • Department of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
  • Bao Lin Qu;
    • Department of Radiotherapy, Chinese PLA General Hospital, Beijing, PR China
  • Xian Feng Li;
    • Department of Radiotherapy, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, PR China
  • Jun Jie Wang;
    • Department of Radiation Oncology, Cancer Center Peking University, 3rd Hospital PR China
  • Dong Cun Jing;
    • Tsuyama Jifukai Tsuyama Chuo Hospital, Japan
  • Fu Quan Zhang;
    • Department of Radiation Oncology, Peking Union Medical College hospital, China
  • Corresponding Author(s): : Feng Wang & Wei Min Li

  • Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, PR China

  • Precision medicine center, West China Hospital, Sichuan University, Sichuan, PR China

  • : wangfeng5024@126.com

  • Wang F & Li WM (2020).

  • This Article is distributed under the terms of Creative Commons Attribution 4.0 International License

Received : Apr 30, 2020
Accepted : Jun 26, 2020
Published Online : Jun 30, 2020
Journal : Journal of Case Reports and Medical Images
Publisher : MedDocs Publishers LLC
Online edition : http://meddocsonline.org

Cite this article: Wang F, Li WM, Chen T, Xie XQ, WU X, et al. A Case Report of Cerebellar Glioblastoma. J Case Rep Med Images. 2020; 3(1): 1050.

Keywords

Keywords: Cerebellar glioblastoma; Chemotherapy; Radiotherapy; Long-term survival.

Case Presentation

      The patient, male 50 years old, was admitted to hospital for 20 days due to headache and vomiting. The CT and MRI of the external hospital head suggest intracranial space occupying, considering the possibility of tumor. Admission examination: clear mind, no abnormal cranial nerve examination; no deformity of spine and limbs; normal muscle strength of limbs. The head MRI of our hospital (2008-1-28 Figure 1 A1, B1,C1,D1,E1): Irregular mixed signal masses were seen in the cerebellar vermis and left cerebellar hemispheres, about 5.5 × 3.3 cm, with long and long T2 signals and multiple separations, accompanied by T2 signals such as partial display. The lesion was closely related to the left transverse sinus, cerebellar curtain and fourth ventricle. mild enlargement of the three ventricle and bilateral ventricle. Concluding remarks: cystic solid space-occupying lesions with mild obstructive hydrocephalus and multiple lines of tumors in the cerebellum and left cerebellum, with gliomas possibly large, excluding others. On January 30, 2008 a intracranial lesion resection, postoperative disease inspection: the cerebellar vermis and the left cerebellar hemisphere pleomorphic glioblastoma, GFAP (+), the EMA (+ / -) (+), S - 100, on February 20, 2008 line head gamma knife treatment, postoperative oral chemotherapy for mo thiazoleamine, 220 mg qd, and 25 with whole brain radiotherapy on foot, review the head MRI (Figure 1A, 2B, 2C 2008-10-07 2, D2, E2): Cerebellar vermis see 3.3 * 1.9 cm, irregular cystic or solid mass shadow with slightly long T1 and T2 signal is given priority to, the boundary is not clear, the surrounding brain parenchyma edema is not obvious, enhanced scan obviously circular reinforcement, and in the brain’s interior see nodular shadows, occipital skull postoperative change, yu no abnormal signals in the brain parenchyma and abnormal strengthening, midline structure without deviation. Diagnostic advice: After glioma operation: Occipital skull showed postoperative changes, the current cerebellar vermis sac solid space, multi-line tumor recurrence, and involving the four ventricles. Mild hydrocephalus. Consider relapse and do fumosetine chemotherapy. After long-term follow-up. The patient developed headache in 2017, and the reexamination found intracranial occupation. MRI (2017-02-15 Figure 2A, B1, C1, D1, E1) showed irregular slightly longer T1, long T2 signal shadow in the cerebellum, about 2.8 X 4.5 in size. The enhancement scan was not uniform annular enhancement. The supratentorial ventricle is slightly enlarged. Diagnostic advice: cerebellar vermis cystic solid mass, considering the possibility of tumor recurrence, patients refused surgery, home recuperation, october 2019 patients with headache with gait instability, our hospital MRI (2020-02-23 Figure 2, A2, B2, C2, D2, E2) showed: Cerebellar vermis see a mass, about 3.4 cm size, high and low mixed signal, internal uneven enhancement, bilateral cystic foci, left larger, four ventricle compression, supratentorial hydrocephalus. Hemoflavin deposition was observed near the operative area and on the brain stem surface. T2 signal of the right mastoid process increased, and the mucosa of maxillary sinus, ethmoid sinus and frontal sinus thickened. Diagnostic advice: Cerebellar space occupying lesions, cystic solid, multi-line tumor recurrence, secondary hydrocephalus. compared with 2017- 2-15 day examination, the mass was enlarged. Nasal sinusitis. Right mastoiditis. Small brain space occupying resection under general anesthesia in 2020-2-28, postoperative pathology: < cerebellar space occupying > examination for extensive bleeding and necrosis tissue, vascular hyperplasia, dilatation; there are very few suspicious tumor tissue, tend to glioma, pathological tissue is too few, the type is difficult to determine, please combine clinical. The results of immunohistochemistry and gene detection are as follows. Simultaneous radiotherapy and chemotherapy with temozolomide was proposed after operation.

Figure 1: Preoperative (2008-01-28) T1 image axis (Fig A1), T2 image axis (Fig B1), T1 flair image (Fig C1), sagittal image (Fig D1), coronal image (Fig E1); Postoperative 2008(2008-10-07) T1 image axis (Fig A1), T2 image axis (Fig B1), T1 image sagittal (Fig D1), T1 image coronal (Fig Pre-operative 2020 after recurrence in 2017).

Figure 2: In 2017 (2017-02-15), T1 images were axial (Fig A1), T2 images axial (Fig B1), T1flair images (Fig C1), T1 images sagittal (Fig D1), and T1 images coronal (Fig E1). Before surgery in 2020 (2020-02-23), T1 images were axial (Fig A2), T2 images axial (Fig B2), T1flair images (Fig C2), T1 images sagittal (Fig D2), and T1 images coronal (Fig E2). After surgery in 2020 (2020-04-08), T1 image axial position (Fig A3), T2 image axial position (Fig B3), T1flair image (Fig C3), T2 image sagittal position (Fig D3), T2 image coronal position (Fig E3).sition (Fig A3), T2 image axial position (Fig B3), T1flair image (Fig C3), T2 image sagittal position (Fig D3), T2 image coronal position (Fig E3).

Discussion

      Glioblastoma (Cerebellar Glioblastoma,cGBM) is a common malignant tumor of adult primary central nervous system. its malignant degree is high, its progression is fast, its prognosis is poor, its clinical manifestation, imaging manifestation and tissue classification are related to the site, but the cGBM is very rare, the incidence rate is 0.24-4.1% of the brain, so the clinical characteristics, classification and therapeutic effect are different from those of supratentorial GBM [1]. The clinical manifestations are headache, vomiting, gait instability, blurred vision and other intracranial hypertension, co-economic disorders, cranial nerve symptoms, the current standard treatment for surgical resection of the focus after temozolomide chemotherapy combined with radiotherapy, bevacizumab has been approved for adult glioblastoma recurrence treatment [2,3] brainstem invasiveness and negative prognosis of EGFR amplification were better [4] The ki-67 of tumor proliferation index (MIB-1) of surgical biopsy showed that the tumor may progress relatively slowly, but it is different from the biological characteristics of recurrence of cerebellar glioblastoma. Molecular analysis of some cGBM cases has found that the frequency of molecular mutations such as H3K27M, BRAF v600E is different between supratentorial and cerebellum, but limited by sample size, it can not guarantee more detailed classification [5]. It is necessary to improve the case data and further study the molecular subtypes of cerebellar glioblastoma to guide clinical treatment and determine prognosis. If VEGF immunohistochemistry positive, may add apatinib to improve the prognosis

Acknowledgements

      This project is funded by the research and data on the evaluation method of stereotactic radiotherapy equipment (Subject No.: 2017YFC0113701).

      Research and development of tumor real-time monitoring molecular diagnostic products based on liquid biopsy -- a major science and technology project of Guang dong province 2019B020232003.

      Dalian municipal Science and technology innovation projects (2018 j12sn063): a new method for the detection optical flow control chip peripheral blood tumor cells research Science and technology innovation project of Dalian City (No: 2018 j12sn063).

      Liaoning provincial key research and development plan project name: construction project no. 2018225050 fat stem cell storage and application platform no. 2018020143-301.

      Project name of natural science foundation of Liaoning province: Basic research on the regulation effect of gegenqinlian decoction based on 16S rRNA gene on intestinal flora of mice with radioactive enteritis project no. 20180550798; Contract no.: 2018011225-301.

      Nature foundation guidance program PhD initiation fund project name: The relationship between fluoxetine in inhibiting astrocytoma growth and TRPC1 research project no.: 20180551182 contract no. 2018011575-301.

      The authors gratefully acknowledge the staff in the Department of Oncology, Radiation Physics Center, and Evidence-Based Medicine Center of West China Hospital, Sichuan University for their valuable work and Jiangsu HengRui Medicine Co., Ltd. Lei Yong Xiang kind help.

References

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  2. Cohen MH, Shen YL, Keegan P, et al. FDA drug approval summary. Bevacizumab (Avastin) as treatment of current glioblastoma multiforme. Oncologist. 2009; 14: 1131-1138.
  3. Stupp R, Mason WP, van den Bent MJ, Weller M. Radiotherapy plus.
  4. concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005; 352: 987-996.
  5. Saito T, Hama S, Kajiwara Y, Sugiyama K. Prognosis of cerebellar glioblastomas correlation between prognosis and immunoreactivity for epidermal growth factor receptor compared with supratentorial glioblastomas.Anticancer Res. 2006; 26: 1351- 1357.
  6. Reinhardt A, Stichel D, Schrimpf D, Acta Neuropathol Commun. 2019; 7: 163.

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