Acute progression of untreated incidental WHO Grade II glioma to glioblastoma in an asymptomatic patient

摘要: WHO Grade II glioma (low-grade [LGG]) is increasingly diagnosed as an incidental finding in patients undergoing MRI for many conditions. Recent data have demonstrated that such LGGs are progressive tumors undergo clinical transformation and ultimately become malignant. Although asymptomatic LGG seems to represent earlier step the natural course of a than symptomatic LGG, it nonetheless impossible predict at individual level when tumor will The authors report case 43-year-old woman with right operculo-insular was incidentally because headaches. No treatment proposed, repeated scans were performed 6 years another institution. Due slow but continuous growth lesion, patient finally referred our center surgery. Interestingly, objective calculation velocity tumor's diametric expansion sudden acceleration rate within 5 months preceding surgery, development contrast enhancement. Remarkably, still asymptomatic. An awake resection intraoperative electrical mapping. There no functional worsening following assessed on postoperative neuropsychological examination. Removal 92% signal abnormality FLAIR achieved, complete area Neuropathological examination revealed glioblastoma, subsequently treated concomitant radiotherapy chemotherapy. "wait see" attitude has been advocated by some respect original demonstrates acute glioblastoma may occur, even before onset any symptoms. Therefore, lack symptoms does not protect from malignant transformation, we propose consideration more systematic manner cases LGG.