A case of atypical meningioma with multiple relapses I have no - PowerPoint PPT Presentation

ESMO Preceptorship Programme ESMO Preceptorship on Brain Tumours – Athens, Greece – 28-29 September 2018 Nikolaos Mitsimponas First Oncological Clinic HYGEIA Hospital Athens Greece A case of atypical meningioma with multiple relapses

 I have no disclosures ESMO PRECEPTORSHIP PROGRAMME

First Diagnosis  42-years old female patient, ECOG 0, without comorbidities.  6.2005: First diagnosis of meningioma 7,5 x 5,5 x 1,5 cm in the left frontal lobe due to persistent headaches.  7.2005: Operation with complete resection of the lesion.  Histology: Atypical meningioma WHO grade II, Ki-67 10%.  After the surgery no residual neurological symptomatology  10.2005 – 7.2007: Monitoring with Brain-MRI. ESMO PRECEPTORSHIP PROGRAMME

First Relapse  11.2007: Reveal of 2 new meningiomas in the left frontal lobe in Brain-MRI.  01.2008: Radiosurgery (Cyber Knife) and the 2 new meningiomas were completely removed.  01.2008-04.2009: Monitoring with Brain-MRI without evidence of recurrence of disease. Patient remained asymptomatic. ESMO PRECEPTORSHIP PROGRAMME

Second Relapse  5.2009: In the monitoring with Brain-MRI reveal of 2 new meningiomas in the left parietal lobe.  6.2009: Radiosurgery (Cyber Knife) with complete resection of the meningiomas.  7.2009-7.2011: Monitoring with Brain-MRI. In this period only mild motoric disorders. ESMO PRECEPTORSHIP PROGRAMME

Third Relapse  7.2011: Reveal of new symptoms (paresis of right arm, speech disruptions and epileptic seizures).  MRI of brain revealed 4 new lesions (1 right parietal, 2 left parietal and 1 left frontal).  10.2011: Radiosurgery (Cyberknife) with resection of the lesions.  After cyberknife improvement of the paresis and recession of epileptic seizures. ESMO PRECEPTORSHIP PROGRAMME

Fourth Relapse  3.2013: Reveal of new lesions (left parietal lobe, left temporal lobe and sickle) . Decision for active surveillance strategy.  4.2014: Recurrence of symptoms (paresis of right arm, Broca aphasia and equilibrium disturbances).  4.2014: Brain-MRI: Increase in size of the known lesions and decision to undergo to operation.  5.2014: Cytoreductive operation of lesions. ESMO PRECEPTORSHIP PROGRAMME

Fifth Relapse  11.2014: Reveal of new lesions (left frontal lobe and sickle).  5.2015: Increase in size of the aforementioned lesions (left frontal lobe with extension to the left temporal lobe and sickle).  9.2015: New cytoreductive operation of the aforementioned lesions. ESMO PRECEPTORSHIP PROGRAMME

Sixth Relapse  3.2016: Reveal of new lesions (again left frontal lobe, left temporal lobe and sickle).  7.2016: Increase in size of the aforementioned lesions.  9.2016: Radiosurgery (Cyber Knife) with resection of the meningiomas. ESMO PRECEPTORSHIP PROGRAMME

Follow up  Monitoring with Brain-MRI  The patient has a permanent hemiplegia and Broca aphasia and her ECOG is 3.  Last Brain-MRI 03.2018: No indication of new lesions. ESMO PRECEPTORSHIP PROGRAMME

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