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

ESMO Preceptorship Programme

A case of atypical meningioma with multiple relapses

Nikolaos Mitsimponas First Oncological Clinic HYGEIA Hospital Athens Greece

ESMO Preceptorship on Brain Tumours – Athens, Greece – 28-29 September 2018

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 I have no disclosures

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First Diagnosis

 42-years

• ld

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.

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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

• f

recurrence

• f

disease. Patient remained asymptomatic.

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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.

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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

• f the lesions.

 After cyberknife improvement of the paresis and

recession of epileptic seizures.

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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.

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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

• peration
• f

the aforementioned lesions.

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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

• f the meningiomas.

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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.

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