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ESMO Preceptorship Programme
Low grade glioma – pathology vs radiological diagnosis
Amin Ali The Christie, Manchester
Brain tumour – Athens – 28-29 Sept 2018
ESMO PRECEPTORSHIP PROGRAMME
Low grade glioma pathology vs radiological diagnosis No conflicts - - PowerPoint PPT Presentation
Low grade glioma pathology vs radiological diagnosis No conflicts - - PowerPoint PPT Presentation
ESMO Preceptorship Programme Brain tumour Athens 28-29 Sept 2018 Amin Ali The Christie, Manchester Low grade glioma pathology vs radiological diagnosis No conflicts of interest ESMO PRECEPTORSHIP PROGRAMME 37 year old lady
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ESMO PRECEPTORSHIP PROGRAMME
37 year old lady primigravida at 25 weeks Found unconscious (Nov 2017) with evidence of GTC
seizure
Intubated and stabilised in ITU, unfortunately complicated
to have intrauterine death and seizures
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ESMO PRECEPTORSHIP PROGRAMME
MRI brain (Nov 2011): LGG crossing corpus collosum Right frontal craniotomy and limited debulking (30%)
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ESMO PRECEPTORSHIP PROGRAMME
Pathology review:
IDH1 WT (IHC), 1p19q intact, diffuse astrocytoma, WHO grade 2
Neuro-rehabilitation for 2 months
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ESMO PRECEPTORSHIP PROGRAMME
MRI brain (Jan 2018): Overall similar size but
some new contrast enhancement inferiorly. Significant mass effect
Pre-op Post-op (limited debulking)
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ESMO PRECEPTORSHIP PROGRAMME
MDT opinion: elective safe debulking resection of
right frontal component
Patient agreed and had subtotal resection (March
2018)
Histology: Subtotal resection of grade II diffuse
astrocytoma, IDH1 mutant (molecular), ATRXm, Ki- 67 <4%
Patient recovered from surgery well with performance
status 0
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ESMO PRECEPTORSHIP PROGRAMME
Given imaging appearances and extent of disease,
managed as grade III
Planned concurrent chemoradiation 59.4Gy/33fr
followed by adjuvant Temozolomide up to 12 cycle
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ESMO PRECEPTORSHIP PROGRAMME
Latest – 29 August 2018
Completed concurrent chemoradiation 10/7/18 Back to full time work after 1 month post radiotherapy Developed partial seizure at work Admitted A&E – MRI showed response to radiotherapy
although she does have considerable extensive bilateral residual frontal tumour
Increased anti-epileptic Came for cycle 1 adjuvant Temozolamide – reduced
dose due to thrombocytopenia grade 3
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ESMO PRECEPTORSHIP PROGRAMME
PRE-CRT 1 MONTH POST CRT
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ESMO PRECEPTORSHIP PROGRAMME
Discussion points
How much should you try to resect - does debulking have a
benefit over biopsy?
Not all IDH mutations are picked up with IHC - role of
molecular testing
Pathology grade 2 vs Radiology grade 3 – management? Young patient – discrepancy of disease extent vs clinical
symptoms
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ESMO PRECEPTORSHIP PROGRAMME
Acknowledgement
Dr Catherine McBain ESMO
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