gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Secondary glioblastoma as a local recurrent after medulloblastoma in a 17-year old – case report on the therapeutic risk of late complications

Sekundäres Glioblastom als Lokalrezidiv nach Medulloblastom bei einem 17-Jährigen – Fallbericht über das Risiko von späten Komplikationen der Therapie

Meeting Abstract

  • presenting/speaker Friederike Sophie Fritzsche - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie, Hamburg, Deutschland
  • Franz Lennard Ricklefs - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie, Hamburg, Deutschland
  • Gertrud Kammler - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie, Hamburg, Deutschland
  • Ulrich Schüller - Universitätsklinikum Hamburg-Eppendorf, Neuropathologie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP002

doi: 10.3205/20dgnc296, urn:nbn:de:0183-20dgnc2964

Veröffentlicht: 26. Juni 2020

© 2020 Fritzsche et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: We report on a 17 year old boy who suffered local tumor reoccurrence 9 years after medulloblastoma (MB) diagnosis. Histopathological workup revealed a glioblastoma (GBM). Cases of secondary GBM after MB are reported rarely. The reasons for these infrequent cases are not consistently understood and probably very distinct. The occurrence of a late intracranial secondary malignancy still is associated with poor prognosis. The purpose of this description is to show the need for risk evaluation concerning adjuvant therapy in young individuals and to ask the question, which patients might be predestined to develop subsequential GBM.

Methods: This report describes the medical curse of a single individual. Clinical records were completely available for analysis. Data was examined concerning clinical symptoms, MRI-studies, surgical procedures, histology and adjuvant therapy.

Results: The patient was 9 years of age at diagnosis of a MB (classical subtype, nuclear beta-catenin accumulation). The resection was subtotal, the clinical findings of 6th nerve palsy, ataxia, nystagmus were not completely resolved after surgery. An individual, alternating chemotherapy with VCR/CCNU/cisplatin, cyclophosphamide and carboplatin followed craniospinal radiation (helical tomotherapy 1,8 Gy, cs 18 Gy, boost fossa posterior 54 Gy, boost onto remaining tumor tissue 59,5 Gy). After 9 years of a disease-free survival the now 17 year old was admitted as an emergency with severe headache, nausea and an intracerebellar MRI lesion and occlusive hydrocephalus. Resection was gross total in the absence of spinal metastasis. Histology showed glioblastoma IDHwt, MGMT not methylated, no MSI and no relation to the original tumor. A combined radiotherapy and chemotherapy (VBL, valproate) is suggested by tumor board.

Conclusion: Secondary GBM in children and adolescents following a disease-free survival of 9 years after MB is considered rare. In those cases the role of molecular markers is significant. In the reported case neuropathological workup did not offer an individual targeted approach. Given the limited treatment options and the poor prognosis, extent of surgical resection is crucial. Such cases are to be collected in comprehensive registries including molecular analyses to gain insights into the patheways leading to possibly therapy associated secondary malignancy.