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Rapid Malignant Transformation of Low-Grade Astrocytomas: Report of 2 Cases and Review of the Literature.
World Neurosurg
  • James L Frazier
  • Michael W Johnson, MD., PhD, Lehigh Valley Health Network
  • Peter C Burger
  • Jon D Weingart
  • Alfredo Quinones-Hinojosa
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BACKGROUND: Low-grade gliomas have been documented to undergo transformation into high-grade astrocytomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients harboring these low-grade lesions. Several studies have investigated the evolution of low-grade gliomas into malignant gliomas by CT and MRI characteristics, but many have not documented the timing of these transformation processes.

CASE DESCRIPTION: The authors discuss the cases of 2 patients with histopathologically confirmed grade II astrocytomas after craniotomies that underwent rapid evolution into malignant gliomas within 13 weeks. Interestingly, both low-grade astrocytomas were positive with immunostaining for the epidermal growth factor receptor, in which its amplification has been implicated as a molecular marker of malignant gliomas. In addition, the grade II astrocytomas were negative for p53 in both patients but were found to be positive upon transformation into malignant gliomas.

CONCLUSIONS: To our knowledge, this is the first report of rapid malignant transformation of low-grade gliomas, which were proven by histology, within 13 weeks. There may be patients with a subtype of low-grade astrocytomas that may warrant molecular characterization to determine if aggressive adjuvant therapy would be of benefit.

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Frazier, J. L., Johnson, M. W., Burger, P. C., Weingart, J. D., & Quinones-Hinojosa, A. (2010). Rapid malignant transformation of low-grade astrocytomas: report of 2 cases and review of the literature. World Neurosurgery, 73(1), 53. doi:10.1016/j.surneu.2009.05.010