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Published on: August 15, 2025
Tonsillar pseudotumor: complications of chronically-administered temozolomide
Kathleen Grisdale1, Melesa Ritterhouse, Kathy Hunter
1Department of Neuro-Oncology, The University of Texas MD Anderson Texas Cancer Center, Houston, TX 77030, USA.
Abstract:
The current standard of care for patients with Glioblastoma multiforme (GBM) is surgery, followed by radiation in combination with Temozolomide (TMZ), followed by adjuvant TMZ. The most appropriate length of treatment of adjuvant TMZ after the completion of radiation is unclear. We present the case of a 45 year old female with GBM who received adjuvant TMZ on an experimental study for 24 1-month cycles (150 mg/M(2) 7 days on/7 days off continuously-a higher TMZ dose than standard). After 24 months on study she was stable without GBM regrowth, but presented with a right tonsil and pharynx mass consistent with a new primary malignancy. Tonsillar biopsy was positive for Epstein-Barr virus, Cytomegalovirus and Herpes Simplex Virus, but no tumor. This case highlights the risks and possible complications of immunosuppression associated with long term TMZ use.
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