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[A very slow-growing exophytic hemisphere glioma: a case report]
Carlos Velásquez1, Hugo Caballero1, Carlos Bucheli1
1Hospital Universitario Marques de Valdecilla, Santander, Espana.
Introduction:
Gliomas are characterized by a infiltrative pattern of growth, with cellular migration along the white matter fiber tracts, exophytic growth in low-grade gliomas has not been described yet. A case of hemispheric glioma with slow growing and an exophytic component is presented.
Case Report:
55 year-old male, with motor partial seizures. MRI shows a WHO grade II oligodendroglioma infiltrating the superior frontal gyrus with exophytic extension above the precentral gyrus. Clinical and radiological follow-up was performed for 23 years. Volumetric assessment of tumor progression revealed a growth rate of 0.5 mm per year. Surgical dissection revealed that the precentral gyrus was displaced inferiorly by the tumor, and a clear subarachnoid plane separated both structures. Functional areas were not identified within the exophytic component. Postoperative neurological deficits were not observed.
Conclusions:
The growth rate in low-grade gliomas has been estimated between 4 and 6 mm per year. The tumor described here had a growth rate of 0.5 mm per year, far below this average. Preoperative identification of this exophytic growth pattern is of major significance for surgical planning. The exophytic tumor is amenable for a safe and complete resection as it is covered by the arachnoid and pial membranes of the cistern and the surrounding brain.
Insights
A rare hemispheric glioma exhibited exceptionally slow growth (0.5 mm/year) and an unusual exophytic component, challenging typical low-grade glioma (LGG) behavior. This unique presentation aids surgical planning for LGGs.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Gliomas typically infiltrate brain tissue along white matter tracts.
- Exophytic growth, extending outward from the brain surface, is not a commonly described feature in low-grade gliomas (LGGs).
- This report details an unusual case of a hemispheric glioma with both infiltrative and exophytic characteristics.
Observation:
- A 55-year-old male presented with motor partial seizures.
- MRI revealed a WHO grade II oligodendroglioma with infiltration of the superior frontal gyrus and exophytic extension.
- Over 23 years, the tumor demonstrated a remarkably slow growth rate of 0.5 mm per year.
Findings:
- The exophytic component displaced the precentral gyrus inferiorly, with a clear subarachnoid plane observed.
- No functional areas were identified within the exophytic tumor portion.
- Surgical resection resulted in no postoperative neurological deficits.
Implications:
- The observed growth rate is significantly lower than the average 4-6 mm/year for LGGs.
- Preoperative identification of exophytic components is crucial for optimizing surgical strategy in LGGs.
- The exophytic nature, covered by meningeal membranes, facilitates safe and complete tumor resection.
