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Rapid progression may indicate pathological under-diagnosis in a case of spinal cord astrocytoma

Hailin Zhu, Chao Li, Ji Yu, Harry huimin Chen

Abstract


Introduction: Most intramedullary spinal cord tumors are low-grade gliomas and are usually characterized by slow progression.  This is a case of a patient histologically diagnosed as low grade intramedullary astrocytomas but with fast growing behavior.

Presentation of Case: A 67-year-old man who was diagnosed with a low-grade but-fast-growing intramedullary astrocytoma. He lost his ability to walk within 1 month after symptom onset.  Preoperative spinal MRI showed an intramedullary lesion from T2 to T4.  Decompression surgery was performed at the T2–T4 level and the tumor was partially removed, followed by standard radiotherapy and TMZ chemotherapy.  Histological examination showed a low-grade astrocytoma (WHO grade II).  However, the tumor rapidly progressed and the patient eventually developed disability in all four limbs.  MRI then showed the tumor to extend from C2 to T7.  The patient died of respiratory failure 17 months after his surgery.

Conclusions: This case indicated that for patient with low-grade spinal cord astrocytoma, if the clinical progression does not match the pathological diagnosis,the treatment plan should be reconsidered.


Keywords


Intramedullary spinal cord tumors ( IMSCTs); low grade astrocytoma; sampling error; fast growing; tumor heterogeneity

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References


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