title: Epithelioid glioblastoma changed to typical glioblastoma: the methylation status of MGMT promoter and 5-ALA fluorescence.
abstract: A 55-year-old man was admitted to our hospital complaining of left hemiparesis. Magnetic resonance imaging (MRI) showed a smooth ring-like enhanced cystic tumor in the right parietal lobe. He underwent gross total resection of the tumor under neuronavigation and 5-aminolevulinic acid (5-ALA) fluorescence guiding method. Histopathological examination of the tumor showed small cells formed epithelioid solid nests with some focus of duct-like structure. On the basis of the MRI and operative and histological findings, this tumor was diagnosed as a metastatic poorly differentiated carcinoma, although the primary cancer could not be detected by metastatic work-ups. Afterward, this tumor recurred repeatedly. Histopathological examination of specimen from the fourth surgery indicated that the tumor was a glioblastoma (GBM). In the review of the histology and immunohistochemistry of the first tumor, atypical fibrillary cells were seen between solid nests and positive for glial fibrillary acidic protein, therefore the tumor was retrospectively diagnosed as epithelioid GBM. We assessed whether the changes in histopathology were accompanied by changes in the methylation status of O6-methylguanine methyltransferase (MGMT) promoter and the status of 5-ALA fluorescence. The methylation status of the MGMT promoter was found to have changed from methylated to unmethylated and 5-ALA fluorescence became positive along with the histological change.
authors.affiliation: Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Satoko
authors.initials: S
authors.lastname: Nakada
authors.forename: Seiko
authors.initials: S
authors.lastname: Sawada-Kitamura
authors.forename: Natsuki
authors.initials: N
authors.lastname: Furuyama
authors.forename: Tomohide
authors.initials: T
authors.lastname: Suzuki
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kamide
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Seiji
authors.initials: S
authors.lastname: Yano
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
mesh_terms: D000622:Aminolevulinic Acid; D014408:Biomarkers, Tumor; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D015254:DNA Modification Methylases; D045643:DNA Repair Enzymes; D005909:Glioblastoma / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008745:Methylation; D008875:Middle Aged; D038361:Neuronavigation; D016133:Polymerase Chain Reaction; D011524:Protoporphyrins; D013050:Spectrometry, Fluorescence; D025521:Tumor Suppressor Proteins
chemical_list: D014408:Biomarkers, Tumor; D011524:Protoporphyrins; D025521:Tumor Suppressor Proteins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes