title: Complete diagnostics and clinical approach for a female patient with unusual glioblastoma: A case study.
abstract: The present study reports a case of a 44-year-old female patient with a large frontal lobe tumor who underwent surgery using a modern navigation system SonoWand that combines the advantages of a non-frame navigation system with intraoperative real-time ultrasound imaging. The right frontal lobe tumor consisted of two morphologically different sections. A diffuse astrocytoma grade II and a glioblastoma grade IV were identified. These tumors were relatively substantially separated. A 17 p deletion, includingTP53, was detected in a diffuse astrocytoma but not in a glioblastoma.EGFRandMDM2amplifications were detected only in a glioblastoma. Detection of these amplifications is typical for primary glioblastomas. These findings support our assumption of two independent tumors. TheKRAS,BRAFandEGFRgene mutations were also detected in a glioblastoma. Such an accumulation of molecular mutations is rare in one tumor. Following oncological treatment the patient was cared for in the oncological center and survived for 15 months after the surgery without any signs of a disease. This is an unusual case, and to the best of our knowledge, is not frequently published in literature.
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 100 34 Prague 10, Czech Republic.
authors.forename: Filip
authors.initials: F
authors.lastname: Samal
authors.affiliation: Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic; Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 66 Pilsen, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Stanek
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 100 34 Prague 10, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Filip
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 100 34 Prague 10, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Haninec
authors.affiliation: Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic.
authors.forename: Ales
authors.initials: A
authors.lastname: Vícha
authors.affiliation: Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague 2, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Musil
authors.affiliation: Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Tesarova
authors.affiliation: Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic.
authors.forename: Lubos
authors.initials: L
authors.lastname: Petruzelka
authors.affiliation: Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic.
authors.forename: Drahomira
authors.initials: D
authors.lastname: Springer
authors.affiliation: Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 66 Pilsen, Czech Republic.
authors.forename: Milena
authors.initials: M
authors.lastname: Kralickova
authors.affiliation: Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague 2, Czech Republic.
authors.forename: Milada
authors.initials: M
authors.lastname: Kohoutova
authors.affiliation: Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Zima
keywords: RAS mutation; duplicate tumor; glioblastoma multiforme; low-grade glioma; sononavigation