Brain Tumor Res Treat.  2017 Oct;5(2):99-104. 10.14791/btrt.2017.5.2.99.

Response of Leptomeningeal Dissemination of Anaplastic Glioma to Temozolomide: Experience of Two Cases

Affiliations
  • 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Pathology, National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea.
  • 3Department of Cancer Biomedical Science, National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea. nsghs@ncc.re.kr

Abstract

The incidence of leptomeningeal dissemination (LMD) of anaplastic glioma has been increasing. LMD can be observed at the time of initial presentation or the time of recurrence. As a result of both rarity and unusual presentation, a standard therapy has not yet been suggested. In contrast to leptomeningeal carcinomatosis for systemic solid cancers, a relatively prolonged survival is observed in some patients with LMD of anaplastic gliomas. Treatment modalities include whole craniospinal irradiation, intra-cerebrospinal fluid (CSF) chemotherapy, and systemic chemotherapy. In some cases, response to temozolomide (TMZ), with or without combined radiation has been reported. Here, we report two cases of LMD of an anaplastic glioma. In one case LMD presented at the time of diagnosis, and in the other at the time of recurrence after radiation. CSF cytology was positive in both cases, and persisted in spite of intrathecal methotrexate chemotherapy. Later, TMZ was prescribed for progressing brain parenchymal lesions, and both radiological and cytological responses were obtained after oral TMZ treatment.

Keyword

Leptomeningeal carcinomatosis; Temozolomide; Drug effect; Cerebrospinal fluid; Malignant glioma

MeSH Terms

Brain
Cerebrospinal Fluid
Craniospinal Irradiation
Diagnosis
Drug Therapy
Glioma*
Humans
Incidence
Meningeal Carcinomatosis
Methotrexate
Recurrence
Methotrexate

Figure

  • Fig. 1 Radiologic findings of Case 1. Initial axial T2-weighted magnetic resonance findings of a 54-year-old male patient diagnosed with anaplastic oligoastrocytoma (A and B), and sagittal and coronal T1-weighted images enhanced with gadolinium after the first craniotomy (C and D). Periventricular enhancement occurred after ifosphamide, carboplatin, and etoposide chemotherapy and intrathecal methotrexate (E and F). After treatment with temozolomide, leptomeningeal enhancement disappeared (G and H), and the T2-weighted signal intensity of the cerebellar lesion decreased (I).

  • Fig. 2 Pathologic findings of Case 1. Increased cellularity and branching capillary networks resembling that of oligodendroglioma (A, original magnification, ×200; hematoxylin and eosin staining) and intermingled oligodendroglial cells having round nuclei and clear cytoplasm and astrocytic cells of elongated nuclei (B, original magnification, ×400; hematoxylin and eosin staining).

  • Fig. 3 Radiologic findings of Case 2. A second illustrative case of a 38-year-old female patient with a mesencephalic T2 high signal intensity lesion with spotty enhancement (A and B). After radiation, the extent of the lesion decreased (C), but metastasis developed 3 years later (D). Multiple enhancing nodules around the periventricular area occurred during ventriculolumbar perfusion chemotherapy (F and G). After six cycles of TMZ, imaging reveals resolution of the enhancing lesion (H), but another solitary lesion at the cerebellopontine angle appeared after 12 cycles of TMZ (I). TMZ, temozolomide.

  • Fig. 4 Pathologic findings of Case 2. High cellularity with closely packed polygonal cells of clear cytoplasm and branching capillary networks with tumor infiltration to surrounding granular layer of the cerebellum (A, original magnification, ×200; hematoxylin and eosin staining), and abundant clear cytoplasm and centrally located round to oval nuclei with nuclear pleomorphism (B, original magnification, ×400; hematoxylin and eosin staining).


Cited by  1 articles

Leptomeningeal Metastasis in Gliomas : Clinical Characteristics and Risk Factors
Jeyul Yang, Ji-Woong Kwon, Sang Hoon Shin, Heon Yoo, Kyu-Chang Wang, Sang Heyon Lee, Ho-Shin Gwak
J Korean Neurosurg Soc. 2023;66(4):465-475.    doi: 10.3340/jkns.2022.0166.


Reference

1. Hansen N, Wittig A, Hense J, Kastrup O, Gizewski ER, Van de. Long survival of primary diffuse leptomeningeal gliomatosis following radiotherapy and temozolomide: case report and literature review. Eur J Med Res. 2011; 16:415–419.
Article
2. Saito R, Kumabe T, Jokura H, Shirane R, Yoshimoto T. Symptomatic spinal dissemination of malignant astrocytoma. J Neurooncol. 2003; 61:227–235.
3. Michotte A, Chaskis C, Sadones J, Veld PI, Neyns B. Primary leptomeningeal anaplastic oligodendroglioma with a 1p36-19q13 deletion: report of a unique case successfully treated with Temozolomide. J Neurol Sci. 2009; 287:267–270.
Article
4. Ostermann S, Csajka C, Buclin T, et al. Plasma and cerebrospinal fluid population pharmacokinetics of temozolomide in malignant glioma patients. Clin Cancer Res. 2004; 10:3728–3736.
Article
5. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; 131:803–820.
Article
6. Sanson M, Ameri A, Monjour A, et al. Treatment of recurrent malignant supratentorial gliomas with ifosfamide, carboplatin and etoposide: a phase II study. Eur J Cancer. 1996; 32A:2229–2235.
Article
7. Gwak HS, Joo J, Shin SH, et al. Ventriculolumbar perfusion chemotherapy with methotrexate for treating leptomeningeal carcinomatosis: a Phase II Study. Oncologist. 2014; 19:1044–1045.
Article
8. Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F. Cerebral glioblastoma with cerebrospinal fluid dissemination: a clinicopathological study of 14 cases examined by complete autopsy. Neurosurgery. 1989; 25:533–540.
Article
9. Yung WA, Horten BC, Shapiro WR. Meningeal gliomatosis: a review of 12 cases. Ann Neurol. 1980; 8:605–608.
Article
10. Dardis C, Milton K, Ashby L, Shapiro W. Leptomeningeal metastases in high-grade adult glioma: development, diagnosis, management, and outcomes in a series of 34 patients. Front Neurol. 2014; 5:220.
Article
11. Roldán G, Chan J, Eliasziw M, Cairncross JG, Forsyth PA. Leptomeningeal disease in oligodendroglial tumors: a population-based study. J Neurooncol. 2011; 104:811–815.
Article
12. Bae JS, Yang SH, Yoon WS, Kang SG, Hong YK, Jeun SS. The clinical features of spinal leptomeningeal dissemination from malignant gliomas. J Korean Neurosurg Soc. 2011; 49:334–338.
Article
13. Franceschi E, Cavallo G, Scopece L, et al. Temozolomide-induced partial response in a patient with primary diffuse leptomeningeal gliomatosis. J Neurooncol. 2005; 73:261–264.
Article
14. Jicha GA, Glantz J, Clarke MJ, et al. Primary diffuse leptomeningeal gliomatosis. Eur Neurol. 2009; 62:16–22.
Article
Full Text Links
  • BTRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr