Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2023; 11(7): 1576-1585
Published online Mar 6, 2023. doi: 10.12998/wjcc.v11.i7.1576
Manifestation of the malignant progression of glioma following initial intracerebral hemorrhage: A case report
En-Xi Xu, Si-Yuan Lu, Bo Chen, Xiao-Dong Ma, Er-Yi Sun
En-Xi Xu, Bo Chen, Er-Yi Sun, Department of Neurosurgery, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
Si-Yuan Lu, Department of Radiology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
Xiao-Dong Ma, Department of Anesthesia, The Affiliated People’s Hospital, Zhenjiang 212002, Jiangsu Province, China
Author contributions: Sun EY wrote and edited the manuscript; Xu EX and Lu SY contributed to data collection; Chen B and Ma XD contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported by Zhenjiang Municipal Health Commission, No. SH2019081.
Informed consent statement: Informed written consent was obtained from the patient’s husband for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Er-Yi Sun, Doctor, Academic Research, Department of Neurosurgery, The Affiliated People’s Hospital of Jiangsu University, Runzhou, No. 8 Dianli Road, Zhenjiang 212002, Jiangsu Province, China. 258736000@qq.com
Received: October 24, 2022
Peer-review started: October 24, 2022
First decision: November 25, 2022
Revised: December 3, 2022
Accepted: February 16, 2023
Article in press: February 16, 2023
Published online: March 6, 2023
Processing time: 129 Days and 0.2 Hours
Abstract
BACKGROUND

Intracranial hemorrhage is extremely rare during the initial stages of glioma. Here, we report a case of glioma with unclassified pathology and intracranial bleeding.

CASE SUMMARY

After the second surgery for intracerebral hemorrhage, the patient experienced weakness in the left arm and leg, but could walk unassisted. One month after discharge, the weakness in the left limbs had exacerbated and the patient also suffered from headaches and dizziness. A third surgery was ineffective against the rapidly growing tumor. Intracerebral hemorrhage may be the initial symptom of glioma in some rare cases, and atypical perihematomal edema can be used for diagnosis during an emergency. Certain histological and molecular features seen in our case were similar to that of glioblastoma with a primitive neuronal component, which is termed diffuse glioneuronal tumor with features similar to oligodendroglioma and nuclear clusters (DGONC). The patient underwent three surgeries to remove the tumor. The first tumor resection had been performed when the patient was 14-years-old. Resection of the hemorrhage and bone disc decompression were performed when the patient was 39-years-old. One month after the last discharge, the patient underwent neuronavigation-assisted resection of the right frontotemporal parietal lesion plus extended flap decompression. On the 50th d after the third operation, computed tomography imaging showed rapid tumor growth accompanied by brain hernia. The patient was discharged and died 3 d later.

CONCLUSION

Glioma can present as bleeding in the initial stage and should be considered in such a setting. We have reported a case of DGONC, which is a rare molecular subtype of glioma with a unique methylation profile.

Keywords: Intracranial hemorrhage; Glioma; Glioneuronal tumor; Rare; Case report

Core Tip: Intracranial hemorrhage is extremely rare during the initial stages of glioma. We hereby report a case of glioma with an unclassified pathology and two instances of intracranial hemorrhage in the initial stage, and atypical perihematomal edema may help in its diagnosis. Certain histological and molecular features in this case are reminiscent of the newly-defined oligodendroglioma and nuclear clusters, a subtype of glioblastoma with a primitive neuronal component, which is currently not recognized by the World Health Organization.