Surgically benign recovery and histopathologically malignant transformation of a gliomatosis cerebri after radiotherapy: natural course or an unpredictable desired effect?

Abstract

Gliomatosis cerebri is a rare primary glial neoplasm of the central nervous system characterized by excessive involvement of the brain tissue. Dispersion and infiltrative growth pattern of this insidious pathology limit the utility of total surgical removal and are underlying causes of its poor prognosis. Furthermore, unresponsiveness of gliomatosis cerebri to radiotherapy and its classification as high grade or type 2 is reportedly associated with poor long-term survival. Contrary to our current knowledge, we report the case of a 54-year-old male who was diagnosed with gliomatosis cerebri. He presented with an exceptional clinical and pathological course and poor prognostic factors but was successfully treated with total surgical resection after radiotherapy. The present case findings indicate the potential utility of surgery, usually underestimated, as a curative treatment for gliomatosis cerebri. Clinicians should be aware of negative predictive factors that may help identify a small subset of patients suitable for total surgical tumor removal, as in the present case.