Synchronous diagnosis of multicentric glioma with distinct isocitrate dehydrogenase molecular profiles: a case report.
Aditya A Mohan, Kristen Batich, Shih-Hsiu J Wang et al.
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Case in brief
A 28-year-old woman presented with dizziness, retro-orbital pain, headache, and right-arm numbness and paresthesia. MRI showed two non-enhancing T2/FLAIR-hyperintense lesions in the left frontal and parietal lobes. Histopathology and molecular testing, including whole-exome sequencing, identified a grade 2 oligodendroglioma with an IDH1 R132S mutation in the frontal lobe and a grade 4 astrocytoma with an IDH1 R132H mutation in the parietal lobe. Their distinct profiles supported consideration of each synchronous tumor as an individual primary when planning treatment.
What made this case unusual
The synchronous lesions had different histologic diagnoses and distinct IDH1 mutations, supporting separate primary tumors rather than spread from one tumor to the other.
Diagnostic / clinical pearl
When synchronous brain lesions differ in appearance or suspected tumor type, analyze each lesion individually; distinct histologic and molecular profiles can clarify whether they represent separate primary tumors.