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. Synchronous multicentric cerebral gliomas are uncommon brain  tumors, mostly malignant, with unknown pathogenesis, unfavorable prognosis  and still controversial management. Preoperative differentiation from other  multiple brain pathologies by conventional magnetic resonance imaging (MRI)  is often difficult, but supplemental use of advanced magnetic resonance  techniques should allow the tumor biology to be predicted, and an appropriate  treatment strategy planned. Case report. We report the case of a 59-year-old  man with double synchronous multicentric cerebral lesions, which had initial  MRI and diffusion-weighted imaging presentation as left parietal metastasis  and ipsilateral amygdalo-hippocampal low-grade glioma. However, magnetic  resonance spectroscopy (MRS) of both lesions showed different metabolite  profiles of malignant glioma. En bloc resection of the easily accessible  parietal lesion revealed glioblastoma with methylated O6-methylguanine-DNA  methyltransferase (MGMT) gene promoter. Subsequently, the patient was treated  with temozolomide (TMZ)-based chemoradiation according to Stupp’s protocol,  with continuous standard (5/28) adjuvant TMZ in 12 courses. Despite prolonged  stabilization of the disease with good life-quality during treatment, the  patient died 19 months after diagnosis. The time to tumor progression  estimated by MRI was 17 months. Conclusion. MRS significantly improved the  differential diagnostic accuracy of conventional MRI in our patient. In  accordance with reviewed literature data, the younger age, good initial  performance status and methylated MGMT gene promoter were all favorable  predictors of longer survival in the reported case. Resection of at least one  easily accessible tumor lesion, followed by TMZ-based chemoradiation, with  continuous adjuvant TMZ in more than 6 standard courses, seems currently to  be the most beneficial therapeutic option for such cases.

vojnosanitetski pregled

Synchronous malignant multicentric cerebral glioma with atypical neuroradiological presentation and comparatively long survival: Case report and literature review