Glioma-IDH1 Mutant

Case contributed by Dr Dalia Ibrahim

Presentation

The patient had a history of lymphoma. Now presented with headache and right-sided weakness, suspected CNS lymphomatous infiltration.

Patient Data

Age: 55 years.
Gender: Male
MRI

Left fronto-parieto-temporal large irregular and infiltrative space-occupying lesion is eliciting low T1 and high signal on T2 and FLAIR. No diffusion restriction. It shows small foci of blooming effect on SWI suggestive of small hemorrhagic foci. Small enhancing nodules within the lesion. The lesion infiltrates the body of the corpus callosum. It exerts a positive mass effect with compression of the left lateral ventricle.

MRS showed an elevated Choline peak and Cho/Cr ratio and reduced NAA peak.

Radiological findings are suggestive of high-grade glioma.

Biopsy revealed IDH-mutant astrocytoma.

Case Discussion

The patient had a history of systemic lymphoma hence when he started to develop neurological manifestations his clinician suspected CNS lymphomatous infiltration. However, radiological features of the lesion showing diffuse infiltrative pattern, lack of diffusion restriction, and tiny hemorrhagic and enhancing foci were suggestive of primary brain neoplasm (glioma), likely of high grade. MRS criteria were also helpful with elevated Choline peak with no significant elevation of the lipid/lactate peak. The biopsy results of only grade II tumor is likely under-grading due to sampling bias.

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