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Diagnosis and treatment of early-stage glioblastoma

1 Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
2 Department of Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
3 Department of Neurosurgery, Juntendo University School of Medicine, Juntendo University, Tokyo, Japan

Correspondence Address:
Makoto Hishii,
Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-Ku, Tokyo 177-8521
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_18_19

Early-stage glioblastoma has few identifiable findings; clinical significance of its early diagnosis and treatment remains unclear as no report has described treatment and long-term follow-up for early-stage glioblastoma. Here, we report a case of a 69-year-old woman with early-stage glioblastoma treated by microsurgical resection and chemoradiotherapy. Magnetic resonance imaging (MRI) revealed a small high-intensity lesion in the right temporal lobe on T2-weighted imaging. Contrast-enhanced T1-weighted MRI revealed ring enhancement. On magnetic resonance spectroscopy, the lesion demonstrated increased choline and reduced N-acetyl-aspartate levels compared with the normal brain. Positron emission tomography with 11C-methionine (MET) revealed 11C-methionine uptake in the lesion. Microsurgical resection was performed, and glioblastoma was pathologically diagnosed. The patient was treated with local radiotherapy and temozolomide chemotherapy postoperatively. Eight years postoperatively, the patient is surviving without tumor recurrence, but progressive cognitive impairment developed 6 years' postoperatively. Aggressive treatment of early-stage glioblastoma may improve its extremely poor prognosis. Conversely, cognitive impairment may become a significant medical and social problem when effective therapies for glioblastoma are developed.

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