Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Case report

Anaplastic astrocytoma mimicking progressive multifocal leucoencephalopathy: a case report and review of the overlapping syndromes

Authors: Ema Kantorová, Michal Bittšanský, Štefan Sivák, Eva Baranovičová, Petra Hnilicová, Vladimír Nosáľ, Daniel Čierny, Kamil Zeleňák, Wolfgang Brück, Egon Kurča

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

Co-occurrence of multiple sclerosis (MS) and glial tumours (GT) is uncommon although occasionally reported in medical literature. Interpreting the overlapping radiologic and clinical characteristics of glial tumours, MS lesions, and progressive multifocal leukoencephalopathy (PML) can be a significant diagnostic challenge.

Case presentation

We report a case of anaplastic astrocytoma mimicking PML in a 27-year-old patient with a 15-year history of MS. She was treated with interferon, natalizumab and finally fingolimod due to active MS. Follow-up MRI, blood and cerebrospinal fluid examinations, and biopsy were conducted, but only the latter was able to reveal the cause of progressive worsening of patient’s disease.

Conclusions

Anaplastic astrocytoma misdiagnosed as PML has not yet been described. We suppose that the astrocytoma could have evolved from a low grade glioma to anaplastic astrocytoma over time, as the tumour developed adjacent to typical MS plaques. The role of the immunomodulatory treatment as well as other immunological factors in the malignant transformation can only be hypothesised. We discuss clinical, laboratory and diagnostic aspects of a malignant GT, MS lesions and PML. The diagnosis of malignant GT must be kept in mind when an atypical lesion develops in a patient with MS.
Literature
1.
Wiendl H, Toyka KV, Rieckmann P, Gold R, Hartung HP, Hohlfeld R. Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol. 2008;255:1449–63.CrossRefPubMed
2.
3.
Kalimo H, Frey H, Raine CS, Törmä T, Röyttä M. Late-onset malignant astrocytoma in a case of multiple sclerosis. Clinical, neuropathological, virological, and tissue culture studies. Acta Neuropathol. 1979;46:231–4.CrossRefPubMed
4.
Hofer S, Linnebank M, Weller M, et al. Cancer risk among patients with multiple sclerosis and their parents. Neurology. 2010;74:614–5.CrossRefPubMed
5.
Werneck LC, Scola RH, Arruda WO, Torres LF. Glioma and multiple sclerosis: case report. Arq Neuropsiquiatr. 2002 Jun;60:469–74.CrossRefPubMed
6.
7.
Hutchinson M. Safety first, efficacy second in disease modifying therapies. Mult Scler. 2011;17:380–1.CrossRefPubMed
8.
Sørensen PS, Bertolotto A, Edan G, et al. Risk stratification for progressive multifocal leukoencephalopathy in patients treated with natalizumab. Mult Scler. 2012;18:143–52.CrossRefPubMed
9.
Bloomgren G, Richman S, Hotermans C, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366:1870–80.CrossRefPubMed
10.
Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol. 2010;9:425–37.CrossRefPubMedPubMedCentral
11.
Berger JR, Aksamit AJ, Clifford DB, et al. PML diagnostic criteria: consensus statement from the AAN Neuroinfectious disease section. Neurology. 2013;80:1430–8.CrossRefPubMedPubMedCentral
12.
Wattjes MP, Richert ND, Killestein J, et al. The chameleon of neuroinflammation: magnetic resonance imaging characteristics of natalizumab-associated progressive multifocal leukoencephalopathy. Mult Scler. 2013;19:1826–40.CrossRefPubMed
13.
Shah R, Bag AK, Chapman PR, Cure JK. Imaging manifestations of progressive multifocal leucoencephalopathy. Clin Radiol. 2010;65:431–9.CrossRefPubMed
14.
Yamashita S, Kimura E, Hirano T, Uchino M. Tumefactive multiple sclerosis. Inter Med. 2009;48:1113–4.CrossRef
15.
Lucchinetti CF, Gavrilova RH, Metz I, et al. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain. 2008;131:1759–75.CrossRefPubMedPubMedCentral
16.
Given CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol. 2004;182:195–9.CrossRefPubMed
17.
Cunliffe CH, Fischer I, Monoky D, et al. Intracranial lesions mimicking neoplasms. Arch Pathol Lab Med. 2009;133:101–23.PubMed
18.
19.
Lee M, Walsh K, Rey-Dios R, Anderson M. Progressive multifocal leukoencephalopathy mimicking high grade glioma in an immunocompetent patient: a case report. Neuro Oncology. 2014;16:v149–50.CrossRefPubMedCentral
20.
Burger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer. 1985;56(5):1106–11.CrossRefPubMed
21.
Kingwell E, Bajdik C, Phillips N, et al. Cancer risk in multiple sclerosis: findings from British Columbia. Canada Brain. 2012;135:2973–9.CrossRefPubMed
22.
Fois AF, Wotton CJ, Yeates D, et al. Cancer in patients with motor neuron disease, multiple sclerosis and Parkinson's disease: record linkage studies. J Neurol Neurosurg Psychiatry. 2010;81:215–21.CrossRefPubMed
23.
Handel AE, Ramagopalan SV. Multiple sclerosis and risk of cancer: a meta-analysis. J Neurol Neurosurg Psychiatry. 2010;81:1413–4.CrossRefPubMed
24.
Catala-Lopez F, Suarez-Pinilla M, Suarez-Pinilla P, et al. Inverse and direct cancer comorbidity in people with central nervous system disorders: a meta-analysis of cancer incidence in 577,013 participants of 50 observational studies. Psychother Psychosom. 2014;83:89–105.CrossRefPubMed
25.
Hemminki K, Liu X, Försti A, Ji J, Sundquist J, Sundquist K. Subsequent brain tumors in patients with autoimmune disease. Neuro-Oncology. 2013;15:1142–50.CrossRefPubMedPubMedCentral
26.
Kim DS, Na DG, Kim KH, Kim J, Kim E, Yun BL, et al. Distinguishing tumefactive demyelinating lesions from glioma or central nervous system lymphoma: added value of unenhanced CT compared with conventional contrast-enhanced MR inaging. Radiology. 2009;251:467–75.CrossRefPubMed
27.
Kuhle J, Gosert R, Bühler R, et al. Management and outcome of CSF-JC virus PCR-negative PML in a natalizumab-treated patient with MS. Neurology. 2011;77:2010–6.CrossRefPubMedPubMedCentral
28.
Cuvinciuc V, Martin-Blondel G, Marchou B. Bonneville F proton MR spectroscopy of progressive multifocal leukoencephalopathy–immune reconstitution inflammatory syndrome. Am J Neuroradiol. 2010;31:E69–70.CrossRefPubMed
29.
Cianfoni AS, Niku SG. Imbesi SG. Metabolite findings in tumefactive demyelinating lesions utilizing short echo time proton magnetic resonance spectroscopy. Am J Neuroradiol 2007; 28:272–277.
30.
31.
De Stefano N, Caramanos Z, Preul MC, Francis G, Antel JP, Arnold DL. In vivo differentiation of astrocytic brain tumors and isolated demyelinating lesions of the type seen in multiple sclerosis using 1H magnetic resonance spectroscopic imaging. Ann Neurol. 1998;44:273–8.CrossRefPubMed
32.
Chung J-K, Kim Y, Kim S, et al. Usefulness of 11C-methionine PET in the evaluation of brain lesions that are hypo or isometabolic on 18F-FDG PET. Eur J Nucl Med Mol Imagine. 2002;29:176–82.CrossRef
33.
Horakova D, Kalincik T. Blahova-Dusankova et al. Clinical correlates of grey matter pathology in multiple sclerosis BMC Neurology. 2012;12:10.PubMed
34.
Weiner HL. The challenge of multiple sclerosis: how do we cure a chronic heterogeneous disease? Ann Neurol. 2009;65:239–48.CrossRefPubMed
35.
Kmiecik J, Zimmer J. Chekenya M. Natural killer cells in intracranial neoplasms: presence and therapeutic efficacy against brain tumours J Neuro-Oncol. 2013;116:1–9.
36.
37.
Kmiecik J, Poli A, Brons NH, Waha A, Eide GE, Enger PØ, et al. Elevated CD3+ and CD8+ tumor-infiltrating immune cells correlate with prolonged survival in glioblastoma patients despite integrated immunosuppressive mechanisms in the tumor microenvironment and at the systemic level. J Neuroimmun. 2013;264:71–83.CrossRef
38.
Perrin G, Schnuriger V, Quiquerez AL, Saas P, Pannetier C, de Tribolet N, et al. Astrocytoma infiltrating lymphocytes include major T cell clonal expansions confined to the CD8 subset. Int Immunol. 1999;11:1337–50.CrossRefPubMed
39.
Elliott LH, Brooks WH, Roszman TL. Cytokinetic basis for the impaired activation of lymphocytes from patients with primary intracranial tumors. J Immunol. 1984;132:1208–15.PubMed
40.
Fontana A, Hengartner H, de Tribolet N, Weber E. Glioblastoma cells release interleukin 1 and factors inhibiting interleukin 2-mediated effects. J Immunol. 1984;132:1837–44.PubMed
41.
Wei J, Barr J, Kong LY, Wang Y, Wu A, Sharma AK, et al. Glioblastoma cancer-initiating cells inhibit T-cell proliferation and effector responses by the signal transducers and activators of transcription 3 pathway. Mol Cancer Ther. 2010;9:67–78.CrossRefPubMedPubMedCentral
42.
Soda Y, Marumoto T, Friedmann-Morvinski D, Soda M, Liu F, Michiue H, et al. Transdifferentiation of glioblastoma cells into vascular endothelial cells. Proc Natl Acad Sci U S A. 2011;15(108):4274–80.CrossRef
43.
Jain RK, di Tomaso E, Duda DG, et al. Angiogenesis in brain tumours. Nat Rev Neurosci. 2007;8:610–22.CrossRefPubMed
44.
Jin H, Aiyer A, Su J, Borgstrom P, Stupack D, Friedlander M, et al. A homing mechanism for bone marrow–derived progenitor cell recruitment to the neovasculature. J Clin Invest. 2006;116:652–62.
45.
Satelli A, Li S. Vimentin as a potential molecular target in cancer therapy or Vimentin, an overview and its potential as a molecular target for cancer therapy. Cell Mol Life Sci. 2011;68:3033–46.CrossRefPubMedPubMedCentral
46.
Ligon KL, Alberta JA, Kho AT, Weiss J, Kwaan MR, Nutt CL, et al. The oligodendroglial lineage marker OLIG2 is universally expressed in diffuse gliomas. J Neuropathol Exp Neurol. 2004;63:499–509.CrossRefPubMed
47.
Schwab EM. Functions of Nogo proteins and their receptors in the nervous system. Nat Rev Neurosci. 2010;11:799–811.CrossRefPubMed
48.
Fisher BJ, Naumova E, Leighton CC, Naumov GN, Kerklviet N, Fortin D, et al. Ki-67: a prognostic factor for low-grade glioma? Int J Radiat Oncol Biol Phys. 2002;52:996–1001.CrossRefPubMed
49.
Khalil A, Serracino H, Damek DM, Ney D, Lillehei KO, Kleinschmidt-DeMasters BK. Genetic characterization of gliomas arising in patients with multiple sclerosis. J Neuro-Oncol. 2012;109:261–72.CrossRef
50.
Rudick RA, Stuart WH, Calabresi PA, et al. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med. 2006;354:911–23.CrossRefPubMed
51.
Butzkueven H, Kappos L, Pellegrini F, Trojano M, Wiendl H, Patel RN, et al. Belachew S; TYSABRI observational program (TOP) investigators. Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results. J Neurol Neurosurg Psychiatry. 2014;85:1190–7.CrossRefPubMedPubMedCentral
52.
International Multiple Sclerosis Genetics Consortium., Hafler DA, Compston A, Sawcer S, Lander ES, Daly MJ, De Jager PL, de Bakker PI, Gabriel SB, Mirel DB, Ivinson AJ, Pericak-Vance MA, Gregory SG, Rioux JD, McCauley JL, Haines JL, Barcellos LF, Cree B, Oksenberg JR, Hauser SL. Risk alleles for multiple sclerosis identified by a genomewide study. N Engl J Med. 2007 Aug 30;357:851–62.
53.
Machulla HK, Steinborn F, Schaaf A, Heidecke V, Rainov NG. Brain glioma and human leukocyte antigens (HLA)-is there an association? J Neuro-Oncol. 2001;52:253–61.CrossRef
54.
Frisullo G, Patanella AK, Nociti V, Cianfoni A, Iorio R, Bianco A, et al. Glioblastoma in multiple sclerosis: a case report. J Neuro-Oncol. 2009;94:141–4.CrossRef
55.
Metz I, Radue E-W, Oterino A, et al. Pathology of immune reconstitution inflammatory syndrome in multiple sclerosis with natalizumab-associated progressive multifocal leukoencephalopathy. Acta Neuropathol. 2012;123:235–45.CrossRefPubMed
56.
Lebrun C, Vermersch P, Brassat D, et al. Cancer and multiple sclerosis in the era of disease-modifying treatments. J Neurol. 2011;258:1304–11.CrossRefPubMed
Metadata
Title
Anaplastic astrocytoma mimicking progressive multifocal leucoencephalopathy: a case report and review of the overlapping syndromes
Authors
Ema Kantorová
Michal Bittšanský
Štefan Sivák
Eva Baranovičová
Petra Hnilicová
Vladimír Nosáľ
Daniel Čierny
Kamil Zeleňák
Wolfgang Brück
Egon Kurča
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3415-1

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Debate

Does anthracycline-based chemotherapy in pregnant women with cancer offer safe cardiac and neurodevelopmental outcomes for the developing fetus?

Research article

The E2F4 prognostic signature predicts pathological response to neoadjuvant chemotherapy in breast cancer patients

Research article

Papillary thyroid microcarcinoma: the significance of high risk features

Research article

Early life socioeconomic environment and mammographic breast density

Research article

18F- FDG PET/CT helps differentiate autoimmune pancreatitis from pancreatic cancer

Research article

Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits