GBM

Case #353: MRI brain, 9/13/93 and HCT, 4/7/94: Left frontal Glioblastoma Multiforme.

Hx: This 25y/o RHF was diagnosed with Glioblastoma Mutiforme by brain biopsy on 9/17/93. She presented to her local physician one month prior to diagnosis with complaint of throbbing holocranial headaches with associated positive visual phenomena. The HAs occurred at any time and were unsuccessfully treated with Midrin, Dilantin, and Prednisone. She denied any other numbness, weakness, tingling, difficulty thinking or other symptomatology. General and Neurological examination were negative. A HCT ,in 9/12/93, revealed a left frontal lesion. MRI Brain 9/13/93 showed a large left frontal heterogenously enhancing mass with surrounding edema and central necrosis. The diagnosis was confirmed after resection on 9/17/93.

She then underwent 6020cGy radiation therapy, ending 11/24/93. She then received 3 cycles of BCNU chemotherapy from 12/6/93 to 4/20/93. Each cycle resulted in neutropenia and as a result her chemotherapy regimen was changed to CCNU/procarbazine/vincristine/neupogen. She received 3 cycles of this regimen from 7/11/94 to 8/24/94. This was complicated by neutropenia as well. Her chemotherapy was then changed to cis-retinoic acid/lovastatin and she underwent 2 cycles of this regimen from 8/29/94 to 10/20/94. MRI brain scan after her second course revealed infiltration of the tumor into the bilateral frontal regions. She was then scheduled to start 5FU/Carboplatin/alpha interferon/neupogen chemotherapy this admission.

At present she has no complaints of weakness, numbness, incoordination, difficulty thinking or remembering, HA, and she has had no seizures.

MEDS:Dilantin 200mg qd alternating with 300mg qd. Coumadin 5mg qd(to prevent infusaport clotting.

PMH: As above and including: 1)right subclavian thrombosis 5/10/94, after infusaport placement, 4/7/94. 2)IUD placement 12/16/94.

FHX:Father age 50 and mother age 48; both are healthy. There is a hisotyr of cancer in secondary relatives. One 1st cousin has testicular cancer.

SHX: She is a former bank worker, high school/college graduate. Married. One daughter age 2years.

EXAM: BP116/69 HR90 RR16 36.4C

MS: unremarkable.

CN: unremarkable. No papilledema.

Motor: unremarkable.

Sensory: unremarkable.

Coordination: unremarkable.

Station/Gait: unremarkable.

Reflexes: Upper extremities: 2+/2 proximally and distally. Lower extremities: 2+/2 proximally and distally. Plantar responses were extensor on the right and flexor on the left.

COURSE: The patient underwent 5FU/Carboplatin/alpha interferon/Neupogen chemotherapy and returned 1/95 for a second cycle. She required 2 units of packed RBCs during her second cycle of treatment due to chemotherapy related anemia. Her chemotherapy had to be discontinued. In 1/95 she developed urinary incontinence and by 2/15/95 she was unable to care for herself.