Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clinical Cases. Sep 16, 2016; 4(9): 296-301
Published online Sep 16, 2016. doi: 10.12998/wjcc.v4.i9.296
Unique case of oligoastrocytoma with recurrence and grade progression: Exhibiting differential expression of high mobility group-A1 and human telomerase reverse transcriptase
Puneet Gandhi, Richa Khare, Kavita Niraj, Nitin Garg, Sandeep K Sorte, Hanni Gulwani
Puneet Gandhi, Richa Khare, Kavita Niraj, Department of Research, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India
Nitin Garg, Sandeep K Sorte, Department of Neurosurgery, Bhopal Memorial Hospital and Research Centre and Bansal Hospital, Bhopal 462038, India
Hanni Gulwani, Department of Pathology, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India
Author contributions: Gandhi P and Niraj K designed the report; Khare R performed the IF-IHC; Khare R, Garg N and Sorte SK collected and analyzed clinical data; Gulwani H analyzed conventional pathological parameters; Gandhi P, Khare R and Niraj K performed immune-marker analysis, statistics and wrote the manuscript.
Supported by M.P. Biotech Council, M.P. for financial assistance; and BMHRC for infrastructural facilities, No. 249.
Institutional review board statement: The present case report is a part of project IEC/21/Res/11, which was reviewed and approved by BMHRC institutional review board.
Informed consent statement: Written informed consent as per institutional ethics committee (IEC/21/Res/11) was obtained from the legal authorised representative prior to study inclusion.
Conflict-of-interest statement: All authors state that they have no financial or any other conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Puneet Gandhi, Professor, Head, Department of Research, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Bhopal 462038, India. puneetgandhi67@yahoo.com
Telephone: +91-755-2742152
Received: April 26, 2016
Peer-review started: April 28, 2016
First decision: May 17, 2016
Revised: May 29, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: September 16, 2016
Processing time: 133 Days and 21.7 Hours
Abstract

Mixed gliomas, primarily oligoastrocytomas, account for about 5%-10% of all gliomas. Distinguishing oligoastrocytoma based on histological features alone has limitations in predicting the exact biological behavior, necessitating ancillary markers for greater specificity. In this case report, human telomerase reverse transcriptase (hTERT) and high mobility group-A1 (HMGA1); markers of proliferation and stemness, have been quantitatively analyzed in formalin-fixed paraffin-embedded tissue samples of a 34 years old patient with oligoastrocytoma. Customized florescence-based immunohistochemistry protocol with enhanced sensitivity and specificity is used in the study. The patient presented with a history of generalized seizures and his magnetic resonance imaging scans revealed infiltrative ill-defined mass lesion with calcified foci within the left frontal white matter, suggestive of glioma. He was surgically treated at our center for four consecutive clinical events. Histopathologically, the tumor was identified as oligoastrocytoma-grade II followed by two recurrence events and final progression to grade III. Overall survival of the patient without adjuvant therapy was more than 9 years. Glial fibrillary acidic protein, p53, Ki-67, nuclear atypia index, pre-operative neutrophil-lymphocyte ratio, are the other parameters assessed. Findings suggest that hTERT and HMGA1 are linked to tumor recurrence and progression. Established markers can assist in defining precise histopathological grade in conjuction with conventional markers in clinical setup.

Keywords: Human telomerase reverse transcriptase; High mobility group-A1; Oligoastrocytoma; Recurrence; Tumor grade

Core tip: The clinical relevance of defining precise histological grade II and III in glioma subtypes is crucial for intervention. This case report presents two new prospective markers high mobility group-A1 and human telomerase reverse transcriptase which can be used to assess stemness and proliferation, with greater sensitivity and specificity, through fluorescence based immunohistochemistry; and demarcate malignancy grade in oligoastrocytoma.