Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2017; 5(6): 247-253
Published online Jun 16, 2017. doi: 10.12998/wjcc.v5.i6.247
Immunophenotypic signature of primary glioblastoma multiforme: A case of extended progression free survival
Puneet Gandhi, Richa Khare, Nitin Garg, Sandeep Sorte
Puneet Gandhi, Richa Khare, Department of Research, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India
Nitin Garg, Sandeep Sorte, Department of Neurosurgery, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India
Nitin Garg, Bansal Hospital, Bhopal 462016, India
Author contributions: Gandhi P designed the report; Khare R performed the experimental parameters, Garg N and Sorte S pooled and analyzed clinical data; Gandhi P and Khare R performed 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 IEC approved project IEC/21/Res/11.
Informed consent statement: Written informed consent as per institutional ethics committee (IEC/21/Res/11) was obtained from the subject prior to study inclusion.
Conflict-of-interest statement: The authors 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: January 29, 2017
Peer-review started: February 12, 2017
First decision: March 8, 2017
Revised: March 23, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: June 16, 2017
Processing time: 136 Days and 6.3 Hours
Abstract

Glioblastoma-multiforme (GBM), the most aggressive glial tumor, has a worldwide age-adjusted incidence ranging from 0.59-3.69/100000 persons. Despite current multimodal-treatment approach, median-survival time and progression-free survival (PFS) remains short. Glioblastomas display a variety of molecular alterations, which necessitates determining which of these have a prognostic significance. This is a case of a 45-year-old patient who presented with progressive slurring of speech and features of raised intracranial pressure. Computed tomography (CT) scan revealed a large heterogeneously enhancing lesion in the left front-temporal-perisylvian region with solid, cystic areas, suggestive of malignant glioma. Partial tumor-excision was followed by concurrent chemo-radiotherapy. Histopathologically, the tumor was astrocytoma grade-IV. Patient had an extended PFS of 12 mo, with an overall survival of 26 mo. Primary-GBM was confirmed using molecular markers and the immunophenotypic signature was defined by evaluating systemic expression of human telomerase reverse transcriptase, interleukin-6, neutrophil-lymphocyte ratio, tissue inhibitor of metalloproteinases-1, human chitinase-3-like-protein-1 (YKL-40) and high mobility group-A1. Current findings suggest that this signature can identify worst outcomes, independent of clinical criteria.

Keywords: Glioblastoma multiforme; Immunophenotypic signature; Progression free survival; Molecular markers; Human telomerase reverse transcriptase; Interleukin-6; Tissue inhibitor of metalloproteinases-1; YKL-40; High mobility group-A1

Core tip: Delineating the immunophenotypic signature for glioblastoma with reference to disease progression is of clinical importance. This case report presents for the first time a panel of 6 systemic molecular markers in circulation namely; human telomerase reverse transcriptase, interleukin-6, neutrophil-lymphocyte ratio, tissue inhibitor of metalloproteinases-1, human chitinase-3-like-protein-1 and high mobility group-A1 representing the mechanistic of inflammation, proliferation and invasion of the tumor. Their expression is suggested to be linked to progression-free survival in glioblastoma-multiforme.