Clinical case recurrence of anaplastic astroblastoma in an adolescent
Abstract: We report the case of a female patient with a rare astroblastoma initially diagnosed in adolescence, who experienced histologically confirmed anaplastic recurrence several years later and a suspected second recurrence thereafter. This case illustrates the complex diagnostic, surgical, and therapeutic strategies required in long-term follow-up of astroblastoma, highlighting challenges in seizure control and neuropathic sequelae.
Patient Information:
Sex: Female
Current Age: Early 20s
Age at First Diagnosis: 12 years
Hospital: Tertiary academic center
Medical History:
No drug allergies
Normal psychomotor development
Vaccination schedule completed
No relevant family or systemic diseases
Initial generalized seizure episode in early adolescence
Clinical Course:
First Diagnosis:
Imaging identified a cystic lesion in the right frontoparietal region.
EEG confirmed epileptogenic activity in the same location.
Surgical resection was performed.
Histopathology: Astroblastoma (low proliferative index, no WHO grading available).
Postoperative seizure control achieved; antiepileptic therapy was eventually discontinued.
First Recurrence:
Several years after surgery, the patient developed new-onset partial seizures and sensory symptoms in the left upper limb.
MRI demonstrated a contrast-enhancing lesion at the previous surgical bed.
Re-resection was performed.
Histopathology confirmed anaplastic astroblastoma, with necrosis, mitotic activity, Ki-67 index 20%, IDH1 and BRAF wild-type, and p53 positive.
Second Recurrence (Suspected):
A new contrast-enhancing lesion with elevated rCBV was identified on MRI during routine follow-up.
The patient reported worsening focal seizures and neuropathic pain in the left limbs.
Anti-seizure treatment was escalated due to drug resistance and suboptimal response to previous regimens.
A third surgical resection was planned and performed.
Histopathological analysis is pending.
Genetic and Molecular Markers (from prior confirmed recurrence):
IDH1: Wild-type
ATRX: Expression retained
BRAF: Wild-type
p53: Positive
Ki-67: 20%
Seizure Management:
Seizure Type: Focal motor and sensory, with occasional postictal paresis
Frequency: 3–4 episodes/month
Current Treatment:
Brivaracetam
Eslicarbazepine
Tapering gabapentin
Introduction of cenobamate following structured titration protocol
Past Medications: Levetiracetam, topiramate, pregabalin, lacosamide (discontinued due to side effects or inefficacy)
Pain and Neurological Status:
Persistent neuropathic pain and dysesthesias in the left hand and leg
Fatigue with impact on daily functioning
No significant motor deficits on examination
Radiological Findings:
Postoperative MRI showed encephalomalacia and gliosis in the right frontal lobe.
New focal contrast enhancement and elevated perfusion in the surgical bed suggested recurrence.
No mass effect or midline shift.
Posterior fossa and brainstem structures preserved.
Multidisciplinary Plan:
Await final histopathology from most recent surgery
If recurrence confirmed, proceed with adjuvant radiotherapy
Monitor neurological status, optimize seizure control, and manage pain
Maintain close imaging surveillance
Second opinion obtained from national reference center confirmed surgical and RT plan
Discussion: Astroblastoma is a rare tumor with unclear classification and behavior. Recurrences, including anaplastic transformation, are possible even years after initial resection. This case underscores the importance of long-term follow-up, individualized management of seizures and pain, and coordination among neurosurgery, neuro-oncology, and neurology teams.
Conclusion: This case highlights the complexity of recurrent anaplastic astroblastoma in a young patient. The combination of advanced imaging, reintervention, evolving pharmacological strategies, and neuro-palliative care exemplifies a personalized approach to a rare and unpredictable neoplasm.
Key Points:
Astroblastomas may recur or transform after long latency
Histological progression can occur with molecularly negative markers
Refractory epilepsy and pain remain central to long-term management
Multidisciplinary and individualized care is critical