Malignant transformation of a dysembryoplastic neuroepithelial tumor - Case report

A 29-year-old man presented in 1984 with a recent onset of partial seizures marked by speech arrest. Electroencephalography identified a left frontote mporal dysrhythmia. Computerized tomography (CT) scanning revealed a superf icial hypodense nonenhancing lesion in the midleft frontal convexity, with some remodeling of the overlying skull. The patient was transferred to the London Health Sciences Centre for subtotal resection of what was diagnosed as a "fibrillary astrocytoma (microcystic)." He received no chemotherapy or radiation therapy and remained well fur 11 years. The patient presented again in late 1995 with progressive seizure activity. Both CT and magnetic resonance imaging demonstrated a recurrent enhancing partly cystic lesion. A Grade IV astrocytoma was resected, and within the m alignant tumor was a superficial area reminiscent of a dysembryoplastic neu roepithelial tumor (DNT). Data on the lesion that had been resected in 1984 were reviewed, and in retrospect the lesion was identified as a DNT of the complex form. It was bordered by cortical dysplasia and contained glial no dules, in addition to the specific glioneuronal element. The glial nodules were significant for moderate pleomorphism and rare mitotic figures. The Ki 67 labeling index averaged 0.3% in the glial nodules and up to 4% focally. Cells were rarely Ki67 positive within the glioneuronal component. This cas e is the first documented example of malignant transformation of a DNT. It serves as a warning of the potential for malignant transformation in this e ntity, which has been traditionally accepted as benign. This warning may be especially warranted when confronted with complex forms of DNT. The comple teness of resection in the benign state is of paramount importance.