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KMID : 0942820080070020161
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Journal of Korean Brain Tumor Society
2008 Volume.7 No. 2 p.161 ~ p.165
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Unusual Manifestations of Anaplastic Astrocytoma with Diffuse Leptomeningeal Seeding；A Report of two Cases Treated Using a Temozolomide-Based Multimodal Approach
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Choi Jung-Won
Kim In-Ah
Choi Ghee-Young
Kim Chae-Yong
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Abstract
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We describe two unusual cases of diffuse leptomeningeal seeding as the initial manifestation of a subtle brain mass lesion.
At first, they were misdiagnosed as tuberculous encephalitis because there was no obvious mass lesion in magnetic
resonance(MR) images of the brain and the cerebrospinal fluid profile was highly suggestive of an infective process. The
MR images showed only ill-defined lesions in the basal ganglia. Anaplastic astrocytomas were finally diagnosed following
stereotactic brain biopsies. Whole-spine MR images from these two patients revealed diffuse leptomeningeal enhancing
lesions that affected the whole spine. We planned aggressive multimodal treatment including concurrent chemoradiation
therapy using temozolomide. One patient died from disease progression eight months after the initial diagnosis. The second patient was treated more aggressively. She survived for more than thirteen months after diagnosis. Biopsy and aggressive treatment must be considered in cases of ill-defined lesions with clinical manifestation indicating unusual encephalitis.
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KEYWORD
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Anaplastic astrocytoma, Concurrent chemoradiation therapy, Leptomeningeal seeding, Temozolomide
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