Low grade glioma

Case contribution: Dr Radhiana Hassan


  • A 53 years old man, with underlying nasoparyhngeal carcinoma diagnosed and completed chemotherapy and radiotherapy 7 years ago.
  • HPE shows moderately differentiated keratinizing squamous cell carcinoma (WHO type 1).
  • He recently presented with headache, vomiting, fever, and altered mental status (E4V4M5). He started to have fitting episodes since last year.
  • Patient currently complains of frequent seizures, but symptoms controlled after the increment dosage of anti-epileptic (on T. Keppra 1.5g BD and C. Phenytoin 300mg ON)

MRI findings:

  • There is an area with abnormal signal intensity at left fronto-temporal lobe
  • It has well-defined margin and hyperintense on T2/FLAIR sequence
  • It is hypointense on T1-weighted image with no enhancement post gadolinium
  • No significant mass effect. No midline shift.
  • No blooming artefact or restricted diffusion
  • Reversel of Cho-NAA peak on MR spectroscopy
  • No lactate or lipid peak

Diagnosis: Low grade glioma (astrocytoma)-presumed diagnosis


  • The development of neoplasms subsequent to therapeutic cranial irradiation is a rare but serious and potentially fatal complication.
  • All tumours arose within the previous radiation fields and related to radiation dose received.
  • Thus, in nasopharyngeal carcinoma temporal lobe is theĀ  most likely site of tumour occurence.
  • The median latency period before the detection of the secondary tumour was 14.5 years (range: 6.5-24 years).
  • One study showed that meningiomas is the commonest type followed by sarcomas and malignant gliomas.
  • In this case there is no definite evidence that the glioma is secondary to previous irradiation as no detail information about previous radiotherapy is available
Author: radhianahassan