Clinical Neurology and Neurosurgery 115 (2013) 490–494 Contents lists available at SciVerse ScienceDirect Clinical Neurology and Neurosurgery j o ur nal homep age: www.elsevier.com/locate/clineuro Case Report Vanishing glioblastoma after corticosteroid therapy: Does this occurrence modify our surgical strategy? Alessandro D’Elia a,* , Vincenza Maiola a , Biagia La Pira a , Elena Arcovio a , Christian Brogna a , Alessandro Frati c , Francesca Santoro b , Antonio Santoro a , Maurizio Salvati a a Department of Neurological Sciences – Neurosurgery, University of Rome “Sapienza”,Italy b Neurosurgery, INM-Neuromed, Pozzilli (IS), Italy c Department of Neurological Sciences – Neuroradiology, University of Rome “Sapienza”,Italy a r t i c l e i n f o Article history: Received 14 January 2012 Received in revised form 31 May 2012 Accepted 10 June 2012 Available online 20 July 2012 Keywords: Glioblastoma Corticosterioid therapy Cerebral lymphoma Surgery 1. Introduction Glioblastoma multiforme is a malignant adult intracranial tumor; it accounts for 10–15% of all intracranial tumors, with a reported male preponderance of 6:4 [1]. The location of glioblas- toma in the brain is principally supratentorial [1]. Brain metastases, abscesses, primary central nervous system lymphoma (PCNSL) and primary CNS lymphomas should be considered in the differential diagnosis of this lesion [1]. Glioblastomas are not known to change their radiological appearance and contrast enhancement pattern under steroid therapy. On the contrary, PCNSL typically exhibits this behavior [1,2]. MRI is the most sensitive radiological procedure for detecting brain lymphoma, but its features are often not diag- nostic, rendering stereotactic biopsy necessary for deciding final surgical strategy. Biopsy is more likely to yield diagnostic tissue if it is performed prior to the administration of corticosteroids, which by killing the malignant tumor cells, may obscure the diagnosis. Furthermore, the spectral patterns seen in PCNSL may be simi- lar to glioblastoma multiforme. Proton magnetic spectroscopy in PCNSL characteristically includes a loss of N-acetylaspartate (NAA), a decrease in creatine (Cr), and a dramatic increase in choline (Cho) and lactate (Lac). The most specific finding for PCNSL on * Corresponding author at: Piazza San Giovanni Bosco, 86, 00175 Rome, Italy. Tel.: +39 3288830330; fax: +39 06 49979111. E-mail addresses: deliaale@gmail.com, albinimar@gmail.com (A. D’Elia). MRS is an increase in lipid resonance [3]. The authors describe a case of a right periventricular glioblastoma multiforme in an adult patient, with partial involvement of the splenium of the corpus callosum, whose radiological appearance dramatically changed fol- lowing corticosteroid therapy. This occurrence led us to change our surgical planned strategy, causing a considerable delay in definitive tumor removal and administration of adjuvant therapy. The case is discussed in the light of the pertinent literature. 2. Case report A 66-year-old man presented with a history of confusion and disorientation, left upper limb weakness and left lateral homony- mous hemianopsia. A MRI scan with gadolinium contrast agent revealed atypical diffuse enhancement in the right parietal region, extending into the splenium of the corpus callosum (Fig. 1), T2 MRI scan showed perilesional edema surrounding the lesion from the posterior horn of the lateral ventricle to the calcarine fissure. A spectroscopy study was performed to investigate the nature of the lesion: results were suggestive for a high-grade glioma (Fig. 1). The patient began to assume dexamethasone 4 mg twice daily. One week later an MRI T1-Weighted scan with gadolinium, performed for neuronavigation purposes, demonstrated a drastic change in the radiological picture: a dramatic reduction of contrast enhancement was evident in the right parietal region (Fig. 2). There was very little edema surrounding the lesion, which was reduced to a small circular hyperintense signal on T2W images in the 0303-8467/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.clineuro.2012.06.010