CASE REPORT Glioblastoma in multiple sclerosis: a case report Giovanni Frisullo Æ Agata Katia Patanella Æ Viviana Nociti Æ Alessandro Cianfoni Æ Raffaele Iorio Æ Assunta Bianco Æ Alessandro Marti Æ Pietro Attilio Tonali Æ Anna Paola Batocchi Received: 1 December 2008 / Accepted: 26 January 2009 / Published online: 13 February 2009 Ó Springer Science+Business Media, LLC. 2009 Abstract Cerebral tumor and multiple sclerosis (MS) relapses can show overlapping clinical and magnetic res- onance imaging features. In a previous study we observed in relapsing MS patients increased T-bet, pSTAT1, and pSTAT3 expressions in circulating mononuclear cells. During the data analysis we observed that T-bet, pSTAT1, and pSTAT3 expression was not increased in circulating mononuclear cells from a relapsing-remitting (RR)MS patient with recent onset of new neurological signs due to glioblastoma multiforme. In conclusion, our patient repre- sents an exemplary case which suggests that T-bet, pSTAT1, and pSTAT3 expression in peripheral blood mononuclear cells (PBMCs) might be useful to differenti- ate MS relapses from other noninflammatory diseases. Keywords Glioblastoma multiforme Á Multiple sclerosis Á Transcription factors Á Differential diagnosis Introduction The concurrence of multiple sclerosis (MS) and glioma is uncommon. Fewer than 40 cases of glioma associated with MS have been reported [1–4], and most have developed in patients with long-standing MS as in the present case [1–4]. The appearance of new neurological symptoms and signs in a MS patient is usually attributed to a reactivation of the disease and neuroradiological studies are not always performed. When done, in some cases atypical imaging features such as solitary large lesions with size [ 2 cm, mass effect, oedema, and/or ring enhancement [5] may render the formulation of a correct diagnosis difficult. Large tumefactive lesions have been frequently described and largely characterized in MS patients and they seem to be a part of the heterogeneous clinical and radiological spectrum of MS [5]. They are, sometimes, hardly distin- guishable from a tumoral lesion and histological confirmation is often required. In this case we describe how specific immunological markers, such as transcription factors, may be useful to discriminate new neurological symptoms as signs of MS or of cerebral cancer. In a pre- vious study we observed a strong upregulation of specific transcription factor of Th1 (pSTAT1 and T-bet) and Th17 (pSTAT3) immune response in circulating CD4 ? , CD8 ? T-cells, and monocytes from relapsing-remitting (RR)MS patients in relapse as compared with patients in remission and controls [6]. During the data analysis we observed atypical transcription factor expression in circulating mononuclear cells from a RRMS patient with recent onset of new neurological signs and symptoms. Report of a case A 45-year-old man, with clinically definite RRMS since 1986, was admitted to our neurological unit in 1996 with a score of 3 on the Expanded Disability Status Scale (EDSS). He started therapy with i.m. interferon beta (IFNb)-1a in G. Frisullo Á A. K. Patanella Á V. Nociti Á R. Iorio Á A. Bianco Á A. Marti Á P. A. Tonali Á A. P. Batocchi (&) Department of Neuroscience, Institute of Neurology, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy e-mail: annapaola.batocchi@rm.unicatt.it A. K. Patanella Á V. Nociti Á P. A. Tonali Fondazione Don Gnocchi, Rome, Italy A. Cianfoni Department of Radiology, Neuroradiology Section, MUSC – Medical University of South Carolina, Charleston, SC, USA 123 J Neurooncol (2009) 94:141–144 DOI 10.1007/s11060-009-9804-9