Subtotal Resection of an Anaplastic Ganglioglioma in Pregnancy

Abstract

Background: Anaplastic ganglioglioma is a rare malignant brain tumor associated with high morbidity and mortality. The diagnosis of a central nervous system malignancy in the early 3rd trimester presents management challenges to both neurosurgeons and obstetricians.

Case: A 33-year-old woman, gravida 2 para 1, presented at 28 6/7 weeks with four months of worsening headaches, nausea, vomiting, and mental status changes due to a 7.5 cm anaplastic ganglioglioma. Maternal deterioration necessitated subtotal tumor debulking allowing prolongation of the gestation to 34 6/7 weeks. After delivery, the patient underwent further resection, followed by chemotherapy and radiation. Both mother and infant are well.

Discussion: This case underscores the importance of timely diagnostic imaging in pregnant women and demonstrates subtotal tumor debulking as a viable means of prolonging gestation.

Figure 1

Axial MRI shows a 7.5 cm heterogenous mass in the right frontal lobe with T1-weighted sequences showing patchy enhancement following contrast administration (a) and hyperintensity with surrounding vasogenic edema on T2-weighted fluid attenuated inversion recovery sequences (b).

Figure 2

H&E stain shows a biphasic neoplasm characterized by dysplastic ganglion cells, including binucleate forms ((a) 400x magnification), and a hypercellular malignant glial component with nuclear atypia and increased mitotic activity ((b) 200x magnification).