case_images: PMC11762706_01
case_images: Patient disease course timeline. RUE = right upper extremity; STR = subtotal resection; IND = investigational new drug; FLAIR = fluid attenuated inversion recovery.
case_images: biomedicines-13-00201-g001.jpg
case_images: PMC11762706_01_biomedicines-13-00201-g001.jpg
case_images: biomedicines-13-00201-f001
case_images: Twenty-five years prior to presentation, a 71-year-old ambidextrous male presented to an outside hospital with syncope (Figure 1).
case_images: Axial T2 (top panels) and FLAIR (bottom panels) brain MRIs demonstrating an interval increase in left parietal-temporal T2/FLAIR-hyperintensity from 2017 (A,B) to 2024 (C,D) with subsequent surgical debulking (residual tumor volume 45 cm3) (E,F) followed by 8 months of vorasidenib (residual tumor volume 40 cm3) (G,H).
case_images: biomedicines-13-00201-g002.jpg
case_images: PMC11762706_01_biomedicines-13-00201-g002.jpg
case_images: biomedicines-13-00201-f002
case_images: He was monitored for 11 years with no evidence of recurrence (Figure 2A,B), and surveillance was discontinued. Magnetic resonance imaging (MRI) of the brain showed an interval increase in T2/FLAIR hyperintensity surrounding the resection cavity with no correlative enhancement (Figure 2C-F). At 8-month follow-up, he remains clinically stable with radiographic findings of an 11% reduction in RTV to 40 cm3 (Figure 2G,H).
case_images: Functional MRI (fMRI) demonstrating areas of activation during lip movement (A), word production, and verb comprehension (B).
case_images: biomedicines-13-00201-g003.jpg
case_images: PMC11762706_01_biomedicines-13-00201-g003.jpg
case_images: biomedicines-13-00201-f003
case_images: A functional MRI showed left-sided language lateralization at Broca's area (Figure 3).
case_images: Classic oligodendroglial morphology, 200x (A). High-grade areas (B) showed brisk mitotic activity (circles) and hypercellularity, 400x.
case_images: biomedicines-13-00201-g004.jpg
case_images: PMC11762706_01_biomedicines-13-00201-g004.jpg
case_images: biomedicines-13-00201-f004
case_images: Pathology (reviewed independently by two board-certified, fellowship-trained neuropathologists) showed a widely infiltrative glioma with classic oligodendroglial morphology, including round to oval nuclei, perinuclear halos, and thin intervening capillaries (Figure 4A). High-grade features were also present (Figure 4B), characterized by markedly cellular areas with brisk mitotic activity (up to 10 mitoses in 10 high power fields).