5-Aminolevulinic acid a biomarker for worse prognosis in IDH-wildtype brain tumors? Evolution of a Fluorescence-Positive Diffuse Astrocytoma: Case Report

Abstract

Introduction: In 2017, the U.S Food and Drug Administration (FDA) approved 5-Aminolevulinic Acid (5-ALA) as an intraoperative optical imaging agent in patients with suspected high-grade gliomas (HGGs). However, the application of 5-ALA for low-grade gliomas is still less accepted. Case Report: A 74-year-old male patient was diagnosed with a right parietal lesion suggestive of a low-grade brain tumor in a surgical resection using 5-ALA, which led to the detection of tiny fluorescence spots during the surgery. The frozen section was consistent with Diffuse astrocytoma, IDH-wildtype (WHO grade II). The patient's postoperative MRI showed complete resection. Eight months after surgery, he began experiencing symptoms again and was admitted with a brain MRI finding consistent with recurrent infiltrating astrocytomas. This required reoperation of the brain tumor resection with 5-ALA. Unlike the first surgery, they observed a high fluorescence intensity; the pathological finding was Glioblastoma, IDH-wildtype (WHO Grade IV). Post-surgical brain MRI showed total resection of the tumor. The patient was discharged four weeks after surgery and continued with specialized clinical follow-up. Conclusion: The use of 5-ALA increasingly approaching its use as a prognostic tool for aggressive clinical behavior. This case report expand knowledge for potentially using to prognosticate IDH-wildtype II tumors.