Annali italiani di chirurgia · 2026
Unveiling Systemic Barriers to High-Grade Glioma Management in Non-Tertiary Centers: A Case Report and Analysis of Resource-Limited Care Challenges.
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Alqahtani Saad Misfer
Аннотация
AIM: High-grade gliomas (HGGs) are among the most aggressive brain tumors, including gliosarcoma. This report aims to present a case of gliosarcoma managed in a general non-tertiary hospital and to highlight the systemic barriers that delayed diagnosis and treatment.
CASE PRESENTATION: A 53-year-old female was diagnosed with two intra-axial brain lesions and was managed in a general non-tertiary hospital. One lesion was excised and identified as gliosarcoma. Pathological analysis concluded that the excised lesion was World Health Organization (WHO) grade 4 gliosarcoma, isocitrate dehydrogenase (IDH)-wild type, with glial and spindle sarcomatous components, P53 mutation, C228T (c.-124C>T) variant of the telomerase reverse transcriptase (TERT) promoter, and hypermethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter status. The final diagnosis was concluded as gliosarcoma, WHO grade 4, IDH-wild type.
RESULTS: Despite the detailed histopathological and molecular findings, there were delays in radiological imaging, surgical treatment, and possible adjuvant therapy because of several systemic barriers, including initial family opposition and resource-limited conditions. The case also shows the challenges of managing high-grade gliomas in non-tertiary settings and the impact of delayed referral and treatment.
CONCLUSIONS: This report highlights the limitations of care in resource-limited settings and the need for stronger referral systems and better access to timely imaging, surgery, and adjuvant treatment to improve outcomes for patients with HGGs. It also suggests that future WHO guidelines for central nervous system tumors may consider adding diagnostic and prognostic parameters relevant to resource-limited settings, rather than relying only on histological entities or using the term "Not Otherwise Specified" when molecular classification is not achievable.
CASE PRESENTATION: A 53-year-old female was diagnosed with two intra-axial brain lesions and was managed in a general non-tertiary hospital. One lesion was excised and identified as gliosarcoma. Pathological analysis concluded that the excised lesion was World Health Organization (WHO) grade 4 gliosarcoma, isocitrate dehydrogenase (IDH)-wild type, with glial and spindle sarcomatous components, P53 mutation, C228T (c.-124C>T) variant of the telomerase reverse transcriptase (TERT) promoter, and hypermethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter status. The final diagnosis was concluded as gliosarcoma, WHO grade 4, IDH-wild type.
RESULTS: Despite the detailed histopathological and molecular findings, there were delays in radiological imaging, surgical treatment, and possible adjuvant therapy because of several systemic barriers, including initial family opposition and resource-limited conditions. The case also shows the challenges of managing high-grade gliomas in non-tertiary settings and the impact of delayed referral and treatment.
CONCLUSIONS: This report highlights the limitations of care in resource-limited settings and the need for stronger referral systems and better access to timely imaging, surgery, and adjuvant treatment to improve outcomes for patients with HGGs. It also suggests that future WHO guidelines for central nervous system tumors may consider adding diagnostic and prognostic parameters relevant to resource-limited settings, rather than relying only on histological entities or using the term "Not Otherwise Specified" when molecular classification is not achievable.