Access to Isocitrate dehydrogenase (IDH) mutation characterization and prognostication in a Kenyan hospital – A first case

Abstract

Abstract Introduction The 2016 WHO classification of tumors of the central nervous system added molecular characterization to enhance diagnosis and prognostication of Gliomas which had previously been based on histopathological patterns under light microscopy and H/E staining. To the best of our knowledge this is the first case of a glioma to access Isocitrate dehydrogenase (IDH) mutation characterisation and prognostication in a Kenyan hospital. This case report illustrates the institutional and individual patient challenges to accessing essential neurosurgical care, and the opportunity provided by an integrated approach to diagnosis. The cased also long period of time between diagnosis and consenting for surgery provided a fortuitous opportunity to describe the natural history of this gliomas. Case Report Presenting complaints: MKM a 40-yr. old male on long-term follow-up for a temporal lobe cystic space occupying lesion presented with uncontrolled seizures despite adequate dosing with anticonvulsants, headaches and progressive behavioral disinhibition. There was a 7-year history of headaches and convulsions initially relieved by over-the counter analgesics and anticonvulsants. Imaging at 2 years into his illness demonstrated a cystic mass in the temporal region at which point he repeatedly refused surgical removal of the lesion. MKM was followed up in a neurosurgical service at the Kenyatta National Referral Hospital. Serial imaging demonstrated an initial regression of the tumor in the first year and then slow growth thereafter.\xa0The persistence of seizure and progressive failure to achieve control and an increase in behavioral disinhibition convinced MKM and immediate family on need for surgery. Pre-op clinical findings- MKM only had mild memory impairment with inability to remember a series of objects 5 minutes after they had been memorised. He had no cranial nerve palsies, motor system weakness or sensory deficits. Treatment- A Transylvian temporal Lobectomy. Histologic diagnosis- Anaplastic astrocytoma grade III, IDH mutant with ATRX loss. He was referred to oncologist for further treatment. Discussion This case highlights the different investments needed by developing country health systems to enable timely management of neurosurgical conditions such as gliomas. The case contributes knowledge on natural history of a temporal glioma in an African patient.