Fast Evolving Glioblastoma in a Pregnant Woman: Diagnostic and Therapeutic Challenges

Gliomas diagnosed during pregnancy are rare and there are no established guidelines for their management. Effective treatment requires a multidisciplinary approach to balance maternal health and pregnancy preservation. We here present a case of rapidly progressing glioma in a 33-year-old pregnant woman. The patient initially presented with a generalized tonic-clonic seizure at 21 weeks' gestation. Imaging revealed a tumor in the right cerebral lobe, involving both cortical and subcortical structures, while magnetic resonance spectroscopy suggested a low-grade glioma. The patient remained clinically stable for two months, but then developed severe headaches; MRI showed a worsening mass effect. At 34 weeks' gestation, an emergency and premature caesarean section was performed under general anesthesia. The patient then underwent a craniotomy for maximal tumor resection, which was histologically and molecularly diagnosed as IDH wild-type glioblastoma. Using qPCR, we found that the glioblastoma tissue showed upregulated expression of genes involved in cell structure (GFAP, VIM) and immune response (SSP1, TSPO), as well as increased expression of genes related to potential hormone response (AR, CYP19A1, ESR1, GPER1). After surgery, the patient showed resistance to Stupp protocol therapy and is currently receiving combination therapy with lomustine and bevacizumab. This case illustrates the aggressive nature and rapid progression of glioblastoma during pregnancy.