By Dr. Ali Haider khan
Abstract:
Introduction:
Pediatric high-grade gliomas are aggressive brain tumors with
a generally poor outlook, even when treated with surgery,
radiotherapy, and chemotherapy. The occurrence of a
high-grade glioma alongside a blood cancer such as T-cell
lymphoblastic lymphoma is extremely rare. Reporting such
cases is important to help doctors understand how best to
diagnose and manage these rare situations.
To date, only a single comparable case has been documented —
a seven-year-old with synchronous T-cell lymphoblastic
lymphoma and CNS High Grade Glioma without prior
irradiation underscoring the extreme rarity of this coexistence
and the importance of reporting additional cases to expand the
knowledge base and guide management. [1]
Keywords: Pediatric high-grade glioma, T-cell lymphoblastic
lymphoma, synchronous malignancy, dual primary cancer, case
report
Case Presentation:
A 10-year-old girl came to us with a two-and-a-half-month
history of severe, persistent headaches that did not improve
with painkillers. She also had episodes of vomiting. An MRI of
the brain showed a large mass (5.5 × 6.2 × 4.2 cm) in the right
temporal lobe with swelling and early signs of herniation. She
underwent urgent right temporoparietal craniotomy in April
2025, with near-total removal of the tumor. The biopsy
confirmed a WHO grade 4 high-grade glioma with a high Ki-67
index.
She was given adjuvant conformal radiotherapy (54 Gy in 30
fractions), which was completed on 7th August 2025. About
two weeks later, she developed a firm, mildly tender swelling
on the left side of her chest wall measuring about 5 cm. A
biopsy confirmed T-cell lymphoblastic lymphoma. She was
referred to a tertiary pediatric oncology center for
chemotherapy for lymphoma while continuing maintenance
temozolomide (100 mg, Days 1–5 every 28 days, 12 cycles
planned) for the brain tumor.
Discussion:
Having two different primary cancers at the same time in a child who has not had prior treatment is extremely rare. This
situation raises the possibility of an underlying
cancer-predisposition syndrome such as Li-Fraumeni
syndrome or mismatch repair deficiency, although it might also
be coincidental. Treating both cancers together is challenging
— treatment must be carefully balanced to control both
diseases while avoiding excessive toxicity. Close follow-up
with regular imaging and systemic evaluation is important to
monitor for new cancers or relapses.