A unique case of the co-existence of two different brain tumors in one patient

Introduction: Multiple primary brain tumors are a rare occurrence that are often accounted for by a complex process of tumorigenesis involving irradiation and possibly the association of residual embryonic tissue turning neoplastic. In this case study, we report a case of coexisting sub ependymoma and oligodendroglioma in a patient. Case: A 32-year-old female was referred to our hospital with a history of seizures for the past 6 months and intact sensorimotor functions. Her Magnetic Resonance Imaging (MRI) revealed a lesion in the parieto-occipital lobe along with perilesional edema which resulted in the effacement of the left lateral ventricle. A second lesion was noted at frontal horn of the right lateral ventricle attached to the septum pellucidum with tiny cystic spaces. The left parieto-occipital lesion (oligodendroglioma) was excised using a supratentorial craniotomy approach and an interhemispheric anterior transcollosal approach was used for debulking the intraventricular tumor (subependymoma). The patient was put on Temozolomide but only took 4 cycles of chemotherapy and refused radiation therapy. She currently has stable disease and is being followed with MRI scans every 6 months. Conclusion: The most commonly reported concomitant tumors are meningioma with glioma followed by schwannoma and pituitary adenoma. The discovery of a second tumor is often done pre-operatively, intraoperatively, years after resection of the first tumor and even during postmortem examinations. We report for the first time, the co-existence of an oligodendroglioma and a sub ependymoma.