New research from the Department of Pathology was just published in Acta Neuropathologica. Led by a team of experts including Drs. Drew Pratt, Yelena Fudym, Sandra Camelo-Piragua, and Sriram Venneti, the study highlights H3K27M-mutant diffuse midline glioma with extensive intratumoral microthrombi in young adults with COVID-19.
The study first examined the emergence of the novel coronavirus disease in 2019 and the unique challenges it presents for oncology patients. Experts analyzed the case of a 21-year-old woman who presented with headaches, blurry vision, and vomiting. Her neurologic examination showed no abnormalities, and the patient was diagnosed with tension-type headache. Two months later, she experienced a syncopal episode. Head CT demonstrated a large (4.3 cm) supratentorial thalamic mass causing obstructive hydrocephalus. She subsequently decompensated from herniation and underwent emergent ventricular drain placement. Post-operative head CT and MRI demonstrated successful drain placement, but exhibited marked hemorrhage in the tumor and ventricles, with a displacement of the septum pellucidum. The patient tested positive for SARS-CoV-2 by nasopharyngeal swab and exhibited classic findings of COVID-19-associated coagulopathy including elevated D-dimer levels, without changes in prothrombin or activated-partial-thromboplastin time. She exhibited no respiratory symptoms, and a chest radiograph demonstrated no evidence of lung disease.
As Dr. Venneti describes, "The effect of COVID-19 on cancer patients has been enormous. Delays in treatment and access to care have had significant negative implications. However, how COVID-19 infection directly impacts the tumor micro-environment is not known. The brain has shown a unique susceptibility to strokes in COVID-19 infection. It is thought that the cytokine storm seen in some COVOD-19 patients results in blood clotting abnormalities that can cause strokes and bleeding within the brain."
Ultimately, recent reports suggest a unique predisposition of the brain to thrombosis in COVID-19 infections attributed to a cytokine storm syndrome. Given the poor association between intratumoral microthrombi and overall prognosis in gliomas, our case raises a critical question concerning the impact of COVID-19-associated coagulopathy on tumor biology, the immune microenvironment, and, in this case, the patient’s clinical course. The case in question poses the hypothesis that COVID-19-associated coagulopathy could affect long-term tumor behavior and disease progression in cancer in a manner yet unrecognized.
"Surprisingly, [we] found similar micro clots and bleeding within a DIPG-like brain tumor in a young adult that negatively impacted the clinical course of this patient. These findings suggest that COVID-19 can cause changes within the tumor micro-environment and can potentially influence tumor biology," concludes Venneti.
The full publication in Acta Neuropathologica is accessible here.