CASE REPORT article
Front. Oncol.
Sec. Neuro-Oncology and Neurosurgical Oncology
Case report:A case of diffuse midline glioma,H3 K27-altered presenting with long-segment spinal cord lesions
Provisionally accepted
Chengcheng Lu1
Songke Lu1Rongrong Li1Rui Pang1Ruijiao Zhao2Yao Cui3Jianguo Zhang4
Wei Li1*
Huiqin Liu1*- 1Department of Neurology, Henan Provincial People's Hospital, Henan, China
- 2Department of Pathology, Henan Provincial People's Hospital, Henan, China
- 3Department of Oncology, Henan Provincial People's Hospital, Henan, China
- 4Department of Neurosurgery, Henan Provincial People's Hospital, Henan, China
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The diffuse midline glioma H3 K27-altered represents a subtype of pediatric-type diffuse high-grade gliomas,characterized as an infiltrative high-grade glioma involving midline structures with H3 K27 mutation.This clinically rare entity poses diagnostic challenges in early stages and carries an extremely poor prognosis.We report a case of diffuse midline glioma H3 K27-altered primarily manifesting as spinal cord lesions,detailing its clinical characteristics to enhance understanding of this disease entity.A 21-year-old male presented with "progressive quadriparesis over 7 months".Seven months prior,he developed bilateral lower limb weakness (grade II) following a cold.MRI at a local hospital revealed abnormal signals at T2-T5,diagnosed as"myelitis".The disease progressed with lesion expansion despite treatment with glucocorticoid pulse therapy and intravenous immunoglobulin.The patient visited our hospital 7 months after the onset of the disease.At that time,the patient exhibited grade I muscle strength in the right upper limb,grade 0 in all other limbs,with sensory impairment below the neck.MRI showed abnormal signals in the medulla oblongata and thoracic spinal cord.The patient received high-dose glucocorticoid pulse therapy again,but the symptoms did not improve.The definitive diagnosis of diffuse midline glioma H3 K27-altered was ultimately established through spinal cord biopsy.The patient was discharged from the hospital due to respiratory failure 12 days after the diagnosis.
Keywords: Demyelinating diseases of the central nervous system, differential diagnosis, H3K27M, Long segmentspinal cord lesion, Pediatric-type diffuse high-grade gliomas
Received: 02 Jul 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Lu, Lu, Li, Pang, Zhao, Cui, Zhang, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Li
Huiqin Liu
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