CT findings in multicentric glioblastoma: diagnostic-pathologic correlation

Multicentric Gliomas. Report of Seven Cases

Multifocal gliomas fall into four main categories: diffuse, multiple, multicentric and multiple-organ. Multicentric gliomas are uncommon lesions of the central nervous system. Even more so are multicentric gliomas lying both above and below the tentorium (16 cases to date, as far we know). We report a clinical series of 7 cases, including 3 supra-Infratentorial tumors. The distinctive features of multicentric gliomas are mainly the absence of gross or microscopic connections and absence of seeding along easily accessible routes like the cerebrospinal fluid pathways or the median commissures. We consider the pathogenetic hypotheses and problems of diagnosis, especially differential from other multifocal diseases of the central nervous system.

Pediatric multifocal glioblastoma multiforme with fulminant course

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in children is less common than in adults and has a better prognosis. Pediatric GBM is a rare entity, and a multifocal development in a pediatric GBM is much rarer. We report to you one such rare case of pediatric multifocal GBM in a 5-year-old child who developed rapidly increasing multiple lesions after radiotherapy. More studies are required to study the genetic analysis, tumor behavior, management and outcome of these rare tumors.

Radiographic incidence of multicentric malignant gliomas

BACKGROUND

Multicentric malignant gliomas are interesting yet uncommon clinical entities with an unknown rate of occurrence.

METHODS

We reviewed the computed tomography (CT) and magnetic resonance (MR) images of 100 consecutive patients with malignant gliomas to determine the incidence of multicentricity in malignant glial neoplasms.

RESULTS

Five patients had multiple lesions on their initial radiographic study (synchronous lesions) and in four patients multiplicity developed after initial diagnosis (metachronous lesions). MR imaging demonstrated one lesion not seen on CT.

CONCLUSIONS

Because synchronous or metachronous multicentricity was found in 9% of patients with malignant gliomas, treatment delivery should not be based on radiographic imaging without attempting to obtain an accurate diagnosis of the ongoing intracranial process.

Imaging patterns of multifocal gliomas

We reviewed the imaging characteristics of 51 consecutive cases of cerebral glioma with multiple foci of involvement. In 26 patients, multifocality was present at the initial diagnosis, whereas in 25, it developed at a later stage. Thirty-two patients were studied with MRI, 13 with CT, and six with both imaging techniques. In 14 cases, no apparent dissemination route was identified; these tumors were presumed to be true multicentric gliomas. In the rest of the cases, various patterns of spread from a primary site were evident or suggested, and the tumors were denoted as multifocal. The most frequent dissemination route in the latter group was the meningeal-subarachnoid space, followed by the subependymal, intraventricular route and direct brain penetration. Multifocal gliomas are more frequent than generally believed and, therefore, multiple cerebral masses should be thoroughly evaluated and not always presumed to be of metastatic origin.

Synchronous double malignancy: adenocarcinoma of lung and malignant astrocytoma induced by asbestos exposure

A 54-year-old male died of cerebellar herniation induced by brain tumor. Radiological examination of this case showed two separate tumorous lesions in the brain and lung. Autopsy proved malignant astrocytoma in the brain and coincidental alveolar cell carcinoma in the lung. He had a history of asbestos exposure for 8 years doing piping work in a shipyard. Furthermore, we detected a large number of asbestos bodies in the lung and one asbestos body in the brain. Therefore, this rare case of double cancer (malignant astrocytoma and lung cancer) might have been induced by asbestos exposure.