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Förster A, Brehmer S, Seiz-Rosenhagen M, Mildenberger I, Giordano FA, Wenz H, Reuss D, Hänggi D, Groden C. Heterogeneity of glioblastoma with gliomatosis cerebri growth pattern on diffusion and perfusion MRI. J Neurooncol 2018; 142:103-109. [PMID: 30565029 DOI: 10.1007/s11060-018-03068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Gliomatosis cerebri (GC) is a rare growth pattern of glioblastoma whose diffuse nature is reflected by unspecific, relatively uniform findings on conventional MRI. In the present study we sought to evaluate the additional value of diffusion (DWI) and perfusion weighted (PWI) MRI for a more detailed characterization. METHODS We analyzed the MRI findings in patients with histologically proven glioblastoma with GC growth pattern with a specific emphasis on T2 lesion pattern, volume, relative apparent diffusion coefficient (rACD), and relative cerebral blood volume (rCBV) and compared these to age-/gender-matched patients with localized glioblastoma. RESULTS Overall, 16 patients (median age 59.5 years, 4 male) were included in the study. Of these, 8 patients had a glioblastoma with GC growth pattern, and 8 a classical localized growth pattern. While the median rADC (1.27 [IQR 1.12-1.41]) within the T2 lesion was significant lower in glioblastoma with GC growth pattern compared to localized glioblastoma (1.74 [IQR 1.45-1.96]; p = 0.003), the median T2 lesion volume and rCBV within the T2 lesion did not differ significantly. Furthermore, six patients with glioblastoma with GC growth pattern showed focal areas with significantly reduced rADC (p = 0.043), and/or increased rCBV (p = 0.028). CONCLUSIONS Lower rADC in glioblastoma with GC growth pattern might reflect the diffuse tumor cell infiltration whereas focal areas with decreased rADC and/or increased rCBV probably indicate high tumor cell density and/or abnormal tumor vessels which may be useful for biopsy guidance.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Iris Mildenberger
- Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Georgakis MK, Tsivgoulis G, Spinos D, Liaskas A, Herrlinger U, Petridou ET. Prognostic Factors and Survival of Gliomatosis Cerebri: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e818-e854. [DOI: 10.1016/j.wneu.2018.08.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/29/2023]
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Perioperative Risk Assessment of Patients with Gliomatosis Cerebri. World Neurosurg 2017; 98:334-338. [DOI: 10.1016/j.wneu.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/21/2022]
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Greenfield JP, Castañeda Heredia A, George E, Kieran MW, Morales La Madrid A. Gliomatosis cerebri: A consensus summary report from the First International Gliomatosis cerebri Group Meeting, March 26-27, 2015, Paris, France. Pediatr Blood Cancer 2016; 63:2072-2077. [PMID: 27466787 DOI: 10.1002/pbc.26169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/01/2016] [Indexed: 02/02/2023]
Abstract
Gliomatosis cerebri (GC) is a universally fatal extensive and diffuse infiltration of brain parenchyma by a glial tumor. Many aspects of this phenomenon remain unknown. The First International Gliomatosis cerebri Group Meeting had the following goals: refine the clinical and radiologic diagnostic criteria for GC, suggest appropriate diagnostic procedures, standardize tissue manipulation for histologic and molecular characterization, and prioritize relevant preclinical projects. Also, general treatment recommendations were outlined for the pediatric population. Importantly, this meeting was the starting point for meaningful collaborative international research projects. This review is a consensus summary of discussions shared and conclusions derived from this meeting.
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Affiliation(s)
- Jeffrey P Greenfield
- Children's Brain Tumor Project, Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | | | - Emilie George
- Children's Brain Tumor Project, Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Mark W Kieran
- The Pediatric Brain Tumor Center, Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Andres Morales La Madrid
- Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain. .,Division of Pediatric Neuro-Oncology, Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain.
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George E, Settler A, Connors S, Greenfield JP. Pediatric Gliomatosis Cerebri: A Review of 15 Years. J Child Neurol 2016; 31:378-87. [PMID: 26239491 DOI: 10.1177/0883073815596612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/17/2015] [Indexed: 01/22/2023]
Abstract
Gliomatosis cerebri is a rare glial tumor that carries a poor prognosis. Seen in both adults and children, gliomatosis cerebri appears to differ in these populations as with adult versus pediatric glioblastoma. We present 10 children who either presented to the Weill Cornell Medical College or enrolled in the institution's Gliomatosis Cerebri International Registry alongside a cohort of 89 pediatric patients reported in the literature between 2000 and 2014. Age ranged from 4 months to 21 years, with a male to female ratio of 1.71. Median overall survival for patients in the registry cohort was 17 months (n = 10) and for the historic cohort was 13 months (n = 52). Overall survival was analyzed for the combined cohort and was significantly longer when presenting at age ≥ 10 (20 vs 10 months), for boys (18 vs 11 months), and with low-grade pathology (26.5 vs 12 months) but did not vary significantly by treatment approach.
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Affiliation(s)
- Emilie George
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Allison Settler
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Scott Connors
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
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Abstract
OPINION STATEMENT Gliomatosis cerebri (GC) is an intriguing disease for several reasons. First, it is difficult to draw the border between GC and diffuse gliomas. In this regard, GC could represent the most invasive form of diffuse gliomas. Second, both in terms of histologic grading and clinical course, GC is a heterogeneous disease, ranging from rapidly evolving to slowly and somewhat indolent forms. Because of the extensive spread of the disease, surgery-outside a biopsy for diagnosis-is rarely indicated in gliomatosis cerebri. Therapeutic options include radiotherapy, generally involving the whole brain, and chemotherapy with temozolomide or nitrosoureas. Because of the rarity of the disease, no trial comparing these two modalities has been undertaken so far. Decision is, therefore, based on small retrospective noncomparative studies and expert opinions. On one hand, there is a rationale to postpone the whole brain radiotherapy because of late neurotoxicity, but on the other hand, there is also the risk that an aggressive disease evolves to intracranial hypertension making the radiotherapy hazardous or even impossible. As a consequence, the patient would lose the opportunity to receive a potentially effective treatment. In this decision, the evaluation of histologic data together with clinical and radiologic features, performance status, and molecular profile may be of help. Because radiotherapy usually involves large volumes of the brain, chemotherapy is generally preferred up front in patients with a slowly evolving disease. Conversely, in patients with rapidly (ie, over few weeks) evolving disease with neurologic deficits or when histologic features of glioblastoma are evident, whole brain radiotherapy (45 Gy with 1.8 Gy fractions), alone or associated with concomitant temozolomide, is often preferred. The value of advanced of magnetic resonance imaging and positron emission tomography techniques to predict outcome and monitoring the treatment still remains to be defined.
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Martin-Vaquero P, da Costa RC, Wolk KE, Premanandan C, Oglesbee MJ. MRI features of gliomatosis cerebri in a dog. Vet Radiol Ultrasound 2012; 53:189-92. [PMID: 22413939 DOI: 10.1111/j.1740-8261.2011.01895.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The features of gliomatosis cerebri involving the brainstem and cerebellum in a 3-year-old dog are described. In magnetic resonance (MR) images, there was diffuse loss of the cerebellar folia and cerebellar gray and white matter contrast. Multiple illdefined T2-hyperintensities were present in the cerebellar parenchyma. A poorly defined, T2-hyperintense mass effect was present ventral to the pons and rostral medulla. No contrast enhancement was noted. Cerebrospinal fluid (CSF) was normal. Postmortem examination was consistent with gliomatosis cerebri, based on compatible histopathology and immunohistochemical findings. Although rare, gliomatosis cerebri should be included as a differential for diffuse infiltrative central nervous system (CNS) lesions.
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Affiliation(s)
- Paula Martin-Vaquero
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
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Plattner BL, Kent M, Summers B, Platt SR, Freeman AC, Blas-Machado U, Clemans J, Cheville NF, Garcia-Tapia D. Gliomatosis Cerebri in Two Dogs. J Am Anim Hosp Assoc 2012; 48:359-65. [DOI: 10.5326/jaaha-ms-5796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 3.5 yr old Saint Bernard was evaluated for nonambulatory tetraparesis and cranial nerve dysfunction, and a 7 yr old rottweiler was evaluated for progressive paraparesis. Clinical signs of left-sided vestibular and general proprioceptive ataxia and cranial nerve VII dysfunction in the Saint Bernard suggested a lesion affecting the brain stem. Signs in the rottweiler consisted of general proprioceptive/upper motor neuron paraparesis, suggesting a lesion involving the third thoracic (T3) to third lumbar (L3) spinal cord segments. MRI was normal in the Saint Bernard, but an intra-axial lesion involving the T13–L2 spinal cord segments was observed in the rottweiler. In both dogs, the central nervous system (CNS) contained neoplastic cells with features consistent with gliomatosis cerebri (GC). In the Saint Bernard, neoplastic cells were present in the medulla oblongata and cranial cervical spinal cord. In the rottweiler, neoplastic cells were only present in the spinal cord. Immunohistochemistry disclosed two distinct patterns of CD18, nestin, and vimentin staining. GC is a rarely reported tumor of the CNS. Although GC typically involves the cerebrum, clinical signs in these two dogs reflected caudal brainstem and spinal cord involvement.
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Affiliation(s)
- Brandon L. Plattner
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Marc Kent
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Brian Summers
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Simon R. Platt
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - A. Courtenay Freeman
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Uriel Blas-Machado
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Jessie Clemans
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - Norman F. Cheville
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
| | - David Garcia-Tapia
- Department of Veterinary Pathology (B.P., N.C., D. G-T.), Department of Veterinary Clinical Sciences (J.C.), College of Veterinary Medicine, Iowa State University, Ames, IA; Department of Small Animal Medicine and Surgery (M.K., S.P., A.F.), Diagnostic Laboratory (U.B-M.), College of Veterinary Medicine, University of Georgia, Athens, GA; and Pathology & Infectious Diseases, The Royal Veterinary College, Herts, United Kingdom (B.S.)
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Gliomatosis Cerebelli in a Saint Bernard Dog. J Comp Pathol 2012; 147:37-41. [DOI: 10.1016/j.jcpa.2011.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 11/18/2022]
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Rajz GG, Nass D, Talianski E, Pfeffer R, Spiegelmann R, Cohen ZR. Presentation patterns and outcome of gliomatosis cerebri. Oncol Lett 2011; 3:209-213. [PMID: 22740882 DOI: 10.3892/ol.2011.445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/23/2011] [Indexed: 11/06/2022] Open
Abstract
A total of 25 patients with gliomatosis cerebri (19 males and 6 females; median age 51 years, range 10-73 years) were diagnosed and treated at the Sheba Medical Center between 1995 and 2009. Of these, 3 patients were 10 years old at the time of diagnosis. Seizures were the initial clinical presentation in 19 patients, focal signs in 16 patients, headaches in 7 patients, cognitive disorder in 4 patients and rapidly progressive hemiparesis in 1 patient. Magnetic resonance imaging (MRI) was performed in the patients and demonstrated a diffuse infiltrative process with a hyperintensity signal on T2-weighted images and a minimal mass effect. Some level of enhancement on MRI was observed in 6 patients. The infiltrative process involved at least two lobes in each patient. Biopsy was performed for diagnosis in the majority of patients. In 1 patient with a markedly rapid deterioration, the diagnosis was established at autopsy. The pathology was compatible with gliomatosis with a diffuse infiltrative low-grade astrocytoma in 21 patients and anaplastic astrocytoma in 5 patients. The patients were treated with whole-brain radiation therapy and 7 patients were treated with combined whole-brain radiation therapy and chemotherapy. Treatment appeared to stabilize 6 patients or improve the clinical condition in 7 patients. Due to the small number of patients in the present study, however, further studies are required to determine the effect of treatment on the natural history of the disease.
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Affiliation(s)
- Gustavo G Rajz
- Department of Neurosurgery, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sakushima K, Yashima-Yamada M, Kubota K, Sawamura Y, Yabe I, Sasaki H. [Gliomatosis cerebri with multifocal progressive lesions on MRI]. Rinsho Shinkeigaku 2011; 51:145-8. [PMID: 21404617 DOI: 10.5692/clinicalneurol.51.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 77-year-old woman with cognitive impairment and multifocal progressive lesions on brain MRI was admitted to our hospital. Analysis of blood and cerebrospinal fluid showed no evidence of infection, autoimmune disease, or metabolic abnormalities. Histological examination of biopsied tissue from a lesion in the right frontal lobe revealed an abnormally increased glial cell density with enlarged nuclei and a high MIB-1 index. These pathological findings coupled with her progressive clinical history indicated a diagnosis of gliomatosis cerebri. General characteristics of gliomatosis cerebri include diffuse infiltrative lesions in neuroimaging with or without mass effect. However, the present case showed unusual multifocal manifestations in brain MRI. Therefore, histopathological examination must be taken into account for a proper diagnosis.
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Affiliation(s)
- Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine
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Landi A, Piccirilli M, Mancarella C, Giangaspero F, Salvati M. Gliomatosis cerebri in young patients' report of three cases and review of the literature. Childs Nerv Syst 2011; 27:19-25. [PMID: 20376465 DOI: 10.1007/s00381-010-1137-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 03/22/2010] [Indexed: 11/28/2022]
Abstract
UNLABELLED Gliomatosis cerebri (GC) is a rare disease, defined as a diffuse neoplastic glial cell infiltration of the brain. Diagnosis and management of GC are difficult. METHOD The authors report a literature review and their experience based on three patients, two male, and one female, all younger than 10 years, who were treated for GC. RESULTS Our series of three patients were combined for the purposes of survival assessment together with the 22 patients from the literature review yielding 25 evaluable patients with diagnosis of GC. We compared the patients treated (16) with chemo, RT, or both combined, with untreated patients (7) to evaluate the median survival. Even though, as expected, the number is too small to show a statistically significant increase of survival (p = 0.08 log rank test), we still demonstrated a slight increase in survival in the group of patients treated (26.6 vs 14.8 months). We also compared the overall survival according to treatment. The comparison between the group of five patients treated with radiotherapy only, ten treated with chemotherapy with TMZ and ten with chemo and RT combined, showed a slight increase in mean survival, although not statistically significant, in the second and third groups (p = 0.6 log rank test). CONCLUSION The optimal treatment in children under 10 years with GC is still obscure and absolutely not clear because total surgical resection is impossible to perform for the diffuse nature of the disease; CHT with TMZ seems to be the best treatment for children because it demonstrates a little reduction of the extension tumoral mass, but the responsivity of this treatment is extremely variable from case to case.
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Affiliation(s)
- Alessandro Landi
- Department of Neurosurgical Sciences, Neurosurgery, University of Rome Sapienza, Via Ostiense 121, Rome, Italy.
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Kong DS, Kim ST, Lee JI, Suh YL, Lim DH, Kim WS, Kwon KH, Park K, Kim JH, Nam DH. Impact of adjuvant chemotherapy for gliomatosis cerebri. BMC Cancer 2010; 10:424. [PMID: 20704759 PMCID: PMC2933624 DOI: 10.1186/1471-2407-10-424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 08/13/2010] [Indexed: 11/16/2022] Open
Abstract
Background Gliomatosis cerebri (GC) is characterized by a diffuse infiltration of tumor cells throughout CNS, however, few details are available about the chemotherapeutic effect on GC. The aim of this study was to investigate its clinical course and to determine the efficacy of chemotherapy for GC. Methods Between Jan. 1999 and Dec. 2004, 37 GC patients were diagnosed by biopsy and treated with radiotherapy in a single institution. To determine the efficacy of chemotherapy for GC, we retrospectively reviewed their clinical courses. The study cohort was divided into 2 groups, those with and without receiving post-radiotherapy adjuvant chemotherapy such as temozolomide or nitrosourea-based chemotherapy. Results Nineteen patients with adjuvant chemotherapy were assigned to the chemotreatment group and 18 with radiotherapy alone were assigned to the control group. Mean survival for chemotreatment group and control group were 24.2 and 13.1 months, respectively (p = 0.045). Time to progression for these groups were 16.0 and 6.0 months, respectively (p = 0.007). Overall review of the clinical course of patients with GC provided that early appearance of new contrast-enhancing lesions within 6 months from the initial diagnosis and higher histological grade were closely associated with poor survival (p < 0.001 and p = 0.008). Conclusion Adjuvant chemotherapy following radiotherapy could prolong the survival in patients with GC. In addition, newly developed contrast-enhanced lesions on the follow-up MR images indicate the progression of GC.
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Affiliation(s)
- Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Desclée P, Rommel D, Hernalsteen D, Godfraind C, de Coene B, Cosnard G. Gliomatosis cerebri, imaging findings of 12 cases. J Neuroradiol 2010; 37:148-58. [PMID: 20334921 DOI: 10.1016/j.neurad.2009.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 12/07/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE We report 12 cases of Gliomatosis cerebri (GC), a rare brain neoplasm, to define its semeiologic criteria. Literature was reviewed to clarify its physiopathology. PATIENTS AND METHODS From 1997 to 2008, 12 histologically proven cases with GC were retrospectively reviewed. Of the 12 patients, nine were male. The mean age was of 54 years. Were performed CT-Scan (n=6), MRI (n=12), diffusion and perfusion weighted images (n=12 and n=4), MR Spectroscopy (n=3), a FDG and a Methionin PET-Scan (n=2 and n=3 respectively). RESULTS Primary diagnosis was missed in six cases. Most frequent clinical signs were seizure and mental changes. Imaging criteria were: area of high signal intensity on FLAIR and T2-weighted images, involving three or more contiguous lobes with conserved architecture. Frequently a bilateral widespread invasion with involvment of the corpus callosum or the anterior white commissure or both was observed. At diagnosis and in the classical form (type I) of GC, no significant contrast enhancement and decreased rCBV were observed. Focal enhancement and increased rCBV were observed in the focal mass in type II GC. MR Spectroscopy showed an increase of the Cho/Cr ratio and a decrease in the NAA/Cr one. FDG PET showed in type I a decreased avidity for the FDG whereas in type II a increased avidity was observed. MET-PET showed an increased avidity for the tracer in a GC type II and a slight avidity in a GC type I. CONCLUSION GC is a rare brain entity. Primary diagnosis is often missed. The imaging findings of GC I, a WHO grade III tumor, should be known and include classical MRI but also PWI, MRS and scintigraphic findings.
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Affiliation(s)
- P Desclée
- Department of Radiology and Medical Imaging, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium.
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Taschner C, Baumgartner S, Weyerbrock A, Hader C, Prinz M. Freiburg neuropathology case conference: a diffusely infiltrating lesion. Clin Neuroradiol 2010; 20:70-3. [PMID: 20198353 DOI: 10.1007/s00062-010-2023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kumar V, Chakrabarti S, Modi M, Sahoo M. Late-onset obsessive compulsive disorder associated with possible gliomatosis cerebri. World J Biol Psychiatry 2010; 10:636-9. [PMID: 19548182 DOI: 10.1080/15622970903036846] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Onset of obsessive-compulsive disorder (OCD) after the age of 50 years is rare, and should alert the physician to possible "organic" causes of OCD. These include infections, degenerative disorders, brain injury and cerebrovascular lesions, principally involving the frontal lobes and basal ganglia. The current patient had obsessive images, anxiety, auditory hallucinations and seizures following (possible) gliomatosis cerebri, with onset around 69 years of age. The atypical presentation, lesions involving the cortical-basal ganglia-thalamic-cortical circuit and the association with neurological signs/symptoms, was characteristic. However, late-onset OCD has not been commonly reported with diffuse lesions, and the association with gliomatosis cerebri is not known. This patient's case illustrates the need for careful screening of older patients with recently acquired OCD, and for further systematic study of OCD in the broad range of neuropsychiatric disorders affecting the elderly.
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Affiliation(s)
- Vineet Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Nagata R, Ikeda K, Nakamura Y, Ishikawa Y, Miura K, Sato R, Kawase Y, Kawabe K, Iwasaki Y. A case of gliomatosis cerebri mimicking limbic encephalitis: malignant transformation to glioblastoma. Intern Med 2010; 49:1307-10. [PMID: 20606365 DOI: 10.2169/internalmedicine.49.3278] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Gliomatosis cerebri (GC) is a specific entity defined as diffuse infiltration of neoplastic glial cells into at least three cerebral lobes and preservation of the surrounding neuronal architecture. We report a patient with secondary GC that mimicked clinicoradiological features of limbic encephalitis (LE). A 72-year-old man had developed headache and disorientation insidiously 2 weeks previously. On admission, neurological examination showed confusion and hyperreflexia in the right extremities. Brain magnetic resonance imaging (MRI) revealed T2-hyperintensity in bilateral frontal, the left parietal, the left temporal lobes and bilateral posterior periventricular zones. Slight enhancement existed in the left lower temporal region. Cerebral angiography exhibited no tumor stains. Repeated cerebrospinal fluid studies showed mild pleocytosis and cytology of class I. There were no infectious pathogenic agents. His neurological symptoms were ameliorated at 7 days after treatment with dexamethasone and glycerol. Follow-up MRI showed no pathognomonic changes. Mild memory dysfunction remained. He was diagnosed as LE of unknown cause. Three months later he became disorientated. Brain CT revealed a hemorrhagic mass with surrounding edema in the left temporal, frontal and parietal lobes. MRI displayed marked enhancement in these regions. Urgent neurosurgery was performed and glioblastoma multiforme (GM) was confirmed pathologically. The early clinicoradiological course of this patient suggested similarities to LE. At 3 months after clinical onset, the neuroradiological features reflected rapid transformation from secondary GC to massive GM. Thus, it is important to pay more attention to the differential diagnoses of GC and LE in patients who have memory deficits and widespread MRI lesions.
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Affiliation(s)
- Riya Nagata
- Department of Neurology, Toho University Omori Medical Center, Tokyo
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19
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Hattingen E, Nichtweiss M, Blasel S, Zanella FE, Weidauer S. [Corpus callosum. Landmark of the origin of cerebral diseases]. Radiologe 2009; 50:152-64. [PMID: 20012004 DOI: 10.1007/s00117-009-1945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Diseases of the corpus callosum include developmental disorders, immunomodulated CNS diseases, vascular malformations, disturbances of metabolism including the electrolyte homeostasis, secondary degenerations and mechanical injuries. This report provides information on the differential diagnosis of reversible and irreversible pathological changes of the corpus callosum with special focus on the localization, which often allows conclusions on the pathogenesis to be drawn.
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Affiliation(s)
- E Hattingen
- Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität Frankfurt/Main, Schleusenweg 2-16, 60528, Frankfurt.
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Belsare G, Lee AG, Maley J, Kirby P, St Louis EK, Follett K. Pseudo-subarachnoid hemorrhage and cortical visual impairment as the presenting sign of gliomatosis cerebri. Semin Ophthalmol 2009; 19:78-80. [PMID: 15590541 DOI: 10.1080/08820530490882742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 49-year-old white male presented with a pseudo-subarachnoid hemorrhage and diffuse brain edema. Neuroimaging showed brain edema causing the unusual findings of a pseudo-subarachnoid hemorrhage and bilateral occipital lobe infarcts following herniation and compression of the posterior cerebral arteries. An enlarged corpus callosum was noted which led to a brain biopsy and a diagnosis of gliomatosis cerebri.
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Affiliation(s)
- Geeta Belsare
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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21
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Sharma S, Kalra V, Garg A, Suri V, Suri A. Gliomatosis cerebri. Indian J Pediatr 2009; 76:553-4. [PMID: 19390795 DOI: 10.1007/s12098-009-0090-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 07/24/2008] [Indexed: 11/30/2022]
Abstract
A 6-year-old boy who presented with worsening hemiplegia, behaviour problems and seizures after an episode of encephalitis-like illness is reported. MRI revealed diffuse signal change and swelling of the left cerebral hemisphere. The diagnosis of gliomatosis cerebri was confirmed by brain biopsy. Parents refused radiotherapy and the child worsened and died 6 months after diagnosis.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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22
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Rossi A. Pediatric Brain Tumors. Atypical Patterns and Peculiarities. Neuroradiol J 2008. [DOI: 10.1177/19714009080210s112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A. Rossi
- Department of Pediatric Neuroradiology, G. Gaslini Children's Hospital; Genova Italy)
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23
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Guzmán-de-Villoria JA, Sánchez-González J, Muñoz L, Reig S, Benito C, García-Barreno P, Desco M. 1H MR spectroscopy in the assessment of gliomatosis cerebri. AJR Am J Roentgenol 2007; 188:710-4. [PMID: 17312058 DOI: 10.2214/ajr.06.0055] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Gliomatosis cerebri is a rare brain tumor with a short survival time; for this reason, it is difficult to establish the degree of aggressivity in vivo. The MR spectroscopic findings on this tumor often do not agree with choline level. The purpose of this study was to evaluate whether MR spectroscopy can be used to measure tumor choline levels and whether the findings give useful information about tumor growth rate and patient survival time. SUBJECTS AND METHODS We performed MRI and 1H MR spectroscopic studies on seven treatment-naive patients with gliomatosis cerebri and on 16 healthy volunteers. We then analyzed the association between survival time and levels of choline (Cho) and N-acetyl aspartate (NAA) normalized to creatine (Cr). RESULTS The results showed a statistically significant (p = 0.05) inverse relation between Cho/Cr ratio and survival time. In addition, NAA/Cr ratio was significantly lower in the patient group than in the control group (p = 0.001). CONCLUSION Cho/Cr ratio measured with MR spectroscopy seems to be related to survival time, possibly explaining the inconsistent findings previously reported for this parameter.
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Armstrong GT, Phillips PC, Rorke-Adams LB, Judkins AR, Localio AR, Fisher MJ. Gliomatosis cerebri: 20 years of experience at the Children's Hospital of Philadelphia. Cancer 2006; 107:1597-606. [PMID: 16955507 DOI: 10.1002/cncr.22210] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gliomatosis cerebri (GC) is a rare and typically fatal glial neoplasm of the central nervous system. In this report, the authors describe the largest cohort of children to date with GC and explore relations between potential prognostic factors, treatment, and survival. METHODS Imaging, pathologic, and outcome data were reviewed from 13 patients who were diagnosed with GC and were treated at the Children's Hospital of Philadelphia (CHOP) between 1982 and 2005. All patients had GC confirmed by biopsy. Twelve patients received cranial irradiation, and 8 of those patients received adjuvant chemotherapy. A single patient age 1 year received chemotherapy alone. A review of the literature identified 51 pediatric patients with GC. RESULTS The progression-free survival rate in this study was 13% (range, 1.5-43 months), and the overall survival (OS) rate was 64% (range, 6.5-67 months) at 2 years. OS was significantly shorter for patients who presented in the first decade of life (P = .04). The time to progression was prolonged significantly for patients who had no evidence of tumor enhancement on imaging studies (P = .03). When survival data from patients reported in the literature were combined with the CHOP cohort, treatment prolonged OS significantly (P = .003). CONCLUSIONS The outcome of pediatric patients with GC was extremely poor; however, the current results indicated that treatment may prolong OS. Age < 10 years and contrast enhancement on magnetic resonance imaging studies at diagnosis may be risk factors for shorter survival in pediatric patients with GC.
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Affiliation(s)
- Gregory T Armstrong
- Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Abstract
Gliomatosis cerebri is a rare tumourous disease of the central nervous system consisting of glial cells characterized by diffuse widespread infiltration and preservation of preformed brain structures. This report describes a case of gliomatosis cerebri in a 9-year-old, male, flat-coated retriever dog with central nervous symptoms. Magnetic resonance imaging of the brain demonstrated ill-defined hyperintense zones of paramedian white matter within the right cerebral hemisphere, brainstem and cerebellum. Histological examination showed a proliferation of tumour cells in the brain structures mentioned. Glial fibrillary acidic protein-immunohistochemistry revealed a lot of fibres positively stained. Based on these findings, the alteration was diagnosed as gliomatosis cerebri.
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Affiliation(s)
- A Gruber
- Department of Pathobiology, Institute of Pathology and Forensic Veterinary Medicine, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Vienna, Austria.
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26
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Kararizou E, Likomanos D, Gkiatas K, Markou I, Triantafyllou N, Kararizos G. Magnetic resonance spectroscopy: a noninvasive diagnosis of gliomatosis cerebri. Magn Reson Imaging 2006; 24:205-7. [PMID: 16455411 DOI: 10.1016/j.mri.2005.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Revised: 10/15/2005] [Accepted: 10/15/2005] [Indexed: 11/20/2022]
Abstract
Gliomatosis cerebri (GC) is characterized by a diffuse infiltration of neoplastic glial cells with preservation of neuronal architecture. It can be very difficult to diagnose during life because the clinical manifestations are protean and tests are often nondiagnostic. The diagnosis of GC needs to be based on radiological, clinical and pathological criteria. We present a patient with GC, which initially presented as acute stroke attack. We discuss the usefulness of noninvasive methods, such a MR spectroscopy, in the diagnosis, grading and management of GC.
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Affiliation(s)
- Evangelia Kararizou
- Department of Neurology, Eginition Hospital, Athens National University, Athens, Greece PC 11528.
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Galanaud D, Nicoli F, Chinot O, Confort-Gouny S, Figarella-Branger D, Roche P, Fuentès S, Le Fur Y, Ranjeva JP, Cozzone PJ. Noninvasive diagnostic assessment of brain tumors using combined in vivo MR imaging and spectroscopy. Magn Reson Med 2006; 55:1236-45. [PMID: 16680716 DOI: 10.1002/mrm.20886] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine the potential value of multimodal MRI for the presurgical management of patients with brain tumors, we performed combined magnetic resonance imaging (MRI) and proton MR spectroscopy (MRS) in 164 patients who presented with tumors of various histological subtypes confirmed by surgical biopsy. Univariate statistical analysis of metabolic ratios carried out on the first 121 patients demonstrated significant differences in between-group comparisons, but failed to provide sufficiently robust classification of individual cases. However, a multivariate statistical approach correctly classified the tumors using linear discriminant analysis (LDA) of combined MRI and MRS data. After initial separation of contrast-enhancing and non-contrast-enhancing lesions, 91% of the former and 87% of the latter were correctly classified. The results were stable when this diagnostic strategy was tested on the additional 43 patients included for validation after the initial statistical analysis, with over 90% of correct classification. Combined MRI and MRS had superior diagnostic value compared to MRS alone, especially in the contrast-enhancing group. This study shows the clinical value of a multivariate statistical analysis based on multimodal MRI and MRS for the noninvasive evaluation of intracranial tumors.
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Affiliation(s)
- Damien Galanaud
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée and Hôpital de La Timone, Marseille, France
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Abstract
MRI has dramatically improved the management of cerebral tumors and consequently oligodendrogliomas. T1 and T2-weighted images and gadolinium enhancement are very useful for tumor detection and characterization. Tumor enhancement is of a great prognostic value because it is highly predictive of high-grade oligodendroglioma. Three-dimensional MR images provide, with high precision, the anatomical location and the relationships with functional structures (motor and language areas). The recent technical progress in MRI and the use of diffusion images in the screening of tumors lead to a better definition of the lesion. Comparative analysis of MRI images is helpful to detect eventual relapse and adverse effects of treatment.
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Affiliation(s)
- F Brami-Zylberberg
- Département d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, Paris.
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29
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Cereda C, Lobrinus JA, Maeder P, Bogousslavsky J. Memory impairment and tonic-clonic seizure in a 39-year-old woman. Lancet Neurol 2005; 4:683-8. [PMID: 16168937 DOI: 10.1016/s1474-4422(05)70197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Carlo Cereda
- Department of Neurology, CHUV, BH13, CH-1011 Lausanne, Switzerland.
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30
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Taillibert S, Chodkiewicz C, Laigle-Donadey F, Napolitano M, Cartalat-Carel S, Sanson M. Gliomatosis Cerebri: A Review of 296 Cases from the ANOCEF Database and the Literature. J Neurooncol 2005; 76:201-5. [PMID: 16200347 DOI: 10.1007/s11060-005-5263-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gliomatosis cerebri (GC) is a rare disease, defined as a diffuse neoplastic glial cell infiltration of the brain. Diagnosis and management of GC are difficult. This study analyzed 296 individual cases (90 patients followed through the ANOCEF network, and 206 cases from the literature), aged 1 month to 85 years (median 42), sex ratio=1.31. Median survival was 14.5 months. It was higher for patients younger than 42 years (17 months vs. 13 months), with performance status>or=80 (27 months vs. 9 months), low grade gliomatosis (grade 2=20 months, grade 3=11.5 months, grade 4=8.5 months), oligodendroglial subtype (36 months compared to 14 months for mixed GC and 11 months for astrocytic GC). Male population was younger (median 39 years vs. 45), had a higher incidence of oligodendroglial GC (22% vs. 13%), which may explain their better prognosis (median survival 17 months vs. 11.5 months) than female population. Despite a high rate of stabilization, the impact on survival of whole brain radiotherapy, which carries the risk of severe toxicity, is still unclear. Up-front chemotherapy benefit to some patients and may be preferred to whole brain radiotherapy. However, the many bias of such retrospective heterogeneous data claim for multicentric clinical trials in this rare disease.
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Affiliation(s)
- Sophie Taillibert
- Fédération de Neurologie, Groupe hospitalier Pitié-Salpétrière, 47-83 bd de l'hôpital, 75651, Paris, cedex 13, France
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31
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Abstract
INTRODUCTION Gliomatosis cerebri (GC) is defined as a diffuse neoplastic glial cell infiltration of the brain involving more than two cerebral lobes and, occasionally, the infratentorial structures or the spinal cord. The tumor may appear de novo (primary GC) or result from the spreading of a focal glioma (secondary GC). Diagnosis and management of GC are difficult. Because of the diffuse nature of gliomatosis cerebri (GC), surgery is not suitable and large field radiotherapy carries the risk of severe toxicity. STATE OF ART The analysis of current literature shows that the male population (58 percent) is younger, has a higher incidence of oligodendroglial GC and better prognosis than the female population. Survival (median=14.5 months) is also better for young patients, with high performance status, low-grade gliomatosis, and oligodendroglial subtype. Initial chemotherapy results in nearly 30 percent clinical or radiological improvement. In this setting, temozolomide is well tolerated and appears to be a valuable alternative to procarbazine-CCNU-vincristine, especially for slow-growing, low-grade GC. PERSPECTIVE Genotyping could be helpful to predict the response to chemotherapy in GC patients.
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Affiliation(s)
- M Sanson
- Fédération de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre-et-Marie-Curie, 75013 Paris.
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Akimoto J, Nishioka H, Miki T, Haraoka J, Kudo M. Clinical diagnosis of gliomatosis cerebri: Report of three cases. Brain Tumor Pathol 2004; 21:87-95. [PMID: 15700839 DOI: 10.1007/bf02484516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Distinction of gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of the brain by tumor, from diffuse glioma is a difficult clinical problem. Most previously reported cases of GC have been autopsy cases because of the lack of objective and quantitative clinical diagnostic criteria. In order to better define this entity, we report the neuroradiological and pathological findings of three cases of GC. Three patients (one man and two women, aged 46-71 years) presented with symptoms of mild increased intracranial pressure, cognitive impairment, or seizure. Magnetic resonance imaging (MRI) was done with T1-weighted images after gadolinium injection, and with T2-weighted images and fluid attenuated inversion recovery (FLAIR) in all cases. Histological confirmation of glial proliferation was obtained in all cases by craniotomy. The topography of the tumoral infiltration was characteristic, involving mainly the white matter, basal ganglia, thalamus, and commissural fibers. More than two cerebral lobes were affected. Contrast enhancement was absent, and mass effects were minimal compared with the extent of tumoral infiltration, but one patient presented with a small frontal enhanced mass during the clinical course. The pathological analyses demonstrated infiltration of the brains by variably differentiated neoplastic glial cells with destruction of the myelin sheath, but the involved axis cylinder and neuronal cells were preserved. Diagnosis of GC should be faithful to the pathological diagnosis criteria of Scheinker and Evans, and therefore the precise assessment of MRI findings according to these criteria is required for clinical, antemortem diagnosis of GC.
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Affiliation(s)
- Jiro Akimoto
- Department of Neurosurgery and Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Lodi R, Setola E, Tonon C, Ambrosetto P, Franceschi E, Crinò L, Barbiroli B, Cortelli P. Gliomatosis cerebri: clinical, neurochemical and neuroradiological response to temozolomide administration. Magn Reson Imaging 2003; 21:1003-7. [PMID: 14684203 DOI: 10.1016/s0730-725x(03)00214-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gliomatosis cerebri is a rare form of diffusely infiltrating glioma that is typically resistant to conventional chemotherapy and radiation therapy and carries a poor prognosis. Temozolomide has shown antineoplastic activity against malignant gliomas and more recently was beneficial in one patient with gliomatosis cerebri. To make an objective assessment of the effect of long-term temozolomide administration in a patient with gliomatosis cerebri we used brain proton magnetic resonance spectroscopy and structural MRI. A 46-year-old man with gliomatosis cerebri was treated with temozolomide (200 mg/m(2) per day for 5 days every 28 days). Twenty cycles of temozolomide resulted in a marked reduction in choline and scyllo-inositol content, as detected using brain proton MR spectroscopy, indicating reduced tumor cellularity and/or growth rate. Neurochemical improvements were associated with normalization of the signal intensity in most of the previously affected cerebral regions and regression of mass effect on MRI. A left pyramidal syndrome, present at the start of the treatment, disappeared. Our observation lends support to larger clinical trials evaluating the use of temozolomide to treat this brain tumor.
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Affiliation(s)
- R Lodi
- Dipartimento di Medicina Clinica e Biotecnologia Applicata "D. Campanacci" Università di, Bologna, Italy.
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Izumiyama H, Abe T, Tanioka D, Fukuda A, Kunii N. Gliomatosis cerebri in a young patient showing various cranial nerve manifestations: a case report. Brain Tumor Pathol 2003; 20:93-6. [PMID: 14756448 DOI: 10.1007/bf02483454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A case of gliomatosis cerebri in a 27-year-old man showing various cranial nerve manifestations is described. He was diagnosed as having cranial mononeuritis multiplex (bilateral oculomotor nerve paralysis, left facial nerve paralysis, bulbar palsy manifestations, and hypoglossal nerve paralysis) and was hospitalized in the neurology department on August 1, 2000. Although he continued to visit the neurology department after discharge, his manifestations showed no improvement. He was sent to our department for brain biopsy in August 2001. A biopsy performed at the Sylvian fissure from the frontal lobe/temporal lobe cortex showed high intensity on T2-weighted and Flair magnetic resonance imaging (MRI). The pathological findings were diffuse low-grade astrocytoma infiltrating between the pia mater and the cerebral cortex. We believed that the astrocytoma spreading on the subpia mater was responsible for the various cranial nerve manifestations, and we started whole-brain irradiation (46 Gy) + interferon (IFN)-beta D.I.V. from September 2001. The pathological findings of the brain biopsy showed diffuse astrocytoma. The clinical presentation was dramatically improved after radiotherapy. It seemed that this tumor had spread along the subpia mater and subependyma. When he was discharged in early December, he walked by himself. The characteristic features of this case are that no lesion in the cerebellum or brain stem was found on MRI, even though the main manifestations were cerebello-brain stem manifestations, and biopsy of the cerebral cortex revealed astrocytoma. It should be noted that the clinical manifestations of astrocytoma in some cases are dissociated from the imaging observations.
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Affiliation(s)
- Hitoshi Izumiyama
- Department of Neurosurgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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35
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Vates GE, Chang S, Lamborn KR, Prados M, Berger MS. Gliomatosis cerebri: a review of 22 cases. Neurosurgery 2003; 53:261-71; discussion 271. [PMID: 12925240 DOI: 10.1227/01.neu.0000073527.20655.e6] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2002] [Accepted: 03/27/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gliomatosis cerebri is an enigmatic diffuse brain neoplasm whose prognosis is grim. We reviewed data for patients with gliomatosis who were treated at the University of California, San Francisco, during a 10-year period. Our focus was on presentation, radiological and pathological features, and outcomes. METHODS We reviewed hospital and clinic records and magnetic resonance imaging scans for 22 patients with gliomatosis. The diagnosis was based on magnetic resonance imaging findings and tissue confirmation for all patients. Seven patients also underwent magnetic resonance spectroscopy. Eleven patients were male (50%), and the median age at presentation was 49 years (range, 7-79 yr). RESULTS Kaplan-Meier analysis demonstrated median lengths of survival as follows: no treatment, 1 month (n = 4); radiotherapy alone, 28 months (95% confidence interval, 5-51 mo; n = 13); radiotherapy followed by chemotherapy, two patients, alive at 28 and 104 months; radiotherapy and chemotherapy simultaneously, three patients, one alive at 18 months and the others dead at 7 and 9 months. There was no significant difference between radiotherapy alone and radiotherapy combined with chemotherapy (P = 0.69). Karnofsky Performance Scale scores of >/=70 and grade were both significantly related to length of survival in univariate analyses (P < 0.05); these correlations were confirmed in the multivariate analysis, although the small numbers of patients and deaths precluded reliable interpretation. CONCLUSION Although the small number of patients in our study and its retrospective nature preclude definitive conclusions regarding the utility of treatment, our findings suggest that biopsies are useful not only for diagnosis but also for prediction of the length of survival.
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Affiliation(s)
- G Edward Vates
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Peretti-Viton P, Brunel H, Chinot O, Daniel C, Barrié M, Bouvier C, Figarella-Branger D, Fuentes S, Dufour H, Grisoli F. Histological and MR correlations in Gliomatosis cerebri. J Neurooncol 2003; 59:249-59. [PMID: 12241123 DOI: 10.1023/a:1019934901750] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The diagnosis of Gliomatosis cerebri (GC) is known to be difficult and is still a matter of debate. In order to better define this entity, we studied clinical, neuroradiological, pathological and follow-up data of 9 patients affected with GC. MRI were done with T1 before and after gadolinium injection, and with T2-weighted images and Flair in 3 cases. Histological confirmation of glial proliferation was obtained in all patients by craniotomy or stereotactic biopsies. Patients were treated and followed-up in our center. The histological analyses highlighted a heterogeneous glial proliferation with various degrees of anaplasia in all the cases including 2 cases of oligodendroglioma, 1 case of anaplastic oligodendroglioma, 2 cases of anaplastic mixed oligoastrocytoma, 1 case of anaplastic astrocytoma, 2 cases of glioblastoma and 1 case of astrocytic proliferation typical of GC. The topography of the tumoral infiltration was characteristic involving mainly the white matter, basal ganglia and thalamus, brainstem and less often hypothalamus. More than two cerebral lobes were involved. Contrast enhancement, mass effect and necrosis were minimal compared to the extent of tumoral infiltration. Patients were treated with various schemes of treatment all including nitrosourea. Survival from diagnosis was under one year except for 2 patients (17 and 14 months). This study shows that the diagnosis of GC needs to be based not on pathological data alone, but on pathological, clinical and, above all, on radiological criteria. Response to therapy could not clearly be observed in GC, despite oligodendroglial component in 6/9 cases. Prognosis of GC was constantly poor.
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37
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Galanaud D, Chinot O, Nicoli F, Confort-Gouny S, Le Fur Y, Barrie-Attarian M, Ranjeva JP, Fuentès S, Viout P, Figarella-Branger D, Cozzone PJ. Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma. J Neurosurg 2003; 98:269-76. [PMID: 12593610 DOI: 10.3171/jns.2003.98.2.0269] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of brain by tumor, lacks objective and quantitative diagnostic criteria. Single-voxel spectroscopy and chemical shift imaging (two-dimensional proton magnetic resonance [MR] spectroscopy) were performed using both short (20- or 22-msec) and long (135-msec) echo times in nine patients suffering from GC, nine patients with low-grade gliomas (LGGs), and 25 healthy volunteers to establish the precise metabolic pattern of this uncommon brain neoplasm. METHODS The gliomatosis infiltration was characterized by markedly elevated levels of creatine-phosphocreatine (Cr) and mvo-inositol (Ins), a reduced level of N-acetyl aspartate (NAA), and a moderately elevated level of choline-containing compounds (Cho). This pattern differs strikingly from LGGs, which are characterized by elevated levels of Cho and Ins, markedly reduced levels of NAA, and low-to-normal Cr concentrations. Although the distinction between GC and LGG, based on histological and MR imaging criteria, is a matter of debate, MR spectroscopy produces valuable information for the differentiation between these two entities and, hence, the choice of therapeutic strategy. It also provides new insight into the pathophysiology of GC because elevated Cr and Ins levels may be related to proliferation of glial elements or, more probably, activation of normal glia. Elevated levels of Cho reflect cellular proliferation and reduced NAA corresponds to reversible neuronal injury and/or focal invasion by the tumor process. CONCLUSIONS Owing to the unfavorable clinical outcome associated with GC compared with that associated with LGG, the findings of this study illustrate the diagnostic and prognostic value of proton MR spectroscopy in the characterization of infiltrating gliomas.
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Affiliation(s)
- Damien Galanaud
- Centre de Resonance Magnétique Biologique et Médicale, Unité Mixte de Recherche, Centre National de Recherche Scientifique 6612, Faculté de Médecine, Université de la Méditerranée, and Hôpital de La Timone, Marseille, France
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Yip M, Fisch C, Lamarche JB. AFIP archives: gliomatosis cerebri affecting the entire neuraxis. Radiographics 2003; 23:247-53. [PMID: 12533659 DOI: 10.1148/rg.231025113] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Melissa Yip
- Department of Radiology, Centre Hospitalier Universitaire de Sherbrooke, 3001 N 12th Ave, Sherbrooke, Quebec, Canada.
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Weinberg JS, Rhines LD, Cohen ZR, Langford L, Levin VA. Posterior Fossa Decompression for Life-threatening Tonsillar Herniation in Patients with Gliomatosis Cerebri: Report of Three Cases. Neurosurgery 2003. [DOI: 10.1227/00006123-200301000-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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40
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Weinberg JS, Rhines LD, Cohen ZR, Langford L, Levin VA. Posterior fossa decompression for life-threatening tonsillar herniation in patients with gliomatosis cerebri: report of three cases. Neurosurgery 2003; 52:216-23; discussion 223. [PMID: 12493121 DOI: 10.1097/00006123-200301000-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2002] [Accepted: 09/06/2002] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Gliomatosis cerebri (GC) is a rare type of primary brain tumor that diffusely infiltrates more than two lobes of the brain while the normal cerebral architecture is maintained. To the best of our knowledge, the association between an acquired tonsillar herniation and GC has never been reported. In this article, we describe three patients with progressive gliomatosis of the cerebellar hemispheres who subsequently showed signs and symptoms secondary to tonsillar herniation. Early recognition of this potentially life-threatening complication allowed us to recommend prompt surgical intervention. CLINICAL PRESENTATION One patient with primary, or Type I, GC presented with suboccipital headaches, and two patients with secondary, or Type II, GC presented with the signs and symptoms of progressive myelopathy. Serial imaging studies demonstrated progressive involvement of the cerebellum, descent of the cerebellar tonsils through the foramen magnum, and cervicomedullary spinal cord compression. INTERVENTION Once the tonsillar herniation was recognized, all three patients underwent posterior fossa decompression, a cervical laminectomy to the lowest level of the tonsillar herniation, and duraplasty. All three patients experienced immediate improvement in their conditions. CONCLUSION Early recognition of tonsillar herniation, a possibly overlooked cause of death in patients with GC, allows for early surgical intervention as a potentially lifesaving procedure and significant improvement in the patient's condition.
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Affiliation(s)
- Jeffrey S Weinberg
- Department of Neurosurgery, Brain Tumor Center, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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41
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Herrlinger U, Felsberg J, Küker W, Bornemann A, Plasswilm L, Knobbe CB, Strik H, Wick W, Meyermann R, Dichgans J, Bamberg M, Reifenberger G, Weller M. Gliomatosis cerebri: molecular pathology and clinical course. Ann Neurol 2002; 52:390-9. [PMID: 12325066 DOI: 10.1002/ana.10297] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Gliomatosis cerebri is a rare, diffusely growing neuroepithelial tumor characterized by extensive brain infiltration involving more than two cerebral lobes. Among 13 patients with gliomatosis cerebri (median age, 46 years), biopsies showed features of diffuse astrocytoma (n = 4), oligoastrocytoma (n = 1), anaplastic astrocytoma (n = 5), anaplastic oligoastrocytoma (n = 1), or glioblastoma (n = 2). Molecular genetic investigation showed TP53 mutations in three of seven tumors and both PTEN mutation and epidermal growth factor receptor overexpression in one tumor. Amplification of CDK4 or MDM2 or homozygous deletion of CDKN2A was not detected. Three of 10 patients receiving radiotherapy showed a partial response (one patient) or had stable disease (two patients) lasting for more than 1 year. Four of six patients treated with procarbazine, carmustine, vincristine chemotherapy demonstrated partial remission (one patient), minor response (two patients), or stable disease (one patient). Median survival time from diagnosis was 14 months (range, 4-91+ months). Infratentorial involvement was associated with shorter survival. We conclude that (1) the molecular genetic alterations in gliomatosis cerebri resemble those in diffuse astrocytomas; (2) the prognosis of gliomatosis cerebri is variable but for at least 50% of patients as poor as for glioblastoma; and (3) some patients respond to radiotherapy and/or procarbazine, carmustine, vincristine chemotherapy.
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42
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Ng SB, Ahmeed Q, Khoo JBK. Pathologic quiz case. Recurrent headache in a 39-year-old woman. Arch Pathol Lab Med 2002; 126:1130-2. [PMID: 12240630 DOI: 10.5858/2002-126-1130-pqcrhi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Siok Bian Ng
- Department of Pathology, Singapore General Hospital
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43
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Meligonis G, Sur M, Ouma J, Grayson W, Farrell VJR. Gliomatosis of the brain and spinal cord masquerading as infective lesions. SURGICAL NEUROLOGY 2002; 57:399-404; discussion 404. [PMID: 12176200 DOI: 10.1016/s0090-3019(02)00707-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gliomatosis of the brain or spinal cord is an infiltrating glial neoplasm that shows widespread invasion of the central nervous system with relative sparing of the underlying cytoarchitecture. Acceptance of the idea that the condition represents a distinct entity remains controversial in the absence of conclusive pathogenetic data. The clinico-pathological problems and difficulties in the ante-mortem diagnosis as well as the clinical and pathological similarities to infective lesions are evaluated. METHODS AND RESULTS Three cases of cerebral and spinal gliomatosis are presented that clinically mimicked infective lesions and were diagnosed and treated as such. The correct diagnosis in each case was only made at post-mortem examination. The ante-mortem diagnosis of this rare tumor remains difficult owing to poor correlation of clinical, neuroradiological, and neuropathological findings. CONCLUSION Gliomatosis of the brain and spinal cord may simulate infective lesions owing to difficulty in ante-mortem diagnosis because of vagueness of physical, radiological, and pathological findings. It is a diagnostic pitfall particularly in our setting where there is a high incidence of HIV/AIDS and patients often present with opportunistic infections such as mycobacterial, fungal, and/or viral infections, which show an atypical clinical picture and radiological findings. Multifocal neurologic deficit with noncontrast enhancing lesions that show diffuse contiguous involvement with overall preservation of the spinal or cerebral architecture and do not respond to infective treatment could suggest a diagnosis of gliomatosis cerebri.
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Affiliation(s)
- George Meligonis
- Department of Anatomical Pathology, School of Pathology, South African Institute for Medical Research, Johannesburg, South Africa
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Cha S, Knopp EA, Johnson G, Wetzel SG, Litt AW, Zagzag D. Intracranial mass lesions: dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging. Radiology 2002; 223:11-29. [PMID: 11930044 DOI: 10.1148/radiol.2231010594] [Citation(s) in RCA: 339] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dynamic contrast agent-enhanced perfusion magnetic resonance (MR) imaging provides physiologic information that complements the anatomic information available with conventional MR imaging. Analysis of dynamic data from perfusion MR imaging, based on tracer kinetic theory, yields quantitative estimates of cerebral blood volume that reflect the underlying microvasculature and angiogenesis. Perfusion MR imaging is a fast and robust imaging technique that is increasingly used as a research tool to help evaluate and understand intracranial disease processes and as a clinical tool to help diagnose, manage, and understand intracranial mass lesions. With the increasing number of applications of perfusion MR imaging, it is important to understand the principles underlying the technique. In this review, the essential underlying physics and methods of dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging are described. The clinical applications of cerebral blood volume maps obtained with perfusion MR imaging in the differential diagnosis of intracranial mass lesions, as well as the pitfalls and limitations of the technique, are discussed. Emphasis is on the clinical role of perfusion MR imaging in providing insight into the underlying pathophysiology of cerebral microcirculation.
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Affiliation(s)
- Soonmee Cha
- Department of Radiology, New York University Medical Center, 530 First Ave, HCC-Basement, MRI Center, New York, NY 10016, USA
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Abstract
We report two young patients with obscure presentations of gliomatosis cerebri. Initial CT scanning was inconclusive and in one case showed intraventricular haemorrhage, a feature not previously described. Magnetic resonance imaging was required to show the lesions with greater definition; however, in both cases, a biopsy was needed to confirm the diagnosis.
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Affiliation(s)
- P Rust
- Department of Neurosurgery, Atkinson Morley's Hospital, London, UK
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46
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Yamada SM, Hayashi Y, Takahashi H, Teramoto A, Matsumoto K, Yamada S. Histological and genetic diagnosis of gliomatosis cerebri: case report. J Neurooncol 2001; 52:237-40. [PMID: 11519853 DOI: 10.1023/a:1010601132673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Gliomatosis cerebri is considered grade III astrocytoma because of the short survival period of patients with this tumor, while the tumor histologically consists of widespread low grade astrocytoma cells. The authors tried to clarify this discrepancy by applying genetic analysis of the tumor. A 29-year-old man originally presented with mild headache and showed diffuse high intensity areas in both hemispheres and in the cerebellum by T2-weighted magnetic resonance imaging (MRI) without gadolinium-dimeglumine (Gd)-enhancement in T1-weighted imaging. Histological diagnosis was gliomatosis cerebri with diffuse grade II astrocytoma. Seven months after temporary improvement following irradiation and chemotherapy, he developed progressive mental deterioration, and died in one year after the surgery. At this time T1-weighted imaging showed Gd-enhanced lesions with enlargement only of the cerebellar tumor. Genetic analysis demonstrated positive FGFR 1 and less FGFR 2 mRNA in the tumor tissue, and FGFR 1 mRNA was beta type dominant. These results indicated that the genetic features of this tumor are similar to those of glioblastoma multiforme concerning FGFR expression. The authors conclude that genetic investigation of the tumor tissue is required to predict the prognosis of gliomatosis cerebri patients, in addition to imaging and histological examinations.
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MESH Headings
- Adult
- Antigens, Nuclear
- Biomarkers, Tumor/genetics
- Brain Neoplasms/chemistry
- Brain Neoplasms/diagnosis
- Brain Neoplasms/genetics
- Brain Neoplasms/pathology
- Brain Neoplasms/therapy
- Cerebellar Neoplasms/chemistry
- Cerebellar Neoplasms/diagnosis
- Cerebellar Neoplasms/genetics
- Cerebellar Neoplasms/pathology
- Cerebellar Neoplasms/surgery
- Combined Modality Therapy
- Contrast Media
- Fatal Outcome
- Gadolinium DTPA
- Humans
- Magnetic Resonance Imaging
- Male
- Neoplasm Proteins/genetics
- Neoplasms, Neuroepithelial/chemistry
- Neoplasms, Neuroepithelial/diagnosis
- Neoplasms, Neuroepithelial/genetics
- Neoplasms, Neuroepithelial/pathology
- Neoplasms, Neuroepithelial/therapy
- Nuclear Proteins/analysis
- RNA, Messenger/analysis
- RNA, Neoplasm/analysis
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Fibroblast Growth Factor, Type 1
- Receptor, Fibroblast Growth Factor, Type 2
- Receptors, Fibroblast Growth Factor/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- S M Yamada
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
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47
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Affiliation(s)
- B Docktor
- Department of Diagnostic Imaging, Foothills Hospital, University of Calgary, Alberta, Canada
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48
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Tagliati M, Perl DP, Drayer B, Olanow CW. Progressive dementia and gait disorder in a 78 year old woman. J Neurol Neurosurg Psychiatry 2000; 68:526-31. [PMID: 10727496 PMCID: PMC1736868 DOI: 10.1136/jnnp.68.4.526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Tagliati
- Department of Neurology, The Mount Sinai Medical Center, NY, USA.
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49
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Shintani S, Tsuruoka S, Shiigai T. Serial positron emission tomography (PET) in gliomatosis cerebri treated with radiotherapy: a case report. J Neurol Sci 2000; 173:25-31. [PMID: 10675576 DOI: 10.1016/s0022-510x(99)00296-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Results of serial positron emission tomography (PET) in a biopsy-proven case of gliomatosis cerebri (GC) are reported. Computed tomography (CT) with and without contrast failed to detect focal abnormalities, but magnetic resonance (MR) revealed iso-intensity or low-intensity lesions in T1-weighted images and high-intensity lesions in T2-weighted images. Lesions were seen in the left thalamus, right temporal lobe and claustrum, and pons. Radiotherapy remarkably improved clinical and imaging findings. Both before and shortly after radiotherapy, 11C-methionine PET images showed hypermetabolism while 15O-water PET images showed a marked increase in cerebral blood flow in GC lesions. However, 6 months later PET images had remarkably improved, appearing nearly normal.
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Affiliation(s)
- S Shintani
- Department of Neurology, Toride Kyodo General Hospital, 2-1-1 Hongoh, Toride City, Ibaraki, Japan.
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50
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Fabre M, Maurent K, Colombe B, Roge A, Berger F, Romanet JP, Pasquier B, Massot C. [Retina where the neurons become tangled]. Rev Med Interne 1999; 20 Suppl 2:322s-324s. [PMID: 10422188 DOI: 10.1016/s0248-8663(99)80483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Fabre
- Service de médecine interne, CHU Michallon, Grenoble
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