1
|
Farhat M, Fuller GN, Wintermark M, Chung C, Kumar VA, Chen M. Multifocal and multicentric glioblastoma: Imaging signature, molecular characterization, patterns of spread, and treatment. Neuroradiol J 2023:19714009231193162. [PMID: 37559514 DOI: 10.1177/19714009231193162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Multifocal and multicentric glioblastoma (GBM) or collectively, m-GBM, is an imaging diagnosis present in up to 34% of patients with GBM. Compared to unifocal disease, patients with m-GBM have worse outcomes owing to the enhanced aggressive nature of the disease and its resistance to currently available treatments. To improve the understanding of its complex behavior, many associations have been established between the radiologic findings of m-GBM and its gross histology, genetic composition, and patterns of spread. Additionally, the holistic knowledge of the exact mechanisms of m-GBM genesis and progression is crucial for identifying potential targets permitting enhanced diagnosis and treatment. In this review, we aim to provide a comprehensive summary of the cumulative knowledge of the unique molecular biology and behavior of m-GBM and the association of these features with neuroimaging.
Collapse
Affiliation(s)
- Maguy Farhat
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Section of Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
2
|
Zhang ZX, Chen JX, Shi BZ, Li GH, Li Y, Xiang Y, Qin X, Yang L, Lv SQ. Multifocal glioblastoma-two case reports and literature review. Chin Neurosurg J 2021; 7:8. [PMID: 33446281 PMCID: PMC7809824 DOI: 10.1186/s41016-020-00223-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Multifocal glioblastoma is a rare type of glioblastoma with worse prognosis. In this article, we aimed to report two cases of classical multifocal glioblastoma. Case presentation In case 1, a 47-year-old male presented with dizziness, and once had a sudden loss of consciousness accompanied by convulsion of limbs. Contrast-enhanced MRI showed multiple lesions with heterogeneously ring-enhanced characters in the left hemisphere, diagnosed as multifocal glioblastoma. He underwent a craniotomy of all lesions, concurrent radiotherapy and chemotherapy as well as additional chemotherapy of temozolomide. After 2 cycles, repeat MRI showed that the new lesions already occurred and progressed. Eventually, he abandoned the chemotherapy after the 2 cycles and died 1 year later. In case 2, a 71-year-old male presented with a history of headache, left limb weakness, and numbness. Discontinuous convulsion of limbs once occurred. Contrast-enhanced MRI showed multiple lesions located in the right hemisphere, diagnosed as multifocal glioblastoma. He underwent a right frontoparietal craniotomy of the main lesion. Hemorrhage of the residual tumor and pulmonary artery embolism occurred synchronously. Eventually, his family decided not to pursue any further treatment and opted for hospice care and he passed away within 11 days of surgery. Conclusions We reported two cases of typical multifocal glioblastoma. Valid diagnosis is crucial; then, resection of multiple lesions and canonical radio-chemotherapy probably bring survival benefits.
Collapse
Affiliation(s)
- Zuo-Xin Zhang
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China
| | - Ju-Xiang Chen
- Department of Neurosurgery, Changzheng Hospital and Shanghai Institute of Neurosurgery, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Bao-Zhong Shi
- Department of Critical Care Medicine & Department of Neurosurgery, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, Henan, People's Republic of China
| | - Guang-Hui Li
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Yao Li
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China
| | - Yan Xiang
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China
| | - Xun Qin
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China
| | - Lin Yang
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China
| | - Sheng-Qing Lv
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing City, 400037, People's Republic of China.
| |
Collapse
|
3
|
H3K27M-mutant diffuse midline glioma presenting as synchronous lesions involving pineal and suprasellar region: A case report and literature review. J Clin Neurosci 2020; 81:144-148. [PMID: 33222904 DOI: 10.1016/j.jocn.2020.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The differential diagnoses for multifocal lesions with pineal and suprasellar involvement in a young adult include germ cell tumour and intracranial metastasis. Other differentials include atypical teratoid/rhabdoid tumour and pineoblastoma. We present the first known case of multicentric H3K27M mutant diffuse midline glioma, which is typically defined by its diffuse nature, midline location, and H3K27M mutation. CASE REPORT A young Chinese female presented subacutely with giddiness, right abducens nerve palsy and unsteady gait. Magnetic resonance imaging (MRI) of the brain with contrast revealed a moderately sized pineal region tumour, extending into the third ventricle, associated with hydrocephalus. There were two other synchronous lesions noted in the suprasellar and left occipital region. Serum and cerebrospinal fluid tumour markers, along with a computed tomography scan of her thorax and abdomen and were unremarkable. She underwent an endoscopic third ventriculostomy and biopsy of pineal and suprasellar lesions. Histology demonstrated a poor prognosis variant multifocal glioblastoma multiforme that was IDH wildtype, H3K27M positive, and MGMT unmethylated. MRI of the whole spine did not reveal any drop metastasis. The patient subsequently underwent adjuvant chemotherapy and radiotherapy after she was deemed to be unsuitable for surgical resection. CONCLUSION Although rare, multicentric H3K27M mutant diffuse midline glioma should be included in the list of differential diagnoses for multifocal enhancing lesions with involvement of the pineal and suprasellar regions, especially if the lesions demonstrate imaging features atypical for more common diagnosis such as germ cell tumours.
Collapse
|
4
|
Picart T, Le Corre M, Chan-Seng E, Cochereau J, Duffau H. The enigma of multicentric glioblastoma: physiopathogenic hypothesis and discussion about two cases. Br J Neurosurg 2018; 32:610-613. [DOI: 10.1080/02688697.2018.1501465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Lyon University Hospital—Hospices Civils de Lyon, Bron, France
| | - Marine Le Corre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Emilie Chan-Seng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Jérôme Cochereau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Institute for Neuroscience of Montpellier, INSERM U1051 (Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors Research Group), Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Institute for Neuroscience of Montpellier, INSERM U1051 (Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors Research Group), Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France
| |
Collapse
|
5
|
Salvati M, Oppido PA, Artizzu S, Fiorenza F, Puzzilli F, Orlando ER. Multicentric Gliomas. Report of Seven Cases. TUMORI JOURNAL 2018. [DOI: 10.1177/030089169107700614] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Maurizio Salvati
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Piero Andrea Oppido
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Spartaco Artizzu
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Fabio Fiorenza
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Fabrizio Puzzilli
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | | |
Collapse
|
6
|
Abstract
PURPOSE Vasogenic edema on glioblastoma multiforme (GBM) or a metastatic brain tumor (METS) may have different T2 relaxation time values because it involves an increased water component. In this study, we assessed the diagnostic utility of T2 mapping techniques in distinguishing GBM from METS. MATERIALS AND METHODS We studied a glioblastoma (GBM) patient and a metastatic brain tumor (METS) patient who had not undergone previous surgery or treatment. All MR imaging was carried out using a 3.0-T whole-body unit, and axial T2 maps were generated with five TEs (TE = 20, 40, 60, 80, and 100 ms). Data were analyzed by using image processing and analysis software. RESULTS The T2 map of a GBM case showed that the -peritumoral area at a T2 relaxation time of 120-160 ms is prominent compared with the area at 210-240 ms. In contrast, the peritumoral area at 210-240 ms was prominent compared with the area at 120-160 ms in a METS case. CONCLUSION The distribution of T2 relaxation time in the peritumoral area shows different patterns in glioblastomas and metastatic brain tumors.
Collapse
|
7
|
Cugati G, Jain PK, Pande A, Symss NP, Chakravarthy V, Ramamurthi R. Pediatric multifocal glioblastoma multiforme with fulminant course. J Neurosci Rural Pract 2012; 3:174-7. [PMID: 22865971 PMCID: PMC3409990 DOI: 10.4103/0976-3147.98224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, Tamil Nadu, India
| | | | | | | | | | | |
Collapse
|
8
|
Giannopoulos S, Kyritsis AP. Diagnosis and management of multifocal gliomas. Oncology 2011; 79:306-12. [PMID: 21412017 DOI: 10.1159/000323492] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/24/2010] [Indexed: 02/03/2023]
Abstract
Patients who present with multiple cerebral tumors are usually considered as having metastatic disease. If they have a history of a primary cancer in another site, the brain tumors are considered metastases and are usually managed with standard whole-brain radiotherapy. If no primary cancer site is known, a diagnostic work-up is performed, but if no primary site is found, they are still considered as brain metastases from an unknown primary site. Thus, such patients can either have brain biopsy (recommended) for further diagnostic consideration or, occasionally, they can be treated with whole-brain radiotherapy, depending on the age, performance status and wish of the patient. However, in some of these patients the multiple brain tumors represent multifocal glioma rather than metastases, resulting in incorrect treatment. In such cases, various MRI characteristics may be helpful in directing towards the correct diagnosis. Thus, patients who present with multiple brain tumors should not always be considered to have metastatic disease even if they have a previous diagnosis of systemic cancer, and multifocal glioma should be ruled out.
Collapse
Affiliation(s)
- Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
| | | |
Collapse
|
9
|
Hassaneen W, Levine NB, Suki D, Salaskar AL, de Moura Lima A, McCutcheon IE, Prabhu SS, Lang FF, DeMonte F, Rao G, Weinberg JS, Wildrick DM, Aldape KD, Sawaya R. Multiple craniotomies in the management of multifocal and multicentric glioblastoma. J Neurosurg 2011; 114:576-84. [DOI: 10.3171/2010.6.jns091326] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers.
Methods
The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated.
Results
In Group A, the median age was 52 years (range 32–78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50–100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively.
Conclusions
Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kenneth D. Aldape
- 2Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | | |
Collapse
|
10
|
Gasco J, Franklin B, Fuller GN, Salinas P, Prabhu S. Multifocal epithelioid glioblastoma mimicking cerebral metastasis: case report. Neurocirugia (Astur) 2010; 20:550-4. [PMID: 19967320 DOI: 10.1016/s1130-1473(09)70133-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Epithelioid glioblastoma is a rare morphologic subtype of glioblastoma that closely mimics metastatic carcinoma or metastatic melanoma histologically. All previous case reports of this unusual glioblastoma variant have been solitary lesions. We report here the first case to our knowledge of multifocal epithelioid glioblastoma mimicking cerebral metastasis. CLINICAL PRESENTATION A 67-year-old man with a prior history of mycosis fungoides, a common form of cutaneous T-cell lymphoma, presented with memory loss and impaired peripheral vision. Two discrete brain lesions highly suspicious for metastases were identified by magnetic resonance imaging (MRI). INTERVENTION The patient underwent two separate craniotomies; both lesions were successfully resected in toto with an excellent post-surgical outcome. CONCLUSION Epithelioid glioblastoma is one of the rarest morphologic subtypes of glioblastoma. Here we describe the first case to our knowledge of multifocal epithelioid glioblastoma that convincingly mimicked a secondary metastatic process. Multifocal epithelioid glioblastoma should be included in the differential diagnosis of patients who present with multiple discrete brain lesions. An attempt at gross total resection is recommended when anatomically feasible for definitive histopathological diagnosis and to improve progression free survival of patients who present with similarly ambiguous and potentially misleading multiple lesions.
Collapse
Affiliation(s)
- J Gasco
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas 77555-0517, USA.
| | | | | | | | | |
Collapse
|
11
|
Stuckey SL, Wijedeera R. Multicentric/multifocal cerebral lesions: Can fluid-attenuated inversion recovery aid the differentiation between glioma and metastases? J Med Imaging Radiat Oncol 2008; 52:134-9. [DOI: 10.1111/j.1440-1673.2008.01931.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
|
13
|
Ampil F, Burton GV, Gonzalez-Toledo E, Nanda A. Do we need whole brain irradiation in multifocal or multicentric high-grade cerebral gliomas? Review of cases and the literature. J Neurooncol 2007; 85:353-5. [PMID: 17534578 DOI: 10.1007/s11060-007-9413-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
|
14
|
Franco CM, Malheiros SM, Nogueira RG, Batista MA, Santos AJ, Abdala N, Stávale JN, Ferraz FA, Gabbai AA. [Multiple gliomas. Illustrative cases of 4 different presentations]. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:150-6. [PMID: 10770881 DOI: 10.1590/s0004-282x2000000100023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.
Collapse
Affiliation(s)
- C M Franco
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Salvati M, Cervoni L, Celli P, Caruso R, Gagliardi FM. Multicentric and multifocal primary cerebral tumours. Methods of diagnosis and treatment. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1997; 18:17-20. [PMID: 9115038 DOI: 10.1007/bf02106225] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Forty patients with multifocal and multicentric cerebral tumours were retrospectively studied. The patients were divided into two groups: ten patients with multicentric tumours (group A), and 30 patients with multifocal tumours. As far as their preoperative clinical history and the incidence of the various symptoms and signs are concerned, there were no significant differences between the two groups. CT permitted a correct diagnosis in 90% of the cases. All of the patients underwent the removal of the tumour(s) and received radiotherapy; 30 patients also received chemotherapy. In group A, nine patients died and one was lost to follow-up one year after treatment; the average survival was ten months from the appearance of the multicentric tumour. In group B, 29 patients died and one is still alive two years after treatment; the average survival was six months. We consider the problems of diagnosis and the long-term follow-up of patients.
Collapse
Affiliation(s)
- M Salvati
- Dipartimento di Scienze Neurologiche, Cattedra di Neurochirurgia, Università di Roma La Sapienza, Italy
| | | | | | | | | |
Collapse
|
16
|
Abstract
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.
Collapse
Affiliation(s)
- A P Kyritsis
- Department of Neuro-Oncology, University of Texas, M.D. Anderson Cancer Center, Houston 77030
| | | | | | | |
Collapse
|
17
|
Kyritsis AP, Yung WK, Leeds NE, Bruner J, Gleason MJ, Levin VA. Multifocal cerebral gliomas associated with secondary malignancies. Lancet 1992; 339:1229-30. [PMID: 1349958 DOI: 10.1016/0140-6736(92)91167-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Abstract
A series of 241 gliomas (astrocytomas, oligodendrogliomas, glioblastomas, and subependymal giant-cell astrocytomas) was studied. This represents all the gliomas examined post mortem over 25 years at one hospital. Two hundred and one cases (85%) were apparently solitary tumors; of the 40 cases with multiple tumor foci, 23 (9.5%) were true multicentric gliomas. After excluding cases in which there was concomitant disease (neurofibromatosis, tuberose sclerosis, or multiple sclerosis), 18 cases of multicentric tumor (7.5%) remained. Multicentric tumors with different histologic appearances accounted for 2.9% of the series. Celloidin-embedded whole brain sections proved invaluable for the detection of microscopic neoplastic foci and unsuspected diffuse spread. The estimated incidence of multiplicity in gliomas is higher than in most series, but the findings suggest that detection of multifocal neoplastic change in these tumors is directly related to the extent to which the brain is sampled, and that figures obtained in this study may well underestimate the true incidence.
Collapse
|
19
|
Sundaresan N, Galicich JH, Tomita T, Shapiro W, Krol G. Computerized tomography findings in multifocal glioma. Acta Neurochir (Wien) 1981; 59:217-26. [PMID: 6280451 DOI: 10.1007/bf01406351] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Six patients with multifocal glioma are presented. Computerized tomography revealed multiple, discrete, contrast-enhancing lesions in the cerebral hemispheres, suggestive of multiple intracranial metastases. The most accessible lesion was resected at craniotomy in each patient, confirming the diagnosis of primary malignant glioma. Postoperative radiation therapy and chemotherapy were instituted according to current protocols. Since neuroradiological studies may not allow distinction of multifocal glioma from multiple brain metastases, surgical biopsy is suggested in those patients who have no history of cancer.
Collapse
|
20
|
Budka H, Podreka I, Reisner T, Zeiler K. Diagnostic and pathomorphological aspects of glioma multiplicity. Neurosurg Rev 1980; 3:233-41. [PMID: 7279228 DOI: 10.1007/bf01650028] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A series of 11 patients with multiple glioma foci is reported with emphasis upon isotope brain scan, angiography, and CT findings; autopsy data is available in 8 cases. In many patients it was necessary to combine the results of several diagnostic techniques in order to demonstrate all the foci proven at autopsy. Thus, the desirability of combining diagnostic techniques in the investigation of glioma patients must be stressed. In spite of this approach, however, multiple metastases and the various types of multiple gliomas are often indistinguishable from each other by current diagnostic techniques.
Collapse
|
21
|
Rao KC, Levine H, Itani A, Sajor E, Robinson W. CT findings in multicentric glioblastoma: diagnostic-pathologic correlation. THE JOURNAL OF COMPUTED TOMOGRAPHY 1980; 4:187-92. [PMID: 6266773 DOI: 10.1016/0149-936x(80)90003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Computerized cranial tomography (CCT) and angiographic findings in three cases of multicentric glioblastoma are reported. Differentiation of multicentric glioblastoma from diffuse metastatic deposits or multiple abscesses can be difficult with CCT. Apart from demonstrating a mass effect in one case and tumor neovascularity in the second case, angiography did not provide additional helpful information. The pathological diagnoses of these lesions were confirmed by biopsy and subsequent autopsy. Pathological differentiation of the multifocal or multicentric nature of the glioblastoma can be made only at autopsy.
Collapse
|
22
|
Pöyhönen L, Heikkinen J, Vehkalahti I. Two different primary tumours of the brain in a patient with breast cancer. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1979; 4:483-4. [PMID: 230047 DOI: 10.1007/bf00300851] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Some reports on multiple primary brain tumours have been published. When one or more tumours are found in brain scintigraphy they are often supposed to be metastases. Further investigations may thus be given up, especially if the patient has or has had a malignant tumour in some other part of the body. In this report a case is described where the patient began to have cerebral symptoms two years after she had been operated for breast cancer. In the scintigraphy a tumour was found in both brain hemispheres. The tumours were regarded as metastases. But when the patient died in a geriatric hospital it was recognized from the autopsy that one tumour was a meningioma and the other a glioblastoma multiforme.
Collapse
|
23
|
Abstract
Glioblastoma multiforme, representing about 50% of all gliomas, encompasses a group of intrinsic tumours of the brain in later years (age peak around 50 years), the morphological hallmarks of which are an ensemble of variations in tumour cell and tissue structure featuring its biological malignancy. Glioblastoma, while sometimes appearing as a distinct "primary" tumour type, is usually accepted as an extreme manifestation of anaplasia and dedifferentiation of glia, mostly astrocytic. The astrocytic nature of most glioblastomas has been confirmed by ultrastructural studies and progressive differentiation of tumours maintained in organotypic tissue culture. Reproducible experimental models are particularly induced by oncogenic RNA (oncorna) viruses. The cell kinetic parameters are similar to those of other solid malignant tumours except for a comparatively low growth fraction of glioblastoma. The frequent occurrence of giant cells as well as of regressive changes with necrosis and vascular responses are indirect (secondary) indicators of malignancy which coincide with histochemical (enzymatic anisochronia) and biochemical data (lower level of glia specific S100 protein than in differentiated gliomas). Vascular proliferation, a characteristic feature of glioblastoma, may occasionally progress to sarcomatous transformation with development of gliosarcomas (mixed glial-mesenchymal tumours). While dissemination of glioblastoma through the cerebrospinal pathways is not uncommon, extraneural distant metastatic spread is rare, and usually observed after craniotomy. The results of modern neuro-oncology support the pathogenetic view that glioblastoma results from neoplastic transformation of glial elements with continuing dedifferentiation. This transformation can be experimentally induced by various factors including oncogenic DNA (oncorna) viruses by using a reverse transcriptase, while there is indirect evidence for an oncorna-virus information in human glioblastoma. The significance of immunological factors in the pathogenesis of brain tumours and in the course of neoplastic transformation of glia is not yet understood, but both morphological and immunological data are in favour of a cell mediated immunological reaction against tumour-specific antibodies. Since immunological factors and changes in cytokinetics are apparently active after the transformed tumour cells proliferate, all available therapeutic methods, including radiation, chemotherapy, and immunotherapy of glioblastoma only influence the final stages of neoplastic development with clinical manifestation of the tumour. In spite of modern combination and multimodality therapy schemes the prognosis of glioblastoma is still poor.
Collapse
|
24
|
|