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A patient with multiple synchronous gliomas of distinctly different grades and correlative radiographic findings.

Nakhl F, Chang EM, Shiau JS, Alastra A, Wrzolek M, Odaimi M, Raden M, Juliano JE - Surg Neurol Int (2010)

Bottom Line: Magnetic resonance imaging (MRI) with and without gadolinium revealed a nonenhancing left temporal lobe mass without surrounding edema, an enhancing left frontal lobe mass with surrounding edema, and an enhancing right parietal lobe mass with surrounding edema.Intraoperative Brainlab® image-guided navigation was used.Postoperative treatment consisted of radiotherapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Hematology/Oncology, Staten Island University Hospital, Neuroscience Associates of New York, New York.

ABSTRACT

Background: Multiple gliomas represent approximately 2 to 5% of all high-grade gliomas which are categorized as multifocal or multicentric depending on the timing, location and pattern of spread. We present a patient with bi-hemispheric, noncontiguous, low- and high-grade gliomas proven by biopsy. She underwent surgical excision and radiotherapy, but unfortunately succumbed to her disease shortly thereafter.

Case description: A 64-year-old female presented to the hospital with confusion, disorientation and retrograde amnesia after an unwitnessed fall. There were no symptoms of headaches or visual disturbances before presentation. Magnetic resonance imaging (MRI) with and without gadolinium revealed a nonenhancing left temporal lobe mass without surrounding edema, an enhancing left frontal lobe mass with surrounding edema, and an enhancing right parietal lobe mass with surrounding edema. The patient underwent a left frontal craniotomy with gross total resection of the left frontal mass and a left temporal craniotomy, anterior temporal lobectomy and sub-total resection of the temporal lobe mass. Intraoperative Brainlab® image-guided navigation was used. Postoperative treatment consisted of radiotherapy.

Conclusion: This is the first reported case of multiple separate glial tumors, each with differing grades in which an MRI can be correlated with the tissue diagnoses. This case also highlights the possible mechanisms of transformation of glial tumors in the continuum from benign to malignant forms, lending insight to the possibility of using advanced genetic analysis in the treatment and diagnosis of these entities.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph of periphery of high-grade frontal tumor. Note cellular neoplasm on the right, and endothelial proliferation in the adjacent brain tissue, on the left. H and E stain, medium power magnification
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Figure 0006: Photomicrograph of periphery of high-grade frontal tumor. Note cellular neoplasm on the right, and endothelial proliferation in the adjacent brain tissue, on the left. H and E stain, medium power magnification

Mentions: The patient was maintained on anti-convulsive medications. Subsequently, she underwent left-sided craniotomies for gross total resection of the left frontal tumor, anterior temporal lobectomy and subtotal resection of the temporal lobe tumor. Intra-operative microscope and BrainLab®, Munich, Germany, image-guided navigational system were utilized for the surgery. There was no attempt to remove or biopsy the right parietal tumor. The left frontal specimen showed primary high grade (WHO grade IV) primary neoplasm with astrocytic and neuronal differentiation [Figure 3a,b]. Immunohistochemical studies confirmed glial and neuronal differentiation of the tumor and excluded metastatic carcinoma. Interestingly, this high-grade frontal tumor showed also areas of lower cellularity with less mitotic activity, suggestive of a possible origin from an underlying low-grade glioma. On the other hand, the temporal tumor showed cerebral tissue with low-grade infiltrating astrocytic glioma (WHO grade II) only [Figure 4a,b].


A patient with multiple synchronous gliomas of distinctly different grades and correlative radiographic findings.

Nakhl F, Chang EM, Shiau JS, Alastra A, Wrzolek M, Odaimi M, Raden M, Juliano JE - Surg Neurol Int (2010)

Photomicrograph of periphery of high-grade frontal tumor. Note cellular neoplasm on the right, and endothelial proliferation in the adjacent brain tissue, on the left. H and E stain, medium power magnification
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958331&req=5

Figure 0006: Photomicrograph of periphery of high-grade frontal tumor. Note cellular neoplasm on the right, and endothelial proliferation in the adjacent brain tissue, on the left. H and E stain, medium power magnification
Mentions: The patient was maintained on anti-convulsive medications. Subsequently, she underwent left-sided craniotomies for gross total resection of the left frontal tumor, anterior temporal lobectomy and subtotal resection of the temporal lobe tumor. Intra-operative microscope and BrainLab®, Munich, Germany, image-guided navigational system were utilized for the surgery. There was no attempt to remove or biopsy the right parietal tumor. The left frontal specimen showed primary high grade (WHO grade IV) primary neoplasm with astrocytic and neuronal differentiation [Figure 3a,b]. Immunohistochemical studies confirmed glial and neuronal differentiation of the tumor and excluded metastatic carcinoma. Interestingly, this high-grade frontal tumor showed also areas of lower cellularity with less mitotic activity, suggestive of a possible origin from an underlying low-grade glioma. On the other hand, the temporal tumor showed cerebral tissue with low-grade infiltrating astrocytic glioma (WHO grade II) only [Figure 4a,b].

Bottom Line: Magnetic resonance imaging (MRI) with and without gadolinium revealed a nonenhancing left temporal lobe mass without surrounding edema, an enhancing left frontal lobe mass with surrounding edema, and an enhancing right parietal lobe mass with surrounding edema.Intraoperative Brainlab® image-guided navigation was used.Postoperative treatment consisted of radiotherapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Hematology/Oncology, Staten Island University Hospital, Neuroscience Associates of New York, New York.

ABSTRACT

Background: Multiple gliomas represent approximately 2 to 5% of all high-grade gliomas which are categorized as multifocal or multicentric depending on the timing, location and pattern of spread. We present a patient with bi-hemispheric, noncontiguous, low- and high-grade gliomas proven by biopsy. She underwent surgical excision and radiotherapy, but unfortunately succumbed to her disease shortly thereafter.

Case description: A 64-year-old female presented to the hospital with confusion, disorientation and retrograde amnesia after an unwitnessed fall. There were no symptoms of headaches or visual disturbances before presentation. Magnetic resonance imaging (MRI) with and without gadolinium revealed a nonenhancing left temporal lobe mass without surrounding edema, an enhancing left frontal lobe mass with surrounding edema, and an enhancing right parietal lobe mass with surrounding edema. The patient underwent a left frontal craniotomy with gross total resection of the left frontal mass and a left temporal craniotomy, anterior temporal lobectomy and sub-total resection of the temporal lobe mass. Intraoperative Brainlab® image-guided navigation was used. Postoperative treatment consisted of radiotherapy.

Conclusion: This is the first reported case of multiple separate glial tumors, each with differing grades in which an MRI can be correlated with the tissue diagnoses. This case also highlights the possible mechanisms of transformation of glial tumors in the continuum from benign to malignant forms, lending insight to the possibility of using advanced genetic analysis in the treatment and diagnosis of these entities.

No MeSH data available.


Related in: MedlinePlus