Brain
Joseph Kovi, Hung Dinh Duong in Frozen Section In Surgical Pathology: An Atlas, 2019
Tumors of the brain and central nervous system are the second most common cause of cancer death in males under age 34 years and in females under the age of 15 years, exceeded only by leukemia in mortality. Oligodendroglioma is most commonly found in the frontal lobe. Meningioma is not a tumor of the brain proper but a tumor of the brain coverings. Accurate information furnished by the surgeon is vital in arriving at a correct frozen section diagnosis: Knowledge of the age of the patient eliminates quite a number of tumors occurring in the brain or central nervous system. Hemangioblastoma is a relatively uncommon intracranial neoplasm. The rapid reticulin stain of Wilder is most useful in differentiating astrocytomas from neurilemomas in frozen section. Glioblastoma multiforme is a necrotic, hemorrhagic lesion which blends imperceptibly into the surrounding brain tissue. Astrocytoma is gray-white in color, usually not necrotic or hemorrhagic.
Neoplasms
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
The common tumours within the nervous system, gliomas and cerebral metastases, are rarely curable. The most common primary brain tumour is glioblastoma multiforme. The terminal management of malignant tumours affecting the nervous system is challenging. The journey from acute presentation to death can be agonising. Evaluating the benefit–risk ratio in the management of neoplasms is critically important. The benefits of debulking surgery, radiotherapy and chemotherapy require balancing against the adverse effects of these relatively crude interventions. The propensity to develop sustained and troublesome anxiety, often precipitated by situations, is enhanced in those with brain tumours. The situation with depression is similar, the risk being enhanced by the multiple losses accumulated during the illness. Anxious irritability, rather than overt misery of mood, is not unusual in organic conditions. Both anxiety and depression are more likely early in the course of illness when insight and judgement is retained and the devastating impact on life is able to be acknowledged.
Glioblastoma
Dongyou Liu in Tumors and Cancers, 2017
Glioblastoma (formerly glioblastoma multiforme), a WHO Grade IV tumor, represents the most common primary malignant brain tumor, with extremely aggressive behavior. It can arise de novo or result from malignant transformation of other gliomas, such as diffuse astrocytoma and/or anaplastic astrocytoma. Glioblastoma exhibits the highest degree of angiogenesis of all solid tumors. Patients with glioblastoma often manifest with the classical triad of increased intracranial pressure. Characteristic histopathological features of glioblastoma include nuclear atypia, mitotic activity, microvascular proliferation, and necrosis. The current standard care for glioblastoma consists of safe maximal surgical resection followed by concurrent radiation followed by adjuvant temozolomide. The prognosis of glioblastoma remains poor despite advancements in treatment. Younger age at diagnosis and good performance status are independent favorable prognostic factors. Glioblastoma exhibits heterogeneity at the morphological, biological, genomic, and antigenic levels, rendering the tumor cells resistant to available treatment modalities.
Glioblastoma multiforme presenting as cryptogenic intracerebral hemorrhage
Published in Baylor University Medical Center Proceedings, 2018
Jose M. Soto, Kristopher A. Lyon, Ethan A. Benardete
We report a case of glioblastoma multiforme that presented as a large, spontaneous intracerebral hemorrhage (ICH). A 52-year-old woman developed headaches associated with photophobia and nausea. Computed tomography scan revealed a large ICH in the right temporal lobe. Further imaging, including magnetic resonance imaging and catheter-based arteriography, did not demonstrate an underlying lesion. She had 2-month follow-up imaging that was consistent with resolution of her hematoma and, again, no evidence of an associated mass. Six months after the initial ICH, she presented with worsening headaches. Magnetic resonance imaging of her brain at that time clearly demonstrated a large enhancing mass in the area of prior hemorrhage. Following tumor resection, histological diagnosis indicated glioblastoma multiforme. This case highlights the benefit of neurosurgical follow-up for patients with cryptogenic ICH and maintaining a high index of suspicion for brain tumor.
Multicentric Glioblastoma Multiforme Mimicking Optic Neuritis
Published in Neuro-Ophthalmology, 2018
Francesco Pellegrini, Andrew G. Lee, Cristina Cercato
A 49-year-old previously healthy woman presented with acute painless visual loss in the right eye, a right relative afferent pupillary defect, and a normal fundus examination. She was diagnosed with retrobulbar “optic neuritis” and given a course of intravenous steroids. Despite treatment, however, she continued to lose vision and serial visual field testing confirmed a junctional scotoma in the fellow eye. Cranial magnetic resonance imaging (MRI) showed a mass at the junction between the right optic nerve and the anterior aspect of the chiasm and a right frontal lesion that proved to be multicentric glioblastoma multiforme. Clinicians should be aware of the possibility of aggressive neoplasm in the differential diagnosis of retrobulbar optic neuritis.
The role of glioma stem cells in chemotherapy resistance and glioblastoma multiforme recurrence
Published in Expert Review of Neurotherapeutics, 2015
Brenda Auffinger, Drew Spencer, Peter Pytel, Atique U Ahmed, Maciej S Lesniak
Glioma stem cells (GSCs) constitute a slow-dividing, small population within a heterogeneous glioblastoma. They are able to self-renew, recapitulate a whole tumor, and differentiate into other specific glioblastoma multiforme (GBM) subpopulations. Therefore, they have been held responsible for malignant relapse after primary standard therapy and the poor prognosis of recurrent GBM. The failure of current therapies to eliminate specific GSC subpopulations has been considered a major factor contributing to the inevitable recurrence in GBM patients after treatment. Here, we discuss the molecular mechanisms of chemoresistance of GSCs and the reasons why complete eradication of GSCs is so difficult to achieve. We will also describe the targeted therapies currently available for GSCs and possible mechanisms to overcome such chemoresistance and avoid therapeutic relapse.
Related Knowledge Centers
- Astrocytoma
- Brain Tumor
- IV
- IV
- Who Classification of The Tumors of The Central Nervous System
- Glial Cell
- Giant Cell Glioblastoma
- Gliosarcoma