Glioblastoma multiforme - Erler Zimmer
Clinical History
Over a span of three years, a 57-year-old female experienced recurrent frontal headaches and memory disruptions that progressed to psychiatric symptoms, eventually leading to vomiting and signs of meningeal involvement. Detectable neurological signs manifested only in the later stages of the disease.
Pathology
A coronal section through the cerebral hemisphere reveals a circular, hemorrhagic, variegated tumor situated in the left temporal lobe. Less defined tumor tissue extends across the midline, replacing the corpus callosum. The ventricular system is nearly completely obliterated. Subsequent sections confirm that these seemingly distinct lesions are extensions of one massive tumor.
Further Information
Gliomas rank as the second most prevalent central nervous system cancer, following meningiomas. The term "glioma" encompasses tumors that histologically resemble normal glial (macroglial) cells—specifically, astrocytes, oligodendrocytes, and ependymal cells. They originate from a progenitor cell that differentiates along one of the cell lines. Glioblastomas (GBMs) can arise spontaneously in the brain or evolve from lower-grade astrocytomas or oligodendrogliomas, often referred to as grade IV astrocytomas. Histologically, GBMs differ from anaplastic astrocytomas by necrotic tissue surrounded by anaplastic cells and the presence of hyperplastic blood vessels.
GBMs exhibit a higher incidence in males and are typically diagnosed in the sixth decade of life. Genetic risk factors include neurofibromatosis type 1 and Li-Fraumeni syndrome. Previous brain radiotherapy is also associated with an increased risk of GBMs. Symptoms vary based on the tumor's location and may include persistent headaches, double or blurred vision, vomiting, loss of appetite, changes in mood and personality, changes in cognitive abilities, new onset of seizures, and gradual speech difficulties.
Diagnostic tools encompass computed tomography (CT scan) and magnetic resonance imaging (MRI). Approximately 50% of these tumors span multiple cerebral hemispheres. GBMs often extend into ventricular walls or meninges, reaching into the cerebrospinal fluid (CSF). Spinal cord spread is rare, and metastasis beyond the central nervous system is uncommon. Tumor growth induces cerebral edema, elevating intracranial pressure. These aggressive tumors, if untreated, result in a typical survival period of three months. The primary treatment for GBMs involves surgery, followed by radiation and chemotherapy.
*Microglia, distinct from macroglia, belong to the microphage lineage and originate initially from the yolk sac and later from the bone marrow.*
