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| ==Historical Perspective== | | ==Historical Perspective== |
| Glioblastoma multiforme was first coined by Percival Bailey and Harvey Cushing in 1926.<ref name=ddd>Terminology of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Classification== | | ==Classification== |
| Glioblastoma multiforme may be classified into several subtypes based on the origin and molecular alterations.<ref name=ddd>Classification of Glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/Glioblastoma multiforme</ref><ref name="pmid20129251">{{cite journal| author=Verhaak RG, Hoadley KA, Purdom E, Wang V, Qi Y, Wilkerson MD et al.| title=Integrated genomic analysis identifies clinically relevant subtypes of Glioblastoma multiforme characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1. | journal=Cancer Cell | year= 2010 | volume= 17 | issue= 1 | pages= 98-110 | pmid=20129251 | doi=10.1016/j.ccr.2009.12.020 | pmc=PMC2818769 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20129251 }} </ref>
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| ==Pathophysiology== | | ==Pathophysiology== |
| Glioblastoma multiforme may be classified according to the molecular alterations into four subtypes.<ref name="pmid20129251">{{cite journal| author=Verhaak RG, Hoadley KA, Purdom E, Wang V, Qi Y, Wilkerson MD et al.| title=Integrated genomic analysis identifies clinically relevant subtypes of Glioblastoma multiforme characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1. | journal=Cancer Cell | year= 2010 | volume= 17 | issue= 1 | pages= 98-110 | pmid=20129251 | doi=10.1016/j.ccr.2009.12.020 | pmc=PMC2818769 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20129251 }} </ref> Genes involved in the pathogenesis of glioblastoma multiforme include ''[[Mdm2]]'', ''[[PTEN]]'', ''IDH1'', ''[[p53]]'', ''[[EGFR]]'', ''PDGFRA'', and chromosomes 10p, 10q, 17p, and 19q. On gross pathology, the characteristic findings of glioblastoma multiforme include a poorly-marginated, diffusely infiltrating, firm or gelatinous mass with a central [[necrosis|necrotic]] core. On microscopic histopathological analysis, the characteristic findings of glioblastoma multiforme include [[pleomorphic]] [[astrocytes]] with marked [[atypia]], [[mitosis]], [[necrosis]], and microvascular proliferation.<ref name=ddd>Pathology of Glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/Glioblastoma</ref>
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| ==Causes== | | ==Causes== |
| There are no established causes for glioblastoma multiforme.<ref name=ddd>Etiology of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Differentiating brain tumors from other diseases== | | ==Differentiating brain tumors from other diseases== |
| Glioblastoma multiforme must be differentiated from [[Metastasis|cerebral metastasis]], [[primary CNS lymphoma]], [[cerebral abscess]], [[Astrocytoma|anaplastic astrocytoma]], [[Demyelination|tumefactive demyelination]], [[stroke]], [[Toxoplasmosis|cerebral toxoplasmosis]], [[Radiation|radiation necrosis]], [[encephalitis]], [[oligodendroglioma]], and [[epilepsy]].<ref name=ddd>DDx of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| Glioblastoma multiforme is the the most common adult primary intracranial neoplasm worldwide.<ref name=ddd>Epidemiology of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref> The incidence of glioblastoma multiforme is estimated to be 3.2 cases per 100,000 individuals worldwide.<ref name="pmid25053711">{{cite journal| author=Thakkar JP, Dolecek TA, Horbinski C, Ostrom QT, Lightner DD, Barnholtz-Sloan JS et al.| title=Epidemiologic and molecular prognostic review of glioblastoma. | journal=Cancer Epidemiol Biomarkers Prev | year= 2014 | volume= 23 | issue= 10 | pages= 1985-96 | pmid=25053711 | doi=10.1158/1055-9965.EPI-14-0275 | pmc=PMC4185005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25053711 }} </ref> Glioblastoma multiforme is a common disease that tends to affect older adult and elderly population. The median age at diagnosis is 64 years.<ref name="pmid25053711">{{cite journal| author=Thakkar JP, Dolecek TA, Horbinski C, Ostrom QT, Lightner DD, Barnholtz-Sloan JS et al.| title=Epidemiologic and molecular prognostic review of glioblastoma. | journal=Cancer Epidemiol Biomarkers Prev | year= 2014 | volume= 23 | issue= 10 | pages= 1985-96 | pmid=25053711 | doi=10.1158/1055-9965.EPI-14-0275 | pmc=PMC4185005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25053711 }} </ref> Males are more commonly affected with glioblastoma multiforme than females. The male to female ratio is approximately 1.5:1. Glioblastoma multiforme usually affects individuals of the caucasian race.
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| ==Risk factors== | | ==Risk factors== |
| Common risk factors in the development of glioblastoma multiforme are [[Radiation|radiation exposure]], [[viruses]], [[polyvinyl chloride]], [[alcohol]], and [[Genetic|genetic disorders]].<ref name=ddd>Risk factors of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Screening== | | ==Screening== |
| Screening for glioblastoma multiforme is not recommended.
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| ==Natural History, Complications and Prognosis== | | ==Natural History, Complications and Prognosis== |
| Common complications of glioblastoma multiforme include [[herniation]], [[systemic]] illness, [[brainstem]] invasion by [[tumor]], neutron-induced cerebral injury, [[weakness]], [[fatigue]], [[numbness]], [[surgical]] complications, and [[coma]].<ref name="pmid1654403">{{cite journal| author=Silbergeld DL, Rostomily RC, Alvord EC| title=The cause of death in patients with glioblastoma is multifactorial: clinical factors and autopsy findings in 117 cases of supratentorial glioblastoma in adults. | journal=J Neurooncol | year= 1991 | volume= 10 | issue= 2 | pages= 179-85 | pmid=1654403 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1654403 }} </ref> Prognosis is generally poor, and the 5-year survival rate of patients with glioblastoma multiforme is less than 10%.
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| ==Staging== | | ==Staging== |
| There is no established system for the staging of glioblastoma multiforme.
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| ==History and Symptoms== | | ==History and Symptoms== |
| Common symptoms of glioblastoma multiforme include [[headache]], [[seizure]], [[memory loss]], [[irritability]], changes in speech, difficulty reading or concentrating, [[drowsiness]], [[nausea]], [[vomiting]], [[muscle weakness]], [[sensory loss]], [[diplopia]], [[blurred vision]], [[vertigo]], [[hearing loss]], and [[hiccups]].<ref name=ddd>Presentation of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Physical examination== | | ==Physical examination== |
| Common physical examination findings of glioblastoma multiforme include [[personality changes]], [[memory loss]], [[aphasia]], [[hemiparesis]], [[sensory loss]], and [[ataxia]].<ref name=ddd>Signs of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Laboratory Findings== | | ==Laboratory Findings== |
| There are no diagnostic lab findings associated with glioblastoma multiforme.
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| ==X Ray== | | ==X Ray== |
| There are no x-ray findings associated with glioblastoma multiforme.
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| ==CT== | | ==CT== |
| Head CT scan is helpful in the diagnosis of glioblastoma multiforme. On head CT scan, glioblastoma multiforme is characterized by a butterfly shaped mass with marked midline shift, irregular and heterogenous enhancement of margins, necrotic center, surrounding vasogenic [[edema]], and [[hemorrhage]].<ref name=ddd>XYZ of glioblastoma multiforme multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma multiforme</ref>
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| ==MRI== | | ==MRI== |
| Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by hypointense mass on T1-weighted MRI and hyperintense mass on T2-weighted MRI.<ref name=ddd>XYZ of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Ultrasound== | | ==Ultrasound== |
| There are no ultrasound findings associated with glioblastoma multiforme.
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| ==Other Imaging Findings== | | ==Other Imaging Findings== |
| Other imaging tests for glioblastoma multiforme include [[PET scan]], which demonstrates accumulation of [18F]-fluorodeoxyglucose (increased [[glucose metabolism]]).<ref name=ddd>Radiographic features of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Other Diagnostic Studies== | | ==Other Diagnostic Studies== |
| Other diagnostic studies for glioblastoma multiforme include [[biopsy]], which demonstrates pleomorphic astroctyes with marked [[atypia]] and [[mitoses]].<ref name=ddd>Pathology of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==Medical Therapy== | | ==Medical Therapy== |
| The predominant therapy for glioblastoma multiforme is [[surgical resection]]. Adjunctive [[chemotherapy]] and [[radiation]] may be required.<ref name=ddd>Treatment of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref> Supportive therapy for glioblastoma multiforme includes [[anticonvulsants]] and [[corticosteroids]].
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| ==Surgery== | | ==Surgery== |
| Surgery is the mainstay of treatment for glioblastoma multiforme.<ref name=ddd>Treatment of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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| ==References==
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| {{reflist|2}}
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |