Glioblastoma multiforme overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]
Overview
Glioblastoma multiforme, also known as glioblastoma, is the most common adult primary intracranial neoplasm worldwide. Glioblastoma multiforme may be classified into several subtypes based on the origin and molecular alterations. On gross pathology, the characteristic findings of glioblastoma multiforme include a poorly-marginated, diffusely infiltrating, firm or gelatinous mass with a central necrotic core. On microscopic histopathological analysis, the characteristic findings of glioblastoma multiforme include pleomorphic astrocytes with marked atypia, mitosis, necrosis, and microvascular proliferation. The incidence of glioblastoma multiforme is estimated to be 3.2 cases per 100,000 individuals worldwide. Glioblastoma multiforme is a common disease that tends to affect older adults and the elderly population. The median age at diagnosis is 64 years. Males are more commonly affected with glioblastoma multiforme than females. Common risk factors in the development of glioblastoma multiforme are radiation exposure, viruses, polyvinyl chloride, alcohol, and genetic disorders. Common complications of glioblastoma multiforme include herniation, systemic illness, brainstem invasion by tumor, neutron-induced cerebral injury, weakness, fatigue, numbness, surgical complications, and coma. Prognosis is generally poor, and the 5-year survival rate of patients with glioblastoma multiforme is less than 10%. 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. Common physical examination findings of glioblastoma multiforme include personality changes, memory loss, aphasia, hemiparesis, sensory loss, and ataxia. Head CT scan and brain MRI are 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. On brain MRI, glioblastoma multiforme is characterized by hypointense mass on T1-weighted MRI and hyperintense mass on T2-weighted MRI. The predominant therapy for glioblastoma multiforme is surgical resection. Adjunctive chemotherapy and radiation may be required. Supportive therapy for glioblastoma multiforme includes anticonvulsants and corticosteroids.
Historical Perspective
The term glioblastoma multiforme was first coined by Percival Bailey and Harvey Cushing in 1926.
Classification
Glioblastoma multiforme may be classified into several subtypes based on the origin (primary and secondary) and molecular alterations (classic, proneural, mesenchymal, and neural).
Pathophysiology
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 necrotic core. On microscopic histopathological analysis, the characteristic findings of glioblastoma multiforme include pleomorphic astrocytes with marked atypia, mitosis, necrosis, and microvascular proliferation.
Causes
There are no established causes for glioblastoma multiforme.
Differentiating brain tumors from other diseases
Glioblastoma multiforme must be differentiated from cerebral metastasis, primary CNS lymphoma, cerebral abscess, anaplastic astrocytoma, tumefactive demyelination, stroke, cerebral toxoplasmosis, radiation necrosis, encephalitis, oligodendroglioma, and seizure disorder.
Epidemiology and Demographics
Glioblastoma multiforme is the the most common adult primary intracranial neoplasm worldwide. The incidence of glioblastoma multiforme is estimated to be 3.2 cases per 100,000 individuals worldwide. Glioblastoma multiforme is a common disease that tends to affect older adult and elderly population. The median age at diagnosis is 64 years. Males are more commonly affected with glioblastoma multiforme than females. The male to female ratio is approximately 1.5 to 1. Glioblastoma multiforme usually affects individuals of the Caucasian race.
Risk factors
Common risk factors in the development of glioblastoma multiforme are radiation exposure, viruses, polyvinyl chloride, alcohol, and genetic disorders.
Screening
Screening for glioblastoma multiforme is not recommended.
Natural History, Complications and Prognosis
If left untreated, glioblastoma multiforme may extend into the meninges, ventricular wall, or spinal cord. Common complications of glioblastoma multiforme include herniation, hydrocephalus, systemic illness, brainstem invasion by tumor, neutron-induced cerebral injury, weakness, fatigue, numbness, surgical complications, and coma. Prognosis is generally poor, and the 5-year survival rate of patients with glioblastoma multiforme is less than 10%.
Staging
There is no established system for the staging of glioblastoma multiforme.
History and Symptoms
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.
Physical examination
Common physical examination findings of glioblastoma multiforme include personality changes, memory loss, aphasia, hemiparesis, sensory loss, and ataxia.
Laboratory Findings
There are no diagnostic lab findings associated with glioblastoma multiforme.
X Ray
There are no x-ray findings associated with glioblastoma multiforme.
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.
MRI
Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by a butterfly shaped mass, which is hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI.
Ultrasound
There are no ultrasound findings associated with glioblastoma multiforme.
Other Imaging Findings
Other imaging tests for glioblastoma multiforme include PET scan, which demonstrates accumulation of [18F]-fluorodeoxyglucose (increased glucose metabolism).
Other Diagnostic Studies
Other diagnostic studies for glioblastoma multiforme include biopsy, which demonstrates pleomorphic astroctyes with marked atypia and mitoses.
Medical Therapy
The predominant therapy for glioblastoma multiforme is surgical resection. Adjunctive chemotherapy and radiation may be required. Supportive therapy for glioblastoma multiforme includes anticonvulsants and corticosteroids.
Surgery
Surgery is the mainstay of treatment for glioblastoma multiforme.
Primary Prevention
There are no established measures for primary prevention of glioblastoma multiforme.
Secondary Prevention
There are no established measures for secondary prevention of glioblastoma multiforme.