High-grade glioma

High-grade gliomas (HGGs), are the most common intrinsic brain tumors in adults hallmarked by rapid proliferation, hypervascularization, and an invasive growth pattern.

The process of malignant transformation (MT) of Low-grade glioma (LGG) to HGG is poorly understood but likely involves the activation of signaling programs that suppress apoptosis.

While there has been progress in understanding the molecular genetics of these tumors 1) , the cell type(s) of origin are still uncertain, and the molecular determinants of disease aggressiveness are not well understood. A better understanding of the cellular origin and molecular pathogenesis of these tumors may identify new targets for treatment of these neoplasms.

Intratumoral hypoxia is thought to be a main contributor to tumorigenesis and angiogenesis of these tumors. Because HIF1A is the major mediator of hypoxia-regulated cellular control, inhibition of this transcription factor may reduce glioblastoma growth.

Dissemination of high-grade gliomas (WHO grade IV) has been investigated poorly so far.

A 58-year-old male with slight left hemiparesis. The radiological evaluation with contrast administred magnetic resonance imaging (MRI) scan demonstrated a right temporo-parietal ring enhancing mass lesion surrounded by edema which was resembling a typical glioma.

The patient was operated on via a temporo-parietal craniotomy and an arteriovenous malformation surrounded by abnormal glial tissue was observed during the exposure. A nidus supplied by several branches arising from the middle cerebral artery (MCA) was obvious. The venous drainage of the malformation was to the superficial venous system. The observed arterial feeders and the draining vein were coagulated and the nidus was macroscopically totally excised. The frozen examination from surrounding glial tissue revealed a high-grade glioma . The tumor was also macroscopically totally excised. Postoperatively, the cerebral angiogram demonstrated a right temporal arteriovenous malformation with a centrally excised nidus. The remaining major feeders involved the angular gyrus and the posterior temporal arteries. The venous drainage was to the straight and sigmoid sinuses.

The final histopathological examination of the specimen revealed an arteriovenous malformation surrounded by a high-grade glioma .

The patient refused a second operation for total removal of the AVM. Postoperatively, he is doing well with improvement of his left hemiparesis 2).

A 57-year-old woman admitted to Neurosurgery due to difficulty opening the door of his house (he has no precision in grasping the doorknob) and a sensation of numbness in his left hand.

History of tachycardia and palpitations (palpitation aura ?)Studied by Holter monitor by Cardiology and discharged in the absence of significant alterations. They prescribe symptomatic treatment of palpitations with bisoprolol if necessary.

Hysterectomy + Oophorectomy for giant myoma.

Calcium carbonate + cholecalciferol

Intraaxial heterogeneous lesion located on the periphery of the right parietal lobe measuring about 25 mm x 21 mm x 26 mm (ap x tra x cc) with a central hypointense-necrotic area and peripheral irregular enhancement, which presents restricted diffusion of its necrotic component and Associated perilesional vasogenic edema. It exerts a mass effect on the adjacent sulci with slight obliteration of the ventricular atrium, a deviation of about 5 mm from the midline to the left, and slight subfalcine herniation. In the T2* sequence, 2 hypointense foci are identified that translate foci of calcification or microbleeding. In the FLAIR sequence, within the hyperintensity of the associated perisessional edema, there are areas of lower signal intensity adjacent to the lesion, which suggests a tumor infiltrative component.

Given the appearance of the lesion, it suggests that it is a high-grade glial neoplasm, less likely metastasis.

G.J. Kitange, K.L. Templeton, R.B. Jenkins Recent advances in the molecular genetics of primary gliomas Curr. Opin. Oncol., 15 (2003), pp. 197–203
Ziyal IM, Ece K, Bilginer B, Tezel GG, Ozcan OE. A glioma with an arteriovenous malformation: an association or a different entity? Acta Neurochir (Wien). 2004 Jan;146(1):83-6; discussion 86. Epub 2003 Dec 5. PubMed PMID: 14740271.
  • high-grade_glioma.txt
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