multiple_gliomas

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multiple_gliomas [2021/01/21 16:04]
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multiple_gliomas [2021/01/29 09:55] (current)
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 +====== Multiple gliomas ======
  
 +Some of the following terms are inconsistently used interchangeably: “[[multicentric glioma]],” “[[multifocal glioma]],” and “[[multiple glioma]]”.
 +----
 +
 +Discussion of multiple [[glioma]]tous masses has to acknowledge the concept that [[astrocytoma]] is a [[multifocal]] disease, not a focal one. Some terms are probably artificial. The term [[gliomatosis cerebri]] has been dropped by the [[World Health Organization Classification of Tumors of the Central Nervous System 2016]]. Now, widespread [[brain invasion]] involving ≥ 3 [[lobe]]s, frequently with bilateral involvement and often with [[posterior fossa]] extension, is considered a special pattern of spread within several diffuse [[glioma]] subtypes.
 +
 +Settings in which multiple gliomatous masses are encountered:
 +
 +conventional glioma that has spread by one of the mechanisms previously described multiple primary gliomas: some of the following terms are inconsistently used interchangeably: “[[multicentric glioma]],” “[[multifocal glioma]],” and “[[multiple glioma]].” The reported range of occurrence is 2–20% of gliomas
 +((Barnard RO, Geddes JF. The Incidence of Multifocal Cerebral Gliomas: A Histological Study of Large Hemisphere Sections. Cancer. 1987; 60:1519–1531))
 +((van Tassel P, Lee Y-Y, Bruner JM. Synchronous and Metachronous Malignant Gliomas: CT Findings. AJNR. 1988; 9:725–732))
 +(lower end of range ≈ 2–4% is probably more accurate; the higher end of the range is probably accounted for by infiltrative extension
 +((Harsh GR, Wilson CB, Youmans JR. Neuroepithelial
 +Tumors of the Adult Brain. In: Neurological
 +Surgery. 3rd ed. Philadelphia: W. B. Saunders;1990:3040–3136))
 +
 +a) commonly associated with neurofibromatosis and tuberous sclerosis
 +
 +b) rarely associated with multiple sclerosis and progressive multifocal leukoencephalopathy meningeal gliomatosis: dissemination of glioma throughout the CSF, similar to carcinomatous meningitis. Occurs in up to 20% of autopsies on patients with high-grade gliomas. May present with cranial neuropathies, radiculopathies, myelopathy, dementia, and/or communicating hydrocephalus
 +
 +In a series of 25 patients with multicentric glioma,
 +((Salvati M, Caroli E, Orlando ER, et al. Multicentric
 +glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev. 2003; 26: 275–279))
 +glioblastoma was the most common pathology (48%), followed by anaplastic astrocytoma (20%), and glioblastoma with simultaneous AA (20%).
 +
 +Rarely multiple gliomas may be undetectable on CT and will be misdiagnosed as [[pseudotumor cerebri]].
 +
 +▶ Treatment considerations for multiple gliomas. There is little data available. In a nonrandomized study of 25 patients with multifocal glioma
 +((Salvati M, Caroli E, Orlando ER, et al. Multicentric
 +glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev. 2003; 26: 275–279)) 
 +the 16 patients who underwent debulking did better than the 9 who did not. However, there was significant selection bias in choosing patients suitable for craniotomy.
 +A biopsy is generally required/recommended to confirm the diagnosis.
 +----
 +Multiple [[glioma]]s were first observed by Virchow in 1864 and Bradley in 1880.
 +
 +In their seminal paper published in 1962, Batzdorf and Malamud characterized the modes of growth in gliomas by establishing criteria to distinguish multiple and [[multicentric glioma]]s 
 +
 +Namely, multiple gliomas disseminates along established CNS routes, such as [[white matter tract]]s, [[cerebrospinal fluid]] (CSF), or local invasion. 
 +
 +see [[Multicentric glioma]] 
  • multiple_gliomas.txt
  • Last modified: 2021/01/29 09:55
  • by administrador