By DR TEFFY JOSE M1 UNIT PROF RUCKMANI’S UNIT
 
 
 
<ul><li>CT scan brain plain study  : </li></ul><ul><li>An illdefined large hypodense area is seen in the right frontal reg...
<ul><li>Impression : </li></ul><ul><li>Illdefined large hypodense SOL in the right frontal region causing mass effect & mi...
 
 
 
 
 
 
<ul><li>MRI  scan of brain  : </li></ul><ul><li>Well defined heterogenously enhancing mass lesion noted in the right front...
<ul><li>Impression  : </li></ul><ul><li>Features highly s/o GLIOBLASTOMA MULTIFORME </li></ul><ul><li>( butterfly glioma )...
Glioblastoma multiforme <ul><li>A diffusely infiltrating astrocytoma ( WHO 2000 classification Grade IV) </li></ul><ul><li...
Pathogenesis <ul><li>Cell of origin </li></ul><ul><li>Cell of origin </li></ul><ul><li>EGFR  amp </li></ul><ul><li>LOH 10 ...
<ul><li>Rapidly growing tumors, highly cellular,often provoke a large amount of edema & usually contain areas of necrosis,...
<ul><li>Seen late in adult life, with a peak occurrence b/w 45 – 60 yrs. </li></ul><ul><li>May  present  with  </li></ul><...
<ul><li>MRI  features: </li></ul><ul><li>High signal intensity on T2 weighted images & low signal intensity on T1 weighted...
<ul><li>Management: </li></ul><ul><li>Dexamethasone – administered at the time of diagnosis & continued for the duration o...
<ul><li>Chemotherapy </li></ul><ul><li>Is marginally effective & is used as an adjuvant therapy following surgery & RT </l...
<ul><li>Experimental approaches include </li></ul><ul><li>- Bypassing BBB using local injections into tumor mass </li></ul...
<ul><li>Prognosis: </li></ul><ul><li>- age, functional status,extent of surgical resection. </li></ul><ul><li>- survival ≈...
 
Upcoming SlideShare
Loading in...5
×

CT Scan: Glioblastoma Multiforme

4,150

Published on

Published in: Health & Medicine, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,150
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
350
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

CT Scan: Glioblastoma Multiforme

  1. 1. By DR TEFFY JOSE M1 UNIT PROF RUCKMANI’S UNIT
  2. 5. <ul><li>CT scan brain plain study : </li></ul><ul><li>An illdefined large hypodense area is seen in the right frontal region & extending across the midline along the genu of the corpus callosum. </li></ul><ul><li>There is mild mass effect in the form of subfalcine herniation & squashing of the frontal horn of right lateral ventricle. </li></ul><ul><li>Left lateral ventricle is prominent. Midline shift of 4.7mm to left is seen. </li></ul><ul><li>Rest of cerebral parenchyma shows normal attenuation. </li></ul><ul><li>All other areas appear to be normal. </li></ul>
  3. 6. <ul><li>Impression : </li></ul><ul><li>Illdefined large hypodense SOL in the right frontal region causing mass effect & midline shift to left. </li></ul><ul><li>Suggested CECT / MRI for further evaluation. </li></ul>
  4. 13. <ul><li>MRI scan of brain : </li></ul><ul><li>Well defined heterogenously enhancing mass lesion noted in the right frontal region basal aspect crossing over to the left frontal region through the corpus callosum with areas of necrosis & hemorrhage. </li></ul><ul><li>The lesion causing mass effect on the frontal horn of both lateral ventricles.The mass lesion measures about 7.8 * 5.6 *4.65 cm. </li></ul><ul><li>MR spectroscopy shows increased lactate,choline peak & reuced NAA levels. </li></ul><ul><li>All other areas appear to be normal. </li></ul>
  5. 14. <ul><li>Impression : </li></ul><ul><li>Features highly s/o GLIOBLASTOMA MULTIFORME </li></ul><ul><li>( butterfly glioma ) involving both frontal lobes ( Rt > Lt ) </li></ul>
  6. 15. Glioblastoma multiforme <ul><li>A diffusely infiltrating astrocytoma ( WHO 2000 classification Grade IV) </li></ul><ul><li>Most common form of cerebral glioma accounting for 12-15 % of all intacranial neoplasms & 50-60% of all astrocytic tumors </li></ul>
  7. 16. Pathogenesis <ul><li>Cell of origin </li></ul><ul><li>Cell of origin </li></ul><ul><li>EGFR amp </li></ul><ul><li>LOH 10 (PTEN) </li></ul><ul><li>CDK4 amp </li></ul><ul><li>MDM2 amp </li></ul><ul><li>Other LOH (eg </li></ul><ul><li>DCC) </li></ul><ul><li>Other amp (eg </li></ul><ul><li>PDGFR) </li></ul><ul><li>DENOVO :GBM </li></ul><ul><li>WHO grade IV </li></ul><ul><li>LOH17p(p53) </li></ul><ul><li>Astrocytoma </li></ul><ul><li>WHO grade II </li></ul><ul><li>LOH19q </li></ul><ul><li>LOH9p(INK4a) </li></ul><ul><li>Astrocytoma </li></ul><ul><li>WHO grade III </li></ul><ul><li>LOH 10 q(PTEN) </li></ul><ul><li>Secondary : GBM, </li></ul><ul><li>WHO gradeIV </li></ul>
  8. 17. <ul><li>Rapidly growing tumors, highly cellular,often provoke a large amount of edema & usually contain areas of necrosis,& do not have a clearly defined margin. </li></ul><ul><li>Supratentorial, frontal lobes are a common site of involvement & extension contralaterally through corpus callosum may give rise to a butterfly pattern. </li></ul><ul><li>May become adherent to the overlying dura , but seldom penetrate it. </li></ul><ul><li>Infiltration of ependyma & dissemination through CSF pathway may occur in late cases. </li></ul><ul><li>Multicentricity can be seen in 4-10% of cases. </li></ul><ul><li>Extraneural metastasis are rare. </li></ul>
  9. 18. <ul><li>Seen late in adult life, with a peak occurrence b/w 45 – 60 yrs. </li></ul><ul><li>May present with </li></ul><ul><li>Seizure </li></ul><ul><li>Subacute progression of a focal neurologic deficit </li></ul><ul><li>Nonfocal neurologic disorder such as headache,dementia, personality change or gait disorder </li></ul><ul><li>Median survival is < 1 yr. </li></ul>
  10. 19. <ul><li>MRI features: </li></ul><ul><li>High signal intensity on T2 weighted images & low signal intensity on T1 weighted images </li></ul><ul><li>Infiltrate along white matter tracts & deeper lesions have a propensity to extend across the corpus callosum to opposite hemisphere </li></ul><ul><li>Often have considerable mass effect, vasogenic edema& more commonly show evidence of haemorrhage </li></ul><ul><li>Irregular ring enhancement with nodularity & nonenhancing necrotic foci is typical of glioblastoma </li></ul><ul><li>Microscopic fingers of tumour usually extend for variable distances beyond the area of enhancement </li></ul>
  11. 20. <ul><li>Management: </li></ul><ul><li>Dexamethasone – administered at the time of diagnosis & continued for the duration of radiotherapy </li></ul><ul><li>Accesible astrocytomas are generally resected aggressively, even though total surgical resection is not possible </li></ul><ul><li>Post op RT – prolongs survival & improve quality of life ( 5000-7000 cGy to tumor mass in 25-35 fractions, 5days/wk) </li></ul><ul><li>Role of stereotaxic radiosurgery & interstitial brachytherapy in glioma trt is uncertain </li></ul>
  12. 21. <ul><li>Chemotherapy </li></ul><ul><li>Is marginally effective & is used as an adjuvant therapy following surgery & RT </li></ul><ul><li>Temozolomide , an oral alkylating agent has replaced nitrosoureas </li></ul><ul><li>- 2½ mths longer survival in pts with methylation & silencing of the promoter for the MGMT gene </li></ul><ul><li>Surgical implantation directly into tumor resection cavity of polymer wafers that releases BCNU locally into surrounding brain </li></ul>
  13. 22. <ul><li>Experimental approaches include </li></ul><ul><li>- Bypassing BBB using local injections into tumor mass </li></ul><ul><li>- Intraarterial injection of chemotherapy following osmotic disruption of BBB </li></ul><ul><li>Molecular targeted therapies – EGFR antagonists or inhibitors of its signalling pathways ( Gefitinib /Erlotinib) , Bevacizumab </li></ul>
  14. 23. <ul><li>Prognosis: </li></ul><ul><li>- age, functional status,extent of surgical resection. </li></ul><ul><li>- survival ≈ 3 mths (without therapy) , 12 mths (with therapy). </li></ul><ul><li>- recurrence is common. </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×