Your SlideShare is downloading. ×
CT Scan: Glioblastoma Multiforme
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

CT Scan: Glioblastoma Multiforme

3,990
views

Published on

Published in: Health & Medicine, Technology

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,990
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
348
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. By DR TEFFY JOSE M1 UNIT PROF RUCKMANI’S UNIT
  • 2.  
  • 3.  
  • 4.  
  • 5.
    • CT scan brain plain study :
    • An illdefined large hypodense area is seen in the right frontal region & extending across the midline along the genu of the corpus callosum.
    • There is mild mass effect in the form of subfalcine herniation & squashing of the frontal horn of right lateral ventricle.
    • Left lateral ventricle is prominent. Midline shift of 4.7mm to left is seen.
    • Rest of cerebral parenchyma shows normal attenuation.
    • All other areas appear to be normal.
  • 6.
    • Impression :
    • Illdefined large hypodense SOL in the right frontal region causing mass effect & midline shift to left.
    • Suggested CECT / MRI for further evaluation.
  • 7.  
  • 8.  
  • 9.  
  • 10.  
  • 11.  
  • 12.  
  • 13.
    • MRI scan of brain :
    • 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.
    • 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.
    • MR spectroscopy shows increased lactate,choline peak & reuced NAA levels.
    • All other areas appear to be normal.
  • 14.
    • Impression :
    • Features highly s/o GLIOBLASTOMA MULTIFORME
    • ( butterfly glioma ) involving both frontal lobes ( Rt > Lt )
  • 15. Glioblastoma multiforme
    • A diffusely infiltrating astrocytoma ( WHO 2000 classification Grade IV)
    • Most common form of cerebral glioma accounting for 12-15 % of all intacranial neoplasms & 50-60% of all astrocytic tumors
  • 16. Pathogenesis
    • Cell of origin
    • Cell of origin
    • EGFR amp
    • LOH 10 (PTEN)
    • CDK4 amp
    • MDM2 amp
    • Other LOH (eg
    • DCC)
    • Other amp (eg
    • PDGFR)
    • DENOVO :GBM
    • WHO grade IV
    • LOH17p(p53)
    • Astrocytoma
    • WHO grade II
    • LOH19q
    • LOH9p(INK4a)
    • Astrocytoma
    • WHO grade III
    • LOH 10 q(PTEN)
    • Secondary : GBM,
    • WHO gradeIV
  • 17.
    • Rapidly growing tumors, highly cellular,often provoke a large amount of edema & usually contain areas of necrosis,& do not have a clearly defined margin.
    • Supratentorial, frontal lobes are a common site of involvement & extension contralaterally through corpus callosum may give rise to a butterfly pattern.
    • May become adherent to the overlying dura , but seldom penetrate it.
    • Infiltration of ependyma & dissemination through CSF pathway may occur in late cases.
    • Multicentricity can be seen in 4-10% of cases.
    • Extraneural metastasis are rare.
  • 18.
    • Seen late in adult life, with a peak occurrence b/w 45 – 60 yrs.
    • May present with
    • Seizure
    • Subacute progression of a focal neurologic deficit
    • Nonfocal neurologic disorder such as headache,dementia, personality change or gait disorder
    • Median survival is < 1 yr.
  • 19.
    • MRI features:
    • High signal intensity on T2 weighted images & low signal intensity on T1 weighted images
    • Infiltrate along white matter tracts & deeper lesions have a propensity to extend across the corpus callosum to opposite hemisphere
    • Often have considerable mass effect, vasogenic edema& more commonly show evidence of haemorrhage
    • Irregular ring enhancement with nodularity & nonenhancing necrotic foci is typical of glioblastoma
    • Microscopic fingers of tumour usually extend for variable distances beyond the area of enhancement
  • 20.
    • Management:
    • Dexamethasone – administered at the time of diagnosis & continued for the duration of radiotherapy
    • Accesible astrocytomas are generally resected aggressively, even though total surgical resection is not possible
    • Post op RT – prolongs survival & improve quality of life ( 5000-7000 cGy to tumor mass in 25-35 fractions, 5days/wk)
    • Role of stereotaxic radiosurgery & interstitial brachytherapy in glioma trt is uncertain
  • 21.
    • Chemotherapy
    • Is marginally effective & is used as an adjuvant therapy following surgery & RT
    • Temozolomide , an oral alkylating agent has replaced nitrosoureas
    • - 2½ mths longer survival in pts with methylation & silencing of the promoter for the MGMT gene
    • Surgical implantation directly into tumor resection cavity of polymer wafers that releases BCNU locally into surrounding brain
  • 22.
    • Experimental approaches include
    • - Bypassing BBB using local injections into tumor mass
    • - Intraarterial injection of chemotherapy following osmotic disruption of BBB
    • Molecular targeted therapies – EGFR antagonists or inhibitors of its signalling pathways ( Gefitinib /Erlotinib) , Bevacizumab
  • 23.
    • Prognosis:
    • - age, functional status,extent of surgical resection.
    • - survival ≈ 3 mths (without therapy) , 12 mths (with therapy).
    • - recurrence is common.
  • 24.