2. 4
week
history
of
67
years-old
caucasian
headache
“especially
male
patient,
no
when
I
wake
up”,
significant
PMH memory
loss;
right-
sided
mild
motor
weakness
T1-weighted
axial
MRI
with
T2-weighted
axial
MRI
intravenous
contrast
3. The
most
common
primary
brain
tumors
are
the
gliomas
(approximately
60%)
Among
all
gliomas,
Glioblastoma
is
the
most
common
and
most
aggressive
tumor
“Glioblastomas are densely cellular,
pleomorphic tumors with mitotic
activity and either microvascular
proliferation or necrosis”
(UpToDate
2012)
5. Epidemiology
Most
common
primary
brain
tumor
(15%)
2-3
new
cases
per
100.000
people/y
It
affects
>45
adults
preferentially
Men
to
female
ratio
3:2
slightly
more
common
in
whites
Overall
median
survival
after
optimal
therapy
is
less then 12 months
23. high signal
area
hemorrhagic
and flow
voids
midline shift
and mass
effect
24. high signal
area
hemorrhagic
and flow
voids
midline shift
and mass
effect
diffuse
edema
25. PET scanning is
a
useful
adjunct
in
GBM
cases,
especially
in
the
follow-up
after
resection
Differential
diagnosis
between
recurrent
or
residual
masses
and
scars
or
radiation
necrosis
is
difficult
with
MRI
-
TC
PET
scans
is
helpful
in
these
cases
26.
27. Treatment
is
consistent
with 3typical
procedures:
SURGERY
RADIATION
CHEMOTHERAPY
28. The
initial
treatment
for
GBM
is
total
resection
with
preservation
of
neurologic
function
preoperative
imaging MRI
-
PET
frameless
stereotaxis
with
cortical
stimulation
and
language
assessments
intraoperative
techniques
operating
rooms
equipped
with
CT
-
MRI
scanners
can
guide
the
resection
in
“real
time”
31. Radiation
dose
of
6000
cGy
administered
in
5
days
showed
a
median
survival
of
42
weeks
Temozolomide
has
been
shown
to
improve:
median
progression-free
survival
(+2
months)
overall
survival
(+2
months)
likelihood
of
being
alive
in
2
years
(26%
vs
10%)
33. Alterations
of
receptor
tyrosine
kinases
(such
as
EGFR)
that
activate
PI3K
signaling,
leading
to
hyperproliferation
and
increased
cell
survival
Dysregulation
of
the
p53
pathway
that
lead
to
effects
such
as
reduced
apoptosis
L o s s
o f
c e l l - c y c l e
c o n t r o l
v i a
disruption
of
Rb
signaling
pathway
they often miss small tumors (including lower-graded masses)\nmultifocal form is not clearly depicted\noverlapping images: diffuse multiple sclerosis, infarct with hemorrhagic transformation,\nbrain abscess, ecc\n
similar diagnostic image quality in both fusions and PET alone\n
\n
Malignant gliomas are characterized by poorly defined tumor margins with infiltration of neoplastic cells along white matter fibers and the perivascular spaces, which can extend well beyond the tumor margin as defined by the surgeon or by radiographic studies\n
\n
\n
\n
\n
progenitor cells vs adult cells\nSeveral gene mutations account for molecular and biologic background of GBM. In spite of the gene involved, all mutations lead to damaging one of these 3 key-regulatory pathways:\nPDGF, EGFR, IGF-1, IDH CDKN2A, CDKN2B, RB1, CDK4\n
