CT findings in multicentric glioblastoma: Diagnostic-pathologic correlation

Multifocal Glioblastoma Multiforme

“…We per-formed open surgical decompression of the larger lesion to improve the neurological deficits and also to get tissue for hisological diagnosis. Though the prognosis of glioblastomas remains unfavorable, but it should be emphasized that the diagnosis of multifocal (as in present case) rather than multiple glioma leads to a more aggres¬sive therapy, ensuring longer survival (2,8). …”

“…These lesions can be divided into two groups multicentric and multifocal. Multifocal gliomas are de¬fined as the lesions result from dissemination or growth by an established route, spread and better survival and also facilitates histopathological analysis and grading of tumor (1,2). However some authors recommend bi¬opsy as the first step, believing that extensive resec¬tion increases the risk of haemorrhage and neurologi¬cal deficit without influencing survival (13).…”

“…Tumor dissemination via CSF pathways has been proposed as another reason for multicentric gliomas (1). Glioblastoma is the most fre¬quent histotype of multicentric glioma but more benign glial neoplasms including astrocytoma and ependymoma have also been reported as multicentric (2,8). The histopathological features of multicentric GBM include nuclear and cellular atypia and pleomorphism, dedifferentiation, mitotic activity, increased cellularity, and endothelial proliferation (9).…”

“…On CT scan there incidence is reported as 2.5% (4). The clinical presentation and radiographic appearance of multicentric gliomas can mimic metastatic and other lesions radiographically; however the treatment of these two disease entities is considerably different (2). Therefore, it becomes impera¬tive to determine the histology of one of the lesions in the presence of multiple lesions on radiographic imag¬ing and in the absence of a known systemic malignancy (4).…”

“…Multicentric gliomas are uncommon lesions but a fascinating clinical and scientific issue (1,2). The rate of true multicentricity in gliomas is defined as lesions with no gross or microscopic linkage and based on necropsy stud¬ies has been reported at 2% to 10% (3).…”