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Glioma

Glial Tumor

Glioma is the most common primary tumor of the brain, with several distinct histological types. The clinical presentation depends on the site of its development, but seizures and cognitive impairment are predominant symptoms. The diagnosis is made through imaging studies, such as magnetic resonance imaging (MRI), and a histopathological examination.


Presentation

With approximately 12,500 deaths and 20,500 new cases every year in the United States, gliomas are the most common primary tumors of the brain [1] [2]. Although numerous risk factors of various origins have been proposed (such as viral infections by varicella zoster virus - VZV and cytomegalovirus - CMV, genetic predisposition, nonionizing radiation from cellular phones, etc.), occupational exposure to pesticides or organic solvents and ionizing radiation have the strongest association with the development of gliomas [1] [2] [3] [4]. These tumors are encountered in two age groups - In the first decade of life (0-8 years) and in late adulthood/the elderly (50-70 years of age) [1]. The clinical presentation can vary widely depending on the tumor location, but the two main symptoms are convulsions and a decrease in cognitive function [5]. In addition, memory and speech deficits, gait disturbances, headaches, nausea, vomiting, visual and/or auditory impairment, as well as personality changes are all mentioned in the literature as possible symptoms of gliomas [1] [6]. Furthermore, tumors originating from the brainstem produce an array of clinical signs, including cranial nerve palsies (predominantly of the V, VI, and VIII) and pyramidal weakness [4]. Progression of symptoms can be either slow or rapid, depending on the subtype. An early diagnosis is mandatory in either case, however, survival rates for gliomas diagnosed in the most advanced stages rarely exceed 1 year [6].

Nausea
  • General symptoms include headache, confusion, change in personality, nausea, loss of balance or coordination, memory loss, blurred vision or other visual abnormalities, and slurred speech.[britannica.com]
  • Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass.[ncbi.nlm.nih.gov]
  • Short term side effects of radiation therapy can include: Nausea Diarrhea Fatigue Skin changes Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.[texaschildrens.org]
  • Symptoms include headaches, nausea, vomiting, dizziness and balance problems. Diagnosis is made with an MRI, but a confirming biopsy is usually required. Treatment may include surgery, radiation and/or chemotherapy.[ucihealth.org]
  • In addition, memory and speech deficits, gait disturbances, headaches, nausea, vomiting, visual and/or auditory impairment, as well as personality changes are all mentioned in the literature as possible symptoms of gliomas.[symptoma.com]
Headache
  • Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache.[ncbi.nlm.nih.gov]
  • We describe a fifty-year-old male with headache, weakness of limbs, and altered sensorium. CT showed hetero-dense enhancing mass lesions in both right and left parietal areas raising suspicion of high grade glioma.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 36-year-old white woman presented to our institution with recurrent attacks of headache.[ncbi.nlm.nih.gov]
  • Here, we report the case of a 62-year-old man presenting with headache, which was caused by CAPNON in the left cingulate gyrus. CT scan revealed a calcified mass exhibiting gradual growth and increasing peritumoral edema.[ncbi.nlm.nih.gov]
  • We present and discuss a case of chordoid glioma that arose in a 46-year-old female who presented with progressive fatigue, headache, and altered mental status, attributable to severe hydrocephalus caused by a third ventricular mass.[ncbi.nlm.nih.gov]
Upbeat Nystagmus
  • Facial sensory loss and a primary-position, upbeating nystagmus may be seen. Crossed deficits (facial signs and symptoms contralateral to arm/leg signs and symptoms) are also characteristic of brainstem gliomas.[emedicine.medscape.com]
Nasal Speech
  • […] fourth ventricle outflow locations Patients with tectal lesions may present with the following: Headache, nausea, and vomiting Diplopia Parinaud syndrome Patients with cervicomedullary lesions may present with the following: Dysphagia, unsteadiness, nasal[emedicine.medscape.com]

Workup

Having in mind the very poor prognosis of late-stage gliomas, all patients with the undisclosed central nervous system (CNS)-related symptoms must be evaluated in a thorough manner. Firstly, the course of symptoms should be noted during history taking, whereas a meticulous physical examination, with an emphasis on the neurological exam and cognitive assessment, can provide vital clues about the location of the lesion. Imaging studies are the cornerstone of diagnosing gliomas. Magnetic resonance imaging (MRI), sometimes supported by magnetic resonance spectroscopy (MRS), is the modality of choice in identifying the exact site of the tumor and in determining the extent of tissue and nodal invasion [1] [4]. To confirm the diagnosis, however, a biopsy and a histopathological examination are necessary, which aids in classifying tumor into one of its three main categories [1] [2] [3] [5] [6]:

  • Astrocytomas - Encompassing about 80% of all gliomas, astrocytomas are diagnosed either as low-grade tumors of limited proliferative capacities (stage I), or as highly malignant lesions (well-differentiated, anaplastic, and glioblastoma multiforme are terms used to describe stages II, III and IV, respectively) [1] [3] [6]. The two main forms are diffuse (malignant) and pilocytic (more often benign), and the distinguishing feature of astrocytomas on pathohistological examinations is the positive staining for glial fibrillary acidic protein (GFAP) on immunohistochemistry [1] [6].
  • Oligodendrogliomas - Contrary to astrocytomas, oligodendrogliomas are principally benign tumors arising in the frontal lobes of the cerebral cortex. This tumor, based on its histological characteristics, is classified into stage II, but more severe anaplastic forms (stage III) carry a somewhat poorer prognosis, although the outcome is much better compared to astrocytomas [1] [6].
  • Ependymomas - These tumors are very rarely encountered and comprise about 5-10% of all gliomas, developing in close proximity of the fourth ventricle in the majority of case.
White Matter Lesions
  • These cases emphasise the importance of careful discussion with patients before starting radiotherapy if there is a previous history of central nervous system demyelination or multiple white matter lesions on MRI.[ncbi.nlm.nih.gov]

Treatment

  • The right-sided optic nerve mass seen before IVC treatment disappeared by the end of the treatment. CONCLUSIONS This case highlights the positive effects of treating NF1 glioma with IVC.[ncbi.nlm.nih.gov]
  • If doctors cannot perform a biopsy, they will diagnose the brain tumor and determine a treatment plan based on other test results. Glioma Treatment The treatment for a glioma depends on its grade.[hopkinsmedicine.org]
  • This article reports on the clinical history, molecular findings, and treatment response in a patient with BRAF V600-mutated high-grade glioma arising from ganglioglioma.[ncbi.nlm.nih.gov]
  • Abstract The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided.[ncbi.nlm.nih.gov]

Prognosis

  • […] associated with favourable prognosis.[proteinatlas.org]
  • Continuing multimodal and multitargeted therapies might lead to an improvement in the dismal prognosis of the disease.[ncbi.nlm.nih.gov]
  • […] in glioma patients. lncRNAs could function as potential molecular biomarkers of the clinicopathology and prognosis of glioma.[ncbi.nlm.nih.gov]
  • Despite 26 clinical trials in newly diagnosed DIPG in the past 5years (including several targeted agents), there is no clear improvement in prognosis.[ncbi.nlm.nih.gov]
  • The complex metastatic mechanism remains unclear, and the prognosis is very poor, with a survival duration of less than 6 months.[ncbi.nlm.nih.gov]

Etiology

  • Despite the frequency of gliomas, the etiology of these tumors remains largely unknown. Diffuse gliomas, including astrocytomas and oligodendrogliomas, belong to a single pathologic class but have very different histologies and molecular etiologies.[ncbi.nlm.nih.gov]
  • However, it is still largely unknown how the GAS5 indel genetic polymorphism is involved in etiology of glioma. We evaluated the association between the GAS5 indel genetic polymorphism and glioma development in a Chinese population.[ncbi.nlm.nih.gov]
  • Genes Chromosomes Cancer 42 : 107–116 14 Ohgaki H and Kleihues P (2005) Epidemiology and etiology of gliomas.[nature.com]
  • PMID 18579016 What is the etiology of human brain tumors? A report on the first Lebow conference. Brem S, Rozental JM, Moskal JR. Cancer. 1995 Aug 15;76(4):709-13.[atlasgeneticsoncology.org]
  • How much of this variation is due to artifactual influences or etiologic differences has been the subject of many debates. Some reports have suggested a slight male preponderance, whereas others have failed to observe any sex predilection.[emedicine.medscape.com]

Epidemiology

  • This presentation of two cases and literature review discusses the epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, and prognosis of high-grade glioma with extracranial metastases.[ncbi.nlm.nih.gov]
  • Data from the Surveillance, Epidemiology, and End Results (SEER) program of NCI from 1973 through 2006 were analyzed to assess survival among 5037 patients. Relationships were modeled using Dickman's piecewise constant hazards RS model.[ncbi.nlm.nih.gov]
  • In Cancer Epidemiology and Prevention, 1231–1281 (Eds Schottenfeld D and Fraumeni JF) New York: Oxford University Press 12 Claus EB et al. (2005) Epidemiology of intracranial meningioma.[nature.com]
  • There exist epidemiological evidence that pediatric brain tumor incidence is among the lowest in the Chinese population. EA is also an ingredient of Lorenzo's oil used against adrenoleukodystrophy, a pediatric demyelinating disease.[ncbi.nlm.nih.gov]
  • Melissa Bondy, professor of medicine and epidemiology and population sciences at Baylor College of Medicine, discusses details about the Gliogene study.[bcm.edu]
Sex distribution
Age distribution

Pathophysiology

  • Delayed infarction in the lenticulostriate artery (LSA) area after insular glioma resection is not common, and its pathophysiology remains unknown.[ncbi.nlm.nih.gov]
  • Circular RNAs (circRNAs) was demonstrated to be involved in a wide range of pathophysiological processes, including tumorigenesis and development. Recently, the abnormally expressed hsa_circ_0001649 was found in several malignancies.[ncbi.nlm.nih.gov]
  • Anatomic location determines the pathophysiological manifestation of the tumor. With tectal lesions, hydrocephalus may occur as a result of fourth ventricular compression.[emedicine.medscape.com]
  • Pathophysiology: the official journal of the International Society for Pathophysiology / ISP. 2015 Mar;22(1):1–13. View Article Google Scholar 32. Humans IWGotEoCRt. Non-ionizing radiation, Part 2: Radiofrequency electromagnetic fields.[journals.plos.org]
  • Pathophysiology GBM is an anaplastic, highly cellular tumor with poorly differentiated, round, or pleomorphic cells, occasional multinucleated cells, nuclear atypia, and anaplasia.[emedicine.medscape.com]

Prevention

  • We describe a novel method for preventing postoperative adhesions after high-grade glioma surgery using BioD film.[ncbi.nlm.nih.gov]
  • In addition to the salient features of this case, we provide a brief review of RT-induced malignancies and the need for further research regarding surveillance and prevention strategies.[ncbi.nlm.nih.gov]
  • In glioma patients, fMRI is frequently used to determine the individual functional anatomy of the motor and language network in a presurgical setting to optimize surgical procedures and prevent extensive damage to functionally eloquent areas.[ncbi.nlm.nih.gov]
  • “It is our hope that results from Gliogene will further brain cancer screening and prevention strategies for future generations.” Forms of glioma, a malignant primary brain tumor, include astrocytoma, oligodendroglioma and glioblastoma multiforme.[bcm.edu]
  • Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2009; 18:204-214.[atlasgeneticsoncology.org]

References

Article

  1. Gladson CL, Prayson RA, Liu W (Michael). The Pathobiology of Glioma Tumors. Annual review of pathology. 2010;5:33-50.
  2. Schwartzbaum JA, Fisher JL, Aldape KD, Wrensch M. Epidemiology and molecular pathology of glioma. Nat Clin Pract Neurol. 2006;2(9):494-503.
  3. Ostrom QT, Bauchet L, Davis FG, et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro-Oncology. 2014;16(7):896-913.
  4. Reyes-Botero G, Mokhtari K, Martin-Duverneuil N, Delattre J-Y, Laigle-Donadey F. Adult Brainstem Gliomas. Oncologist. 2012;17(3):388-397.
  5. Posti JP, Bori M, Kauko T, et al. Presenting symptoms of glioma in adults. Acta Neurol Scand. 2015 Feb;131(2):88-93.
  6. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.

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Last updated: 2019-07-11 22:54