Late-onset globoid cell leukodystrophy mimicking an infiltrating glioma

Clinical and neuroradiological findings in classic infantile and late-onset globoid-cell leukodystrophy (Krabbe disease)

In the present study the clinical course and imaging of early and late-onset forms of Krabbe disease are analyzed. We report on 11 patients with a biochemical diagnosis of galactosyl ceramide beta-galactoside deficiency. Two presented as the classic infantile form and died within the second year of life. In 9 children the first clinical signs, such as gait difficulties and visual failure, started after age 2 years. All these patients developed slow regression of motor and mental capacities, and most of them died within their first decade. In patients of both groups computed tomography (CT) and magnetic resonance imaging (MRI) were performed. In the late-onset form, hypodensities of the central white matter and pyramidal tracts were the leading radiological signs, whereas in the early-onset form, hyperdensities and cerebellar white matter lesions were also detected. From our results it becomes clear that variability of Krabbe disease refers not only to clinical manifestation but also to CT and MRI findings. Better knowledge of phenotypic and radiological diversity will help to understand the pathogenesis of the disease.

Brainstem and other malignant gliomas: II. Possible mechanisms of brain infiltration by tumor cells

Gliomas that arise in the brain stem and other malignant gliomas constitute approximately 60% of all brain tumors and have eluded effective therapy, in part because they are able to infiltrate the normal brain. Histopathologic studies have confirmed the presence of infiltrating tumor cells very distant from the glioma mass. We review the neuroimaging and pathologic features of glioma-cell infiltration and some of the complex cellular and biochemical determinants of tumor-cell motility and invasiveness. Understanding how glioma cells become motile and invasive is pivotal to therapeutically targeting the machinery that enables gliomas to infiltrate the brain.