Oligodendrogliomas arising in the scar of a brain contusion. Report of two surgically verified cases

Post-traumatic brain injury glioma: Characteristics, report of 2 cases report and literature review

BACKGROUND

Traumatic brain injury (TBI) as a pathogenetic factor in glioma remains controversial, and currently there is still no clear mechanism behind post-TBI glioma. Thus, we provide two case reports of post-TBI glioma contributing power to this research, and we provide a summary of the mechanisms of post-TBI glioma through literature review.

METHODS

We report two cases of brain gliomas that developed in the scar of a previous brain trauma. Both patients were male and both had suffered prior traumatic brain injuries (time interval 10-20 years), and postoperative pathological findings reported glioblastoma and WHO grade III glioma, respectively.

RESULTS

These two cases further support the association of between traumatic brain injury and gliomas development.

CONCLUSION

Although the epidemiological investigation between TBI and glioma is still controversial, there are still some important aspects here that can determine the possibility between TBI and gliomagenesis. Besides, we found that the reparative response of neural stem cells and the dysregulation of inflammatory cells are timportant theories of the mechanism of post-TBI glioma.

Traumatic brain injury and subsequent brain tumor development: a systematic review of the literature

The role of prior head trauma in stimulating brain tumor development has been previously described in the literature but continues to be debated. The goal of this study was to conduct a systematic review interrogating the contemporary literature to delineate any possible relationship between traumatic brain injury and brain tumor development. A systematic review exploring development of post-TBI brain tumor was conducted by searching electronic databases. Abstracts from articles were read and selected for full-text review according to criteria previously established in the scientific literature. Relevant full-text articles were divided into case reports and single-arm studies and epidemiological studies. Of 1070 resultant articles, 18 case reports and single-arm studies (level of evidence of IV and V) with 45 patients were included. The most common cause of TBI was traffic accidents. The average period between TBI and subsequent tumor diagnosis was 12.8 years. Meningiomas represented the largest share of tumors, followed by gliomas. Most post-TBI brain tumors developed in the frontal and temporal lobes. Fifteen epidemiological studies were also interrogated from a variety of countries (level of evidence of III). Case-control studies were more common than cohort studies. There were 9 of 15 studies proposed a possible relationship between history of head trauma and development of brain tumor. The relationship between head trauma and neoplastic growth continues to be heavily debated. There are certainly case reports and epidemiological studies in the literature that suggest a correlational relationship between the two. However, there is no concrete evidence of a causal relationship between TBI and brain tumors. More research is needed to definitively delineate the extent of any such relationship.

Post-Traumatic Gliomas in Adults: Review of the Case Reports and Studies

Traumatic brain injury (TBI) was first proposed as a potential risk factor for developing a glioma in the 1800s, and conditions for establishing a causal relationship between brain injury and gliomas have since been proposed. Given the medical and legal ramifications, the current literature was reviewed to better understand this possible association. Articles that examined the relationship between TBI and glioma formation in adults and were published in English between 1978 and 2022 were reviewed. There were 19 case reports of 25 patients and 16 observational studies. The case reports describe glioma formation at the precise site of prior brain injury in continuity with traumatic scar; the observational studies report conflicting findings, but they largely demonstrate no association. Most of the observational studies are limited by their retrospective nature, but we identified one prospective cohort study which found a positive association. Altogether, we suggest that glioma formation after TBI is a rare occurrence that warrants further study.

Post-traumatic Glioma: Report of two Cases

We report two cases of brain glioma that developed in the scar of an old brain trauma. The first is that of a 40-year-old man who presented with severe headaches; CT and MRI showed a large mass in the right parietal region. The tumor was unresectable and surgical biopsy showed a glioblastoma multiforme. The patient had suffered a cranial trauma in a road accident 20 years previously with an intrathecal hematoma in the right parietal region. The second case concerns a 60-year-old man who, 15 years after severe head injury in a road accident, developed a glioblastoma multiforme which was localized in the scar of the brain contusion. These cases fulfill the established criteria for a traumatic origin of brain tumors and add further support to the relationship between cranial trauma and the onset of glioma. As stated by other authors, an association between head trauma and brain tumor risk cannot be ruled out and should be studied further.

Post-Traumatic Glioma. Report of Four Cases and Review of the Literature

Aims and background

To add a further contribution to the literature supporting the relationship between previous head trauma and development of glioma.

Methods

We report on four patients who developed brain gliomas in the scar of an old brain injury.

Results

All cases fulfilled the widely established criteria for brain tumors of traumatic origin. In all of our cases there was radiological evidence of absence of tumor at the time of the injury.

Conclusions

We believe that in specific cases it is reasonable to acknowledge an etiological association between a severe head trauma and the development of a glioma. This assumption is further sustained if there is radiological and surgical documentation of the absence of neoplasia at the moment of the trauma.

Post-traumatic glioblastoma multiforme: a case report

Malignant glioma development after trauma is a rare occurrence. We report a glioblastoma multiforme case that developed after a depressed skull fracture. A 65-year-old man was admitted because of right sided hemiplegia, epilepsy and changes in consciousness due to a malignant glial tumor. He had been operated on for a left calvarial depression fracture caused by cerebral laceration thirty-five years before. Radiologic imaging revealed a large contrast-enhanced mass lesion at the left frontotemporoparietal junction under the depression site. The patient underwent urgent surgery, and radical excision of the mass was achieved. The histopathologic diagnosis was a high-grade glial tumor. Although the possibility of a pre-existing tumor rather than a trauma-induced tumor is very high, the presented case suggests that traumatic cerebral lesions may also be a predisposing factor for the development of malignant glial tumors.

Oligodendroglioma and multiple sclerosis. A case report

BACKGROUND

The concurrence of multiple sclerosis (MS) and glioma is uncommon. Approximately 30 cases have been reported, but in only six of them the tumour was pure or mixed oligodendroglioma. The appearance of new neurological symptoms and signs in a patient with multiple sclerosis is usually attributed to a relapse of this disease and neuroradiological studies are not always performed. When done, the finding of a new focal mass lesion is usually interpreted as a pseudotumoural plaque.

CASE REPORT

A 37-year-old man was admitted because of partial simple seizures and an enlarging intracranial mass. He had been diagnosed of MS eleven years earlier. A MRI study performed eight years before admission showed a large mass in the right frontal lobe which was thought to be a pseudotumoural plaque. Two years later, he developed simple partial motor seizures that were initially controlled with valproic acid. He remained well until three months before admission, when seizures reappeared with a poor response to valproic acid. A new MRI study showed an heterogeneous right frontal enlarging mass lesion. A primary neoplasm was suspected and a subtotal removal was performed. The pathological diagnosis was oligodendroglioma with a periferic demyelinating area.

CONCLUSION

Atypical MRI lesions in a patient with MS must be carefully interpreted. Pseudotumoural plaques have been described both clinically and radiologically to be hardly distinguishable from a tumoural lesion and histological confirmation is often required. The association between MS and glioma is uncommon but it must be kept in mind when a mass lesion develops in a patient with MS.

Pathology and molecular genetics of oligodendroglial tumors

Oligodendroglial gliomas are second only to astrocytic gliomas in frequency. The lack of stringent diagnostic criteria cause high interobserver variation in regard to classification and grading of these tumors. Previous studies have described oligodendrogliomas with features that overlap with those of neurocytic tumors, thus further complicating diagnostic decisions. The increasing need for standardized diagnostic criteria in this subset of gliomas is emphasized by the benefit of adjuvant therapies in patients with anaplastic oligodendrogliomas. Characteristic chromosomal aberrations have been successfully determined for oligodendroglial tumors in recent years. In contrast to astrocytomas, however, no genes in the affected regions have been clearly linked to their pathogenesis. However, the molecular findings promise to be helpful for diagnostic and therapeutic decisions. This review compiles clinical, pathological, and molecular genetic findings on WHO grades II and III oligodendrogliomas and oligoastrocytomas.

Development of glioblastoma multiforme following traumatic cerebral contusion: case report and review of literature

BACKGROUND

Diagnostic criteria for posttraumatic brain tumors were formulated in the pre-CT (computerized tomography) era. We propose that radiologic criteria incorporating imaging data be added to the existing criteria.

CASE DESCRIPTION

We report a case of a 56-year-old man who presented with history of raised intracranial pressure of 20 days' duration. Imaging showed a large left frontal intra-axial mass lesion. He had history of head injury 5 years prior with CT evidence of bilateral basifrontal contusions. There was no contrast enhancement at the site of the contusions in an intervening CT scan done 18 months after the trauma. He underwent radical excision of the mass, and the histopathology was reported as glioblastoma multiforme. We formulated additional radiologic criteria for tumors that may present following trauma. A review of the literature of posttraumatic gliomas is also presented.

CONCLUSION

Fulfillment of the additional radiologic criteria proposed by us will help distinguish a tumor that developed following trauma from that which was present before the occurrence of the injury.

Head trauma and brain tumours revisited

The authors report a case of an anaplastic astrocytoma which on magnetic resonance imaging and direct visualisation was continuous with an area of gliosis in the left frontal lobe. This gliosis was secondary to a head injury received 19 years earlier that required evacuation of an intracerebral haematoma. This case largely meets the accepted criteria for brain tumour associated with head trauma.

The relationship between cortical injury and brain tumour. Report of two cases and review of the literature

We report on two cases of brain tumour and discuss the possible relationship to previous cortical trauma. The first patient, a 67-year-old male patient developed a glioblastoma at the same site of an open shell-splinter injury of the brain after a latency of 48 years. The second patient, a 55-year-old male, had a malignant anaplastic astrocytoma in the right frontal lobe 10 years after clipping of an aneurysm of the anterior communicating artery. Both cases fulfill the criteria of Zülch [52] for the correlation between cortical trauma and tumour. We believe that the development of a brain tumour following a cortical injury is very rare, although possible. Probably the brain must display some form of predisposing genetic alteration for a tumour to develop following a cortical injury.

Post-traumatic malignant glioma. Report of a case

Only a few cases reported in the literature fulfil the currently established criteria for accepting the traumatic origin of some intracranial tumors. A case of post-traumatic glioma is presented. Several years after sustaining a commotive left parietal trauma, our patient developed symptoms of intracranial tumor. Neuroimaging (CT and MRI) showed a large neoplasia in the left temporo-parietal-occipital region, and stereotactic biopsy revealed a mixed glioma in continuity with the scar resulting from the trauma.

[Cystic oligodendroglioma and positivity of reactions for cysticercosis: report of a case]

A case of a 32-year old male patient with complaints of frontal headache progressive decrease in visual acuity, altered behaviour, and positive results of immunological tests for cysticercosis performed on the cystic and cerebrospinal fluids is presented. After several clinical and surgical proceedings, the frontal craniotomy was indicated and a multi-lobulated cystic tumor was excised. Biopsy material revealed an oligodendroglioma invading the degenerated membrane of cystic wall. Some aspects related to the possible mechanisms involved in the association of oligodendroglioma with neurocysticercosis in the presented case are discussed. Three different types of conclusions may be reached: (1) neurocysticercosis may have acted as an oncogenetic factor for the oligodendroglioma; (2) the glycoprotein nature of the antigens of gliomas and cysticercosis and the similarity in the molecular weight range of their polypeptides may be responsible for the positivity of the reactions for cysticercosis in the cystic fluid; or (3) the association of oligodendroglioma with cysticercosis may be a simple coincidence. The present study strengthens the opinion that other pathologies should be looked for when clinical treatment of cysticercosis does not follow the expected course.

Medical risk factors and the development of brain tumors

Several diseases and medical treatments are discussed as risk factors for the development of brain tumors. A population-based case-control study in the Rhein-Neckar-Odenwald area (containing 1.3 million inhabitants) of Germany was established to investigate this question. A total of 226 patients (cases) with primary brain tumors (International Classification of Diseases, ninth edition, classes 191, 191.1, and 192.0) and 418 control subjects (controls) were interviewed using a standardized questionnaire over a period of 2 years. No association was seen for head injuries, hereditary diseases, family history, and radiographic examination of the head and teeth. However, more cases than controls had had meningitis (relative risk [RR], 2.7; 95% confidence interval [CI], 0.9 to 8.6) or epilepsy (RR, 2.6; 95% CI, 0.6 to 11.7). The RR was decreased for those who had allergic diseases (RR, 0.7; 95% CI, 0.5 to 1.0), diabetes (RR, 0.7; 95% CI, 0.3 to 1.8), and infections and colds (RR, 0.3; 95% CI, 0.1 to 0.8).