A rare combination of multicentric gliomas: a problem of interpretation

Multicentric Gliomas. Report of Seven Cases

Multifocal gliomas fall into four main categories: diffuse, multiple, multicentric and multiple-organ. Multicentric gliomas are uncommon lesions of the central nervous system. Even more so are multicentric gliomas lying both above and below the tentorium (16 cases to date, as far we know). We report a clinical series of 7 cases, including 3 supra-Infratentorial tumors. The distinctive features of multicentric gliomas are mainly the absence of gross or microscopic connections and absence of seeding along easily accessible routes like the cerebrospinal fluid pathways or the median commissures. We consider the pathogenetic hypotheses and problems of diagnosis, especially differential from other multifocal diseases of the central nervous system.

Multicentric glioma studied with positron emission tomography: a case report

Positron emission tomography (PET) studies of a multicentric glioma case were undertaken using 11C-methionine (Met) and 18F-fluorodeoxyuridine (FUdR). Met-PET revealed high accumulating lesion in both the left and right hemispheres, whereas in the FUdR-PET, the lesion on the right showed marked accumulation, but not that on the left. For both foci, the histologic diagnoses were anaplastic astrocytoma, but the lesion on the right showed higher density of undifferentiated tumor cells than that on the left. PET studies using Met and FUdR are effective in delineating the proliferative potential of glioma cells, which otherwise cannot be determined by histopathologic studies.

Computerized tomography findings in multifocal glioma

Six patients with multifocal glioma are presented. Computerized tomography revealed multiple, discrete, contrast-enhancing lesions in the cerebral hemispheres, suggestive of multiple intracranial metastases. The most accessible lesion was resected at craniotomy in each patient, confirming the diagnosis of primary malignant glioma. Postoperative radiation therapy and chemotherapy were instituted according to current protocols. Since neuroradiological studies may not allow distinction of multifocal glioma from multiple brain metastases, surgical biopsy is suggested in those patients who have no history of cancer.

Diagnostic and pathomorphological aspects of glioma multiplicity

A series of 11 patients with multiple glioma foci is reported with emphasis upon isotope brain scan, angiography, and CT findings; autopsy data is available in 8 cases. In many patients it was necessary to combine the results of several diagnostic techniques in order to demonstrate all the foci proven at autopsy. Thus, the desirability of combining diagnostic techniques in the investigation of glioma patients must be stressed. In spite of this approach, however, multiple metastases and the various types of multiple gliomas are often indistinguishable from each other by current diagnostic techniques.

Multifocal glioma of the brain. Case report

A case is presented in which two separate concurrent astrocytomas of the brain in the same patient were successfully operated on. The patient has been followed for 3 years and remains well. The authors believe that the diagnosis of multifocal tumors can be established on clinical grounds when the tumors are remote from each other, and when there has been no recurrence of neoplasm between the lesions after a long follow-up period. It is felt that a more optimistic approach to the treatment of multifocal tumors may yield good results.

Multicentric and isolated multifocal glioblastoma multiforme simulating metastatic disease

Single case reports of multicentric glioblastoma multiforme and multifocal glioblastoma multiforme tumours are presented. Multicentric glioblastoma multiforme tumours are those which have no macroscopic or microscopic connection. Multifocal gliomatous tumours, on the other hand, are those with either gross or microsopic continuity or evidence of cerebral spinal fluid spread and/or local metastases. The cerebral scintigram findings, cerebral angiogram studies and pathological description of these entities are presented. These lesions may be mistaken for metastases. In patients with multiple cerebral lesions multiple primary malignancies of brain should be considered when there is no clinical or radiographical evidence for extracranial primary neoplasms.