Glioblastoma
| Glioblastoma | |
|---|---|
| Diagnosis in short | |
 Glioblastoma. H&E stain. | |
|
| |
| LM | astrocytic differentiation, nuclear atypia, necrosis, microvascular proliferation, +/-pseudopalisading necrosis |
| Subtypes | gliosarcoma |
| LM DDx | anaplastic astrocytoma |
| IHC | GFAP +ve, IDH-1 -ve/+ve |
| Site | brain, spinal cord |
|
| |
| Radiology | intra-axial |
| Prognosis | very poor |
| Clin. DDx | metastatic brain tumours |
Glioblastoma a very common malignant primary brain tumour in adults. It has a very poor prognosis.
It was previously known as glioblastoma multiforme, abbreviated GBM.
General
- Median survival is measured in months.[1]
- Only about 5% can expect to survive more than three years.[2]
Macroscopy
Features:
- Usu. in white matter.
- central necrotic core.
- ill-defined borders.
- yellowish to dark-brown changes.
- midline shift due to tumor mass.
- In the corpus callosum as bihemispheric "butterfly glioma"
Ring-enhancement in GBM (WC/Hellerhoff)
Left insular GBM macroscopy (WC/Sbrandner)
"Butterfly glioma" (WC/AFIP)
Microscopic
Features:
- Astrocytic tumour with:
- Nuclear atypia.
- Necrosis.
- Endothelial proliferation (AKA microvascular proliferation).
- +/-"Pseudopalisading necrosis" - tumour cells lined-up like a picket fence around necrotic areas.
Images
Core features of GBM: Necrosis, MVP and mitoses (WC/jensflorian)
Anaplastic cells in GBM (WC/jensflorian)
Endothelial proliferations in GBM (WC/jensflorian)
Mitotic activity in GBM (WC/jensflorian)
Pseudopalisading necrosis in GBM (WC/jensflorian)
Diffuse brain infiltration in GBM (WC/jensflorian)
MVP adjacent to tumor infiltration border in GBM (WC/jensflorian)
GBM - low mag. (WC)
GBM juxtaposed with near normal white matter - intermed. mag. (WC)
GBM juxtaposed with near normal white matter - high mag. (WC)
GBM - very high mag. (WC)
GBM - high mag. (WC)
Extreme nuclear enlargement in a GBM - very high mag. (WC)
Giant cell glioblastoma (WC/jensflorian)
Adenoid growth pattern in GBM (WC/jensflorian)
Adenoid growth pattern in GBM (AFIP)
Epitheloid glioblastoma (WC/jensflorian)
GBM with PNET component (WC/jensflorian)
GBM with PNET component (WC/jensflorian)
GBM with oligodendroglial component (WC/jensflorian)
Nuclear pleomorphism in with oligodendroglial component (WC/jensflorian)
GBM with granular cell component (WC/jensflorian)
Glioblastoma with ependymal-like growth pattern (WC/jensflorian)
Spinal cord GBM (AFIP)
Glioblastoma mimicking a (amelanotic) melanoma (WC/jensflorian)
Resection borders in a recurrent GBM (WC/jensflorian)
Radiation changes in a recurrent GBM (WC/jensflorian)
GFAP immunostaining in GBM (WC/Marvin 101)
WT1 immunostaining in GBM (WC/jensflorian)
GBM with strong p53 immunreactivity (WC/jensflorian)
IDH1 R132H immunreactivity in a secondary GBM (WC/Marvin101)
www:
- Microvascular proliferation in a GBM (ouhsc.edu).
- Pseudopalisading necrosis in GBM (aacrjournals.org).
IHC
- GFAP +ve (cytoplasm).
- IDH-1 -ve.
- +ve if developed from lower grade astrocytoma. (???)
See also
References
- ↑ Jubelirer, SJ.. "A review of the treatment and survival rates of 138 patients with glioblastoma multiforme.". W V Med J 92 (4): 186-90. PMID 8772403.
- ↑ Krex, D.; Klink, B.; Hartmann, C.; von Deimling, A.; Pietsch, T.; Simon, M.; Sabel, M.; Steinbach, JP. et al. (Oct 2007). "Long-term survival with glioblastoma multiforme.". Brain 130 (Pt 10): 2596-606. doi:10.1093/brain/awm204. PMID 17785346.