glioblastoma multiforme, sanchez ashley ms4, blair md · 2020-01-06 · discussion- glioblastoma...
TRANSCRIPT
Glioblastoma Multiforme
Ashley Sanchez
Oct 16, 2019
Diagnostic Radiology 4001
Dr. Blair
McGovern Medical School
Clinical History
• 59 yo M• CC: “Personality changes, intermittent confusion, memory problems”
• Duration: several weeks
• Initial workup (7/23/19): • Non-contrast Brain CT
• Brain MRI w/ & w/o contrast
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Axial Non Contrast CTWhite Matter Hypodensities
White Matter
Grey Matter
Lateral Ventricle
s
Genu Corpus Callosum
Splenium Corpus Callosum
Falx
Cer
ebri
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T2 Axial HyperintensityEdema
ThirdVentricle
Basal Ganglia
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T1 Post Contrast
“Butterfly” Appearance
Central Necrosis
Peripheral Enhancement
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GREBlood
Products
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Imaging + History
CC: “personality/ memory changes”
Problem Area: Frontal Lobe
Imaging: B/l Frontal Lobe Mass
Executive Functioning
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Differential Diagnosis
• Brain lesion
• No systemic sx (fever)• No PMH/FHx of cancer• Crosses midline• Immunocompetent
• Primary Brain Tumors• Glioblastoma• Meningioma• Lymphoma
• Metastatic Brain Tumor• Infections- Abscess• Vascular Disease
• Cerebral hemorrhage• Stroke
• Gradual onset sx
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Characteristic Imaging Findings
Butterfly lesion (crosses midline)CT- Hypodensities +
Mass effect
MRI T2: Hyperintensities + Vasogenic Edema +
Central Necrosis
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Discussion- Glioblastoma Multiforme• Presenting Sx:
• executive function changes• Common presenting sx: headache, seizure, focal neuro deficit• Risk factors:
• ionizing radiation (therapeutic from childhood brain tumor)• Male, >50 yrs old, Caucasian or Asian ethnicity
• Pathophysiology: • not clearly understood• error w/ tumor regulator genes (EFGR, MDM2, PTEN, PDGFA, IDH)
• Biopsy to confirm dx: Glioblastoma, IDH- wildtype, WHO grade IV• Glial tumor type: Glioblastoma• IDH status: wildtype• WHO Grade: IV
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WHO Classification
Treatment
• Combo• Surgical Resection + Biopsy (histological dx)
• Max tumor resection ↔ Neurologic function• Adjuvant Post-op:
• Chemo (Temolozomide) • Radiation therapy
• Our patient:• craniotomy + partial resection x2 (7/24/19 &
8/22/19)• started chemotherapy: Temozolomide
(9/16/19)
Peripheral Enhancement
Partial Lobectomy
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Prognosis
• Extent of resection is a strong prognostic factor• 10 yr study of 20,000 adults w/ Glioblastoma looking at survival times with
different extent of resections• Gross total resection: 15 months • Subtotal resection: 12 months • No surgery 7 months
• Poor survival: < 1-2 yrs• High rate of recurrence
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ACR appropriateness Criteria
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Cost to Patient
Image Typical Charge Insured Uninsured
MRI Brain W-W/O Contrast $7431 $523 $2675
CT Head W/O Contrast $3157 $98 $1374
*Prices for imaging at MHH- TMC https://www.memorialhermann.org/patients-caregivers/pricing-estimates-and-information/
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Take Home Points
• Changes in personality/ memory• 1. Brain CT w/o Contrast• 2. Brain MRI w/ + w/o Contrast
• Brain lesion that crosses midline:• 1. Glioblastoma Multiforme• 2. CNS Lymphoma
• Glioblastoma • MC malignant primary brain tumor in adults
• most aggressive + fastest growing• Rarely metastasizes
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References
• https://radiopaedia.org/cases/normal-ct-brain-pre-and-post-contrast?lang=us• https://radiopaedia.org/cases/normal-brain-mri-6?lang=us• https://www.memorialhermann.org/patients-caregivers/pricing-estimates-and-information/• Noorbakhsh A, Tang JA, Marcus LP, McCutcheon B, Gonda DD, Schallhorn CS, Talamini MA,
Chang DC, Carter BS, Chen CC. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014 Jan;120(1):31-9. doi: 10.3171/2013.9.JNS13877. Epub 2013 Nov 8. PubMed PMID: 24205904.
• https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-initial-surgical-management-of-high-grade-gliomas?search=glioblastoma%20prognosis&topicRef=5211&source=see_link#H2
• https://braintumor.org/wp-content/assets/WHO-Central-Nervous-System-Tumor-Classification.pdf• https://radiopaedia.org/articles/glioblastoma?lang=us• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563115/
Questions?