High-grade glioma
High-grade gliomas (HGGs), are the most common intrinsic brain tumors in adults hallmarked by rapid proliferation, hypervascularization, and an invasive growth pattern.
The process of malignant transformation (MT) of Low-grade glioma (LGG) to HGG is poorly understood but likely involves the activation of signaling programs that suppress apoptosis.
Classification
Epidemiology
Etiology
While there has been progress in understanding the molecular genetics of these tumors 1) , the cell type(s) of origin are still uncertain, and the molecular determinants of disease aggressiveness are not well understood. A better understanding of the cellular origin and molecular pathogenesis of these tumors may identify new targets for treatment of these neoplasms.
Pathophysiology
Intratumoral hypoxia is thought to be a main contributor to tumorigenesis and angiogenesis of these tumors. Because HIF1A is the major mediator of hypoxia-regulated cellular control, inhibition of this transcription factor may reduce glioblastoma growth.
Dissemination
Dissemination of high-grade gliomas (WHO grade IV) has been investigated poorly so far.
Diagnosis
Differential diagnosis
A 58-year-old male with slight left hemiparesis. The radiological evaluation with contrast administred magnetic resonance imaging (MRI) scan demonstrated a right temporo-parietal ring enhancing mass lesion surrounded by edema which was resembling a typical glioma.
The patient was operated on via a temporo-parietal craniotomy and an arteriovenous malformation surrounded by abnormal glial tissue was observed during the exposure. A nidus supplied by several branches arising from the middle cerebral artery (MCA) was obvious. The venous drainage of the malformation was to the superficial venous system. The observed arterial feeders and the draining vein were coagulated and the nidus was macroscopically totally excised. The frozen examination from surrounding glial tissue revealed a high-grade glioma . The tumor was also macroscopically totally excised. Postoperatively, the cerebral angiogram demonstrated a right temporal arteriovenous malformation with a centrally excised nidus. The remaining major feeders involved the angular gyrus and the posterior temporal arteries. The venous drainage was to the straight and sigmoid sinuses.
The final histopathological examination of the specimen revealed an arteriovenous malformation surrounded by a high-grade glioma .
The patient refused a second operation for total removal of the AVM. Postoperatively, he is doing well with improvement of his left hemiparesis 2).
Treatment
Outcome
Systematic reviews
A total of 68 patients across 10 clinical studies were diagnosed with leptomeningeal disease from high-grade glioma and included in the review. Among these patients, the average age at diagnosis was 44.2 years. Glioblastoma was the most common tumor type (n = 58, 85.3%). A majority of the patients presented with recurrent disease (n = 29, 60.4%). The review encompassed various IT chemotherapy regimens, including mafosfamide, thio-TEPA, 5-fluoro-2'-deoxyuridine (FdUrd), methotrexate (MTX), and cytarabine; however, dosages and frequencies were inconsistently reported. The mean progression-free survival (PFS) and overall survival (OS) for this cohort were 7.5 months and 11.7 months, respectively. Common side effects of IT chemotherapy included headaches, nausea, and vomiting, with more severe complications such as myelotoxicity, disseminated intravascular coagulation, meningitis, and gastrointestinal toxicity reported in some cases.
Leptomeningeal disease continues to be an uncommon complication associated with high-grade glioma with a poor prognosis 3).
Case series
Case reports
High-grade glioma case reports from the General University Hospital of Alicante
Q11696
The patient is a 58-year-old woman with no significant medical history except for treated hypertension. She presented to the emergency department with disorientation, incoherent speech, and difficulty finding words for the past week, accompanied by holocranial headache. Neurological examination revealed a lesion in the left frontal lobe, and imaging studies, including brain MRI, suggested a large mass crossing to the contralateral frontal lobe, indicative of a high-grade glioma, with the alternative possibility of lymphoma.
A temporal lobe lesion with diffusion restriction, suggestive of an acute ischemic focus, was also noted. The patient had recently traveled and experienced increased stress and forgetfulness. A CT scan of the chest and abdomen showed no evidence of primary or metastatic malignancies, except for a hepatic hemangioma.
A biopsy was performed and the pathology report confirmed an intra-glioma of high grade,
A 57-year-old woman admitted to Neurosurgery due to difficulty opening the door of his house (he has no precision in grasping the doorknob) and a sensation of numbness in his left hand.
History of tachycardia and palpitations (palpitation aura ?)Studied by Holter monitor by Cardiology and discharged in the absence of significant alterations. They prescribe symptomatic treatment of palpitations with bisoprolol if necessary.
Hysterectomy + Oophorectomy for giant myoma.
Calcium carbonate + cholecalciferol
Intraaxial heterogeneous lesion located on the periphery of the right parietal lobe measuring about 25 mm x 21 mm x 26 mm (ap x tra x cc) with a central hypointense-necrotic area and peripheral irregular enhancement, which presents restricted diffusion of its necrotic component and Associated perilesional vasogenic edema. It exerts a mass effect on the adjacent sulci with slight obliteration of the ventricular atrium, a deviation of about 5 mm from the midline to the left, and slight subfalcine herniation. In the T2* sequence, 2 hypointense foci are identified that translate foci of calcification or microbleeding. In the FLAIR sequence, within the hyperintensity of the associated perisessional edema, there are areas of lower signal intensity adjacent to the lesion, which suggests a tumor infiltrative component.
Given the appearance of the lesion, it suggests that it is a high-grade glial neoplasm, less likely metastasis.