2. Clinical Profile
48 years, female, history of headache and few episodes
of vomiting with few episodes of vacant look off and
on over 10 days.
On examination, no neurological deficit.
3.
4.
5. SURGICAL MANAGEMENT
She underwent
1. RIGHT FRONTO PARIETAL PARASAGGITAL
CRANIOTOMY, INTERHEMISPHERIC APPROACH,
TRANSCALLOSAL EXCISION OF TUMOUR
Intra-operative frozen section was reported as a Low
Grade lesion, so 2nd tumour has been operated.
2. LEFT FRONTAL SUPRAORBITAL CRANIOTOMY
AND EXCISION OF LESION on 29.05.2015
19. Post operative period was uneventful,.
She was covered with pre and post operative
anticonvulsants and corticosteroids.
EVD and surgical drain removed on POD 3 , Sutures
removed on POD10
Advised Radiotherapy after 2 weeks
20. DEFINITION OF MULTICENTRIC /
MULTIFOCAL
Multifocal glioma consists of tumours separated by
white matter tracts within the same hemisphere.
Multicentric glioma consists of tumors in opposite
hemispheres or separated by the tentorium.
21. MULTIFOCAL / MULTICENTRIC
GBM
Batzdorf et al. (1963) distinguish between
"Multicentric" and "Multifocal"
Showalter et al. (2007) suggests that "the clinical
utility of this... may be scant."
Lim et al. (2007) hypothesize that multifocal GBM is
a subtype of GBM arising from Subventricular zone
(SVZ) stem cells
22. -
The incidence of solitary, multiple, and multicentric
gliomas a series of 209 gliomas was 72.2%, 25.4%, and
2.4%, respectively
U. Batzdorf and N. Malamud, “The problem of multicentric
gliomas,” Journal of Neurosurgery, vol. 20, pp. 122–136, 1963.
23. TYPES OF GBM
TYPE1: SVZ+, CTX +
TYPE 2: SVZ +, CTX –
TYPE 3: SVZ -, CTX +
TYPE 4: SVZ -, CTX -
24. MULTICENTRIC / MULTIFOCAL:
INCIDENCE
Multiple glioma in the form of multifocal or
multicentric is uncommon entity.
Incidence in literature varies from 0.15% to
25.4%
Even more uncommon is the Intraventricular
GBM as one of the tumors
25. PATHOLOGY
Still there is no unified theory regarding the pathogenesis of
multifocal and multicentric GBM, several hypotheses have been
developed.
The traditionally held view of the pathogenesis of
multifocal/multicentric GBM is by three possible pathways.
1) First, a previously known primary high-grade glioma spreads
through the cerebrospinal fluid or white matter tracts to other
locations.
2) Second, multiple areas of high-grade glioma arise de
novo from initially non-neoplastic cells that are influenced by
genetic defect.
3) Third and last, initially diffuse low-grade glioma develops
separate from separate areas of malignant transformation within
itself, hence giving rise to multifocal/multicentric GBM.
26. .
Some literature proposes that the pathogenesis of
multiple and multicentric GBM may involve neural
stem cells within the subventricular zone or could
result from tumor dissemination along established
CNS routes, such as white matter tracts and CSF
pathways.
Neural stem cells have been found to express matrix
metalloproteinases, which are proteolytic enzymes
implicated in tumor spread . Furthermore, the SVZ is
thought to be a highly permissive environment for
tumor growth and cellular migration.
27. Currently there is no clear
guidelinesregarding the optimal
management of MF/MC GBM, role of
surgery for MF/MC remains
controversial.
Aggressive resection of one tumor focus, biopsy alone followed by
chemotherapy and radiation treatment, and multiple craniotomies during
a single operation have all been described with no clear indication of which
modality is superior
TREATMENT MODALITIES
28. REFERENCES
Andrea Arcos b, Lorena Romero b,∗, Ramón Serramito a, José M. Santína, Antonio Prieto
a, Miguel Gelabert a, Miguel Ángel Arráez b: Multicentric glioblastoma multiforme.
Report of 3 cases, clinical and pathological study and literature review: neuroc i rugia. 2 0
1 2;23(5):211–215
Zamponi N1, Rychlicki F, Ducati A, Regnicolo L, Salvolini U, Ricciuti RA.: Multicentric
glioma with unusual clinical presentation.: Childs Nerv Syst. 2001 Jan;17(1-2):101-5.
Sophia F. Shakur,1 Esther Bit-Ivan,2 William G. Watkin,2 Ryan T. Merrell,3 andHamad I.
Farhat: Multifocal and Multicentric Glioblastoma with Leptomeningeal Gliomatosis: A
Case Report and Review of the Literature: Case Reports in Medicine
Volume 2013 (2013), Article ID 132679, 8 pages
http://dx.doi.org/10.1155/2013/132679
Yusuf ZC, Do¤a GÜRKANLAR, Erdener T‹MURKAYNAK: Multicentric Gliomas: Still
Remains a Controversial Issue: Turkish Neurosurgery 2005, Vol: 15, No: 2, 71-75
