glial neoplasm (glioma)
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Etiology
- prior exposure to radiation therapy only consistent risk factor[1]
Epidemiology
- 50% of all primary brain neoplasms
- most commonly occur in 4th-6th decade of life
- grade 3 & 4 most commonly occur in patients 40-70 years
Genetics
- down-regulation of BTBD10, CHN2
- overexpression of PHF19, MDM2
- ARHGAP29 is up-regulated in migrating glioma cells
- other implicated genes: XRRA1, IIP45
Clinical manifestations
- seizures is most common presenting symptom
- patients may present with focal neurologic deficit
Diagnostic procedures
- tissue diagnosis by brain biopsy or craniotomy & resection
Radiology
- MRI with gadolinium contrast is imaging modality of choice
- low-grade gliomas appear lesions with
- indistinct margins
- minimal contrast enhancement
- little or no edema
- higher grade gliomas are more likely to show contrast enhancement & surrounding edema
- oligodendrogliomas are generally calcified (90%)
- low-grade gliomas appear lesions with
* image[6]
Staging
- grade 1: low grade
- grade 2:
- low grade, grows slowly
- inevitably transforms into higher grade if left untreated
- grade 3: high grade
- grade 4: glioblastoma multiforme
Management
- surgical resection is curative in patients with grade 1 gliomas
- grade 2 & 3 gliomas: surgical resection followed by radiation therapy &/or chemotherapy[2][3]
- see astrocytoma
- see oligodenroglioma
- see glioblastoma multiforme
- prognosis:
- median survival is 9 years for grade 2 gliomas
- median survival is 3 years for grade 3 gliomas
- median survival is 1 year for grade 4 gliomas (glioblastoma multiforme)
- predictors of poor prognosis
- advanced age,
- poor performance status
- larger tumor size
- tumors crossing the midline
- astrocytic histopathology
- higher WHO grade
More general terms
More specific terms
- astrocytoma (astrocytic neoplasm)
- chordoid glioma of the third ventricle
- ependymal neoplasm
- ganglioglioma; dysembryonic neuroepithelial neoplasm
- gliomatosis cerebri
- malignant glioma
- mixed glioma
- oligodendroglial neoplasm
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
- ↑ 2.0 2.1 Kaloshi G et al. Supratentorial low-grade gliomas in older patients. Neurology 2009 Dec 15; 73:2093. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19907009
- ↑ 3.0 3.1 Smith JS, Chang EF, Lamborn KR et al Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008 Mar 10;26(8):1338-45 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18323558
- ↑ Surma-aho O, Niemela M, Vilkki J et al Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology. 2001 May 22;56(10):1285-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11376174
- ↑ Weller M, Stupp R, Hegi ME et al Personalized care in neuro-oncology coming of age: why we need MGMT and 1p/19q testing for malignant glioma patients in clinical practice. Neuro Oncol. 2012 Sep;14 Suppl 4:iv100-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23095825
- ↑ 6.0 6.1 Khanna O, Ghobrial GM, Farrell CJ 10 Brain Lesions to Recognize (MRI images) Medscape. October 25, 2021 https://reference.medscape.com/slideshow/brain-lesions-6013313