Updated: 12/26/2021

Glioblastoma

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  • Snapshot
    • A 63-year-old man is brought to the physician's office by his son due to progressively worsening headache and weakness. His headache began approximately 3 months prior to presentation and is described as diffuse but worse on the right-side of the head. The headache worsens with coughing and lifting heavy objects and is associated with nausea, multiple episodes of vomiting, and left-sided weakness. He previously worked for the synthetic rubber industry for over 30 years. Physical examination is significant for 3/5 strength in the left upper and lower extremity. Magnetic resonance imaging (MRI) of the head is shown.
  • Introduction
    • Clinical definition
      • a highly malignant astrocytic brain tumor
  • Epidemiology
    • Incidence
      • 3/100,000 in the United States
      • the most common malignant primary brain tumor
    • Demographics
      • slightly more common in men
    • Risk factors
      • ionizing radiation
      • exposures include
        • synthetic rubber and petrolium production
        • vinyl chloride or pesticides
      • genetic disorders such as
        • Turcot syndrome
        • Li-Fraumeni syndrome
        • Lynch syndrome
        • Neurofibromatosis type 1
        • Cowden syndrome
  • ETIOLOGY
    • Pathogenesis
      • tumor can contain neoplastic astrocytes that are poorly differentiated
        • the tumor can result in a diffuse infiltrative growth pattern
  • Presentation
    • Symptoms
      • headache
        • features that are suggestive of a brain tumor in patients with headache include
          • nausea and vomiting
          • change in headache pattern
          • abnormal neurologic exam
          • worsening headache with changes in body position (e.g., bending over) and Valsalva maneuvers
      • seizure
      • cognitive change
    • Physical exam
      • focal neurologic deficit
  • Imaging
    • MRI
      • indication
        • this imaging modality is most commonly used when assessing for brain tumors
      • modality
        • gadolinium-enhancement
      • findings
        • ring-enhancing lesion with serpentine irregularity of the margins
        • "butterfly" glioma
  • Studies
    • Histology
      • confirms the diagnosis which is typically assessed after surgical resection
      • histological findings include
        • pleomorphic cells arranged in a "pseudopalisading" pattern around a central area of necrosis
        • nuclear atypia
        • invasive growth
  • Differential
    • Anaplastic astrocytoma
    • Metastatic brain cancer
    • Demyelination
  • Treatment
    • Medical
      • temozolomide
        • indication
          • can be used as concurrent chemoradiotherapy for glioblastoma
    • Surgical
      • tumor resection
        • indications
          • to achieve maximal surgical resection while preserving neurologic function and allows for a histologic diagnosis
          • adjuvant radiation therapy is standard therapy after resection
  • Complications
    • Survivors glioblastoma can result in
      • cognitive deficits
      • focal neurologic deficits
      • personality changes
      • apathy
  • Prognosis
    • This is typically a poor prognosis
      • < 30% survival rate in 1 year
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