Assuntos
Aneurisma Roto/prevenção & controle , Aspirina/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Roto/metabolismo , Ciclo-Oxigenase 2/metabolismo , Humanos , Aneurisma Intracraniano/metabolismo , Oxirredutases Intramoleculares/metabolismo , Macrófagos , Prostaglandina-E SintasesRESUMO
Glioblastoma multiforme is a malignant tumour with a universally fatal diagnosis. We report two patients with glioblastoma with symptomatic metastasis to the spinal cord and perform a systematic review all 35 reports of symptomatic glioblastoma dissemination to the spinal leptomeninges and/or intramedullary spinal axis. Our analysis of the data shows a median time to spinal metastasis of 10 months and a median time of three months from spinal metastasis to death. Treatments described include palliative laminectomies, radiotherapy and chemotherapy. No treatment strategy offered a therapeutic advantage as patients deteriorated rapidly regardless of intervention. Patients who underwent only a biopsy for intracranial glioblastoma had a shorter time to development of spinal metastasis. In addition, there may be an association between intramedullary metastasis and shorter survival. This paper highlights the importance of considering symptomatic spinal dissemination in glioblastoma multiforme. We also review the incidence and postulate mechanisms of tumour dissemination in the central nervous system. Clearly, further research into radiotherapeutic and chemotherapeutic options in this clinical setting is required.
Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Neoplasias da Medula Espinal/secundário , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/mortalidade , Tomografia Computadorizada por Raios XRESUMO
We report a case of de novo malignant ganglioglioma. A 61-year-old male presented with a 12-day history of headaches and general malaise. Pre-operative magnetic resonance imaging revealed an irregular enhancing mass in the left temporal lobe with associated dural enhancement and subacute subdural hematoma. The findings at surgery were of a vascular tumor intimately involving the surrounding white matter, with central necrosis. Histological and immunohistochemical studies showed an anaplastic ganglioglioma with World Health Organization grade IV characteristics. Gangliogliomas of the central nervous system are rare and are typified by a pediatric predilection and indolent behavior. A review of the de novo anaplastic and malignant gangliogliomas is presented.