Glioma pathophysiology: Difference between revisions

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Image:Glioma Gross 45.jpg|Brain: [[Glioblastoma Multiforme]]: Gross natural color large hemorrhagic lesion in right centrum semiovale
Image:Glioma Gross 45.jpg|Brain: [[Glioblastoma Multiforme]]: Gross natural color large hemorrhagic lesion in right centrum semiovale
Image:Pilocytic astrocytoma gross.jpg|CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.
Image:Pilocytic astrocytoma gross.jpg|CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.
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Revision as of 14:53, 14 September 2012

Glioma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Glioma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Glioma pathophysiology On the Web

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Glioma pathophysiology

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Risk calculators and risk factors for Glioma pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Pathophysiology

High-grade gliomas are highly-vascular tumors and have a tendency to infiltrate. They have extensive areas of necrosis and hypoxia. Often tumor growth causes a breakdown of the blood-brain barrier in the vicinity of the tumor. As a rule, high-grade gliomas almost always grow back even after complete surgical excision.

On the other hand, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms.

Gross Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology


  • Brain: Glioma: Gross; fixed tissue, horizontal section brain stem and cerebellum with obvious gelatinous appearing neoplasm a pontine glioma

    Brain: Glioma: Gross; fixed tissue, horizontal section brain stem and cerebellum with obvious gelatinous appearing neoplasm a pontine glioma

  • Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left frontal lobe

    Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left frontal lobe


  • Brain: Glioma: Gross; fixed tissue, horizontal sections brain stem and cerebellum showing large pontine glioma

    Brain: Glioma: Gross; fixed tissue, horizontal sections brain stem and cerebellum showing large pontine glioma

  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with brain stem and cerebellum removed. Pontine asymmetry is easily seen due to low grade astrocytoma and meningeal gliomatosis is easily seen over frontal lobes

    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with brain stem and cerebellum removed. Pontine asymmetry is easily seen due to low grade astrocytoma and meningeal gliomatosis is easily seen over frontal lobes


  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.

    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.

  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule

    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule


  • Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor

    Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor

  • Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere

    Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere


  • Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass

    Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass

  • Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter

    Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter


  • Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus

    Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus

  • Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle

    Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle


  • Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion

    Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion

  • Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion

    Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion


  • Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle

    Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle

  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)

    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)


  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres

    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres

  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres

    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres


  • Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma

    Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma

  • Brain: Microglioma: Gross; fixed tissue; cerebellum and fourth ventricle with periventricular tumor invasion

    Brain: Microglioma: Gross; fixed tissue; cerebellum and fourth ventricle with periventricular tumor invasion


  • Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate

    Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate

  • Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration

    Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration


  • Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum

    Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum

  • Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion

    Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion


  • Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation

    Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation

  • Glioma: Optic Nerve

    Glioma: Optic Nerve


  • Brain: Oligodendroglioma, Frontal Lobe

    Brain: Oligodendroglioma, Frontal Lobe

  • Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma

    Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma


  • Brain: Oligodendroglioma

    Brain: Oligodendroglioma

  • Brain: Oligodendroglioma

    Brain: Oligodendroglioma


  • Brain: Glioma, Grade II Anaplastic

    Brain: Glioma, Grade II Anaplastic

  • Brain: Glioma, Brain stem, Low Grade

    Brain: Glioma, Brain stem, Low Grade


  • Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve

    Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve

  • Brain: Glioma, Hypothalamic, Circle Around Region of Tumor

    Brain: Glioma, Hypothalamic, Circle Around Region of Tumor


  • CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.

    CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.

  • Brain: Glioma, Pontine

    Brain: Glioma, Pontine


  • Brain: Glioblastoma Multiforme: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum

    Brain: Glioblastoma Multiforme: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum

  • Brain: Glioblastoma Multiforme: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III

    Brain: Glioblastoma Multiforme: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III


  • Brain: Glioblastoma Multiforme: Gross natural color large hemorrhagic lesion in right centrum semiovale

    Brain: Glioblastoma Multiforme: Gross natural color large hemorrhagic lesion in right centrum semiovale

  • CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.

    CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.

  • Brain: Oligodendroglioma; Ventricular Cobblestone Effect

    Brain: Oligodendroglioma; Ventricular Cobblestone Effect

Microscopic Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • CNS: Pilocytic astrocytoma: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of pilocytic astrocytomas in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.

    CNS: Pilocytic astrocytoma: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of pilocytic astrocytomas in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.

  • CNS: Pilocytic astrocytoma: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an ependymoma. Note the spongy background unusual for ependymomas.

    CNS: Pilocytic astrocytoma: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an ependymoma. Note the spongy background unusual for ependymomas.



  • CNS: Pilocytic astrocytoma: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the cerebellum, it can be difficult to distinguish such solid, paucicellular, highly fibrillar pilocytic astrocytomas from reactive gliosis with abundant Rosenthal fiber formation.

    CNS: Pilocytic astrocytoma: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the cerebellum, it can be difficult to distinguish such solid, paucicellular, highly fibrillar pilocytic astrocytomas from reactive gliosis with abundant Rosenthal fiber formation.

  • CNS: Pilocytic astrocytoma: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic astrocytoma.

    CNS: Pilocytic astrocytoma: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic astrocytoma.







  • CNS: Oligodendroglioma (frozen section); Oligodendrogliomas in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of cerebral cortex with perineuronal satellitosis suggest the correct diagnosis.

    CNS: Oligodendroglioma (frozen section); Oligodendrogliomas in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of cerebral cortex with perineuronal satellitosis suggest the correct diagnosis.

  • CNS: Clear cell ependymoma; Perinuclear clearing similar to that seen in oligodendrogliomas is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.

    CNS: Clear cell ependymoma; Perinuclear clearing similar to that seen in oligodendrogliomas is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.



  • CNS: Glioblastoma multiforme; Characteristic of most glioblastomas are small cells with elongated nuclei and bipolar processes. As here, the chromatin is generally not markedly dense nor are nucleoli usually prominent.

    CNS: Glioblastoma multiforme; Characteristic of most glioblastomas are small cells with elongated nuclei and bipolar processes. As here, the chromatin is generally not markedly dense nor are nucleoli usually prominent.

  • CNS: Glioblastoma multiforme; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).

    CNS: Glioblastoma multiforme; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).


  • CNS: Glioblastoma multiforme; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).

    CNS: Glioblastoma multiforme; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).

  • CNS: Glioblastoma multiforme; In many instances, necrosis is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.

    CNS: Glioblastoma multiforme; In many instances, necrosis is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.


  • CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.

    CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.

  • CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.

    CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.


  • CNS: Glioblastoma multiforme; Higher magnification reveals the small cell nature of such tumors.

    CNS: Glioblastoma multiforme; Higher magnification reveals the small cell nature of such tumors.

  • CNS: Glioblastoma multiforme; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.

    CNS: Glioblastoma multiforme; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.





References


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