Glioblastoma multiforme classification: Difference between revisions

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Revision as of 16:13, 16 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Glioblastoma may be classified into several subtypes based on its origin and molecular alterations.^[1]^[2]

Classification

Glioblastoma may be classified according to its origin into two subtypes: Primary and secondary.^[1]


Differential diagnosis	Characteristic features of the differential diagnosis

Cerebral metastasis	May look identical Both may appear multifocal Metastases are centred on grey-white matter junction and spare the overlying cortex
Primary CNS lymphoma	In patients with AIDS Central necrosis is more common Homogeneously enhancing on MRI
Cerebral abscess	Central restricted diffusion is helpful Hemorrhagic then assessment may be difficult Presence of smooth and complete SWI low intensity rim Presence of dual rim sign
Anaplastic astrocytoma	No central necrosis
Tumefactive demyelination	Can appear similar Open ring pattern of enhancement Younger patients
Stroke	History is suggestive of diagnosis No elevated choline
Cerebral toxoplasmosis	In patients with AIDS
Radiation necrosis	History of radiation exposure
Encephalitis	History of fever Confusion Stiff neck may be present suggestive of meningoencephalitis
Oligodendroglioma	Biopsy helps in differentiation Slower growing tumor Better prognosis
Epilepsy	Multifactorial Mass may or may not be observed on MRI depending on the cause

Primary glioblastoma

De novo origin
More aggressive
Occurs in older patients

Secondary glioblastoma

Arises from pre-existing lower grade gliomas
Less aggressive
Occurs in younger patients

Glioblastoma may be classified according to its molecular alterations into four subtypes:^[2]

Classic
Proneural
Mesenchymal
Neural

References

↑ ^1.0 ^1.1 Classification of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma
↑ ^2.0 ^2.1 Verhaak RG, Hoadley KA, Purdom E, Wang V, Qi Y, Wilkerson MD; et al. (2010). "Integrated genomic analysis identifies clinically relevant subtypes of glioblastoma characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1". Cancer Cell. 17 (1): 98–110. doi:10.1016/j.ccr.2009.12.020. PMC 2818769. PMID 20129251.

Template:WikiDoc Sources

[ddd-1] 1.0 ^1.1 Classification of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma

[pmid20129251-2] 2.0 ^2.1 Verhaak RG, Hoadley KA, Purdom E, Wang V, Qi Y, Wilkerson MD; et al. (2010). "Integrated genomic analysis identifies clinically relevant subtypes of glioblastoma characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1". Cancer Cell. 17 (1): 98–110. doi:10.1016/j.ccr.2009.12.020. PMC 2818769. PMID 20129251.

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[2]

@@ Line 8: / Line 8: @@
 ==Classification==
 Glioblastoma may be classified according to its origin into two subtypes: Primary and secondary.<ref name=ddd>Classification of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
+|valign=top|
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential diagnosis}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Characteristic features of the differential diagnosis}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
+:[[Metastasis|Cerebral metastasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*May look identical
+*Both may appear multifocal
+*Metastases are centred on grey-white matter junction and spare the overlying cortex
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Primary CNS lymphoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In patients with [[AIDS]]
+*Central [[necrosis]] is more common
+*Homogeneously enhancing on [[MRI]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Cerebral abscess]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Central restricted diffusion is helpful
+*[[Hemorrhagic]] then assessment may be difficult
+*Presence of smooth and complete SWI low intensity rim
+*Presence of dual rim sign
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Astrocytoma|Anaplastic astrocytoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*No central [[necrosis]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Demyelination|Tumefactive demyelination]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Can appear similar
+*Open ring pattern of enhancement
+*Younger patients
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Stroke]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*History is suggestive of diagnosis
+*No elevated choline
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Toxoplasmosis|Cerebral toxoplasmosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In patients with [[AIDS]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Radiation|Radiation necrosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*History of [[radiation]] exposure
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Encephalitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*History of [[fever]]
+*[[Confusion]]
+*[[Stiff neck]] may be present suggestive of [[meningoencephalitis]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Oligodendroglioma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Biopsy]] helps in differentiation
+*Slower growing [[tumor]]
+*Better [[prognosis]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:[[Epilepsy]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Multifactorial
+*Mass may or may not be observed on MRI depending on the cause
+|}
 ====Primary glioblastoma====