Glioma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Sujit Routray, M.D. [3]
Overview
A glioma is a type of primary central nervous system (CNS) tumor that arises from glial cells. The most common site of involvement of gliomas is the brain, but gliomas can also affect the spinal cord or any other part of the CNS, such as the optic nerve.[1] Gliomas were reported as early as the 1850s. Retinal gliomas were most commonly reported because they were easier to detect and sample in the absence of advanced imaging and surgical techniques. Glioma may be classified into several subtypes based on the type of cell, grade, and location.[2] The pathogenesis of cerebral glioma involves invasion of the astrocytes into the adjacent normal brain tissue. The gross and histopathological appearance of glioma varies with the tumor grade and type.[3] Glioma must be differentiated from primary CNS lymphoma, cerebral metastases, meningioma, brain abscess, cavernous malformation, stroke, acute disseminated encephalomyelitis, cavernous sinus syndrome, intracranial hemorrhage, hamartoma, germinoma, teratoma, piloid gliosis, and progressive multifocal leukoencephalopathy.[4][2] The incidence of glioma is estimated to be 4.9 cases per 100,000 individuals in the US.[5] Patients of all age groups may develop glioma. Males are more commonly affected with glioma than females. It usually affects individuals of the caucasian race. African american, latin american, and asian individuals are less likely to develop glioma. Common risk factors in the development of glioma are occupational factors, environmental factors, genetic factors, and viruses.[2][6][7][4][5] Common complications of glioma include brain herniation, coma, metastasis, and recurrence. The prognosis for glioma varies with the grade of tumor. The 1-year and 2-year survival rate of patients with malignant glioma is approximately 50% and 25%, respectively.[8] Common symptoms of glioma include morning headaches, nausea and vomiting, seizures, drowsiness, changes in speech, difficulty in swallowing, vision changes, abnormal eye movements, changes in personality, memory loss, loss of balance, difficulty in walking, weakness in extremities, numbness in extremities, pain in extremities, and loss of appetite.[2] The predominant therapy for glioma is surgical resection. Adjunctive chemotherapy and radiation may be required.[2]
Historical Perspective
Gliomas were reported as early as the 1850s. Retinal gliomas were most commonly reported because they were easier to detect and sample in the absence of advanced imaging and surgical techniques.
Classification
Glioma may be classified into several subtypes based on the type of cell, grade, and location.[2]
Pathophysiology
The pathogenesis of cerebral glioma involves invasion of the astrocytes into the adjacent normal brain tissue. Although in certain areas the margin of the tumor may seem to be macroscopically well defined from the brain, there are always microscopic nests of tumor cells extending well out into the brain.[4] Genes involved in the pathogenesis of glioma include ERCC1, ERCC2, XRCC1, MGMT, IDH1, IDH2, p53, EGFR, TSC1, TSC2, RB1, APC, hMLH1, hMSH2, PMS2, PTEN, NF1, and NF2.[2][5] The gross and histopathological appearance of glioma varies with the tumor grade and type.[3]
Causes
There are no established causes for glioma.
Differentiating brain tumors from other diseases
Glioma must be differentiated from primary CNS lymphoma, cerebral metastases, meningioma, brain abscess, cavernous malformation, stroke, acute disseminated encephalomyelitis, cavernous sinus syndrome, intracranial hemorrhage, hamartoma, germinoma, teratoma, piloid gliosis, and progressive multifocal leukoencephalopathy.[2][4]
Epidemiology and Demographics
Glioma is the most common primary intracranial tumor. The incidence of glioma is estimated to be 4.9 cases per 100,000 individuals in the US.[5] Patients of all age groups may develop glioma. Males are more commonly affected with glioma than females. It usually affects individuals of the caucasian race. African american, latin american, and asian individuals are less likely to develop glioma.
Risk factors
Common risk factors in the development of glioma are occupational factors, environmental factors, genetic factors, and viruses.[2][4][5][6][7] The CT scan and MRI findings of glioma vary with the tumor grade and type.[2][3][4][6][9][8]
Screening
There is insufficient evidence to recommend routine screening for glioma.
Natural History, Complications and Prognosis
Common complications of glioma include brain herniation, coma, metastasis, and recurrence. The prognosis for glioma varies with the grade of tumor. The 1-year and 2-year survival rate of patients with malignant glioma is approximately 50% and 25%, respectively.[8]
Staging
There is no established system for the staging of glioma.[8]
History and Symptoms
Common symptoms of glioma include morning headaches, nausea and vomiting, seizures, drowsiness, changes in speech, difficulty in swallowing, vision changes, abnormal eye movements, changes in personality, memory loss, loss of balance, difficulty in walking, weakness in extremities, numbness in extremities, pain in extremities, and loss of appetite.[2]
Physical examination
Common physical examination findings of glioma include aphasia, vision loss, strabismus, memory loss, sensory loss, paresis, abnormal gait, ataxia, papilledema, and focal neurological deficits.[2]
Laboratory Findings
There are no diagnostic lab findings associated with glioma.
X Ray
There are no x-ray findings associated with glioma.
CT
Head CT scan may be diagnostic of glioma. The CT scan findings of glioma vary with the tumor grade and type.[4][6][9][2][8][3]
MRI
Brain MRI may be diagnostic of glioma. The MRI findings of glioma vary with the tumor grade and type.[4][6][9][2][8][3]
Ultrasound
There are no ultrasound findings associated with glioma.
Other Imaging Findings
Other imaging studies for high-grade gliomas include PET scan, which demonstrates accumulation of [18F]-fluorodeoxyglucose (increased glucose metabolism).[2]
Other Diagnostic Studies
Other diagnostic studies for glioma include biopsy, which demonstrates astrocytes with or without atypia and mitoses, depending on the type of glioma.[2]
Medical Therapy
Treatment for glioma depends on the location and grade. The predominant therapy for glioma is surgical resection. Adjunctive chemotherapy and radiation may be required.[2]
Surgery
Surgery is the mainstay of treatment for glioma.[2]
References
- ↑ Mamelak A.N., and Jacoby, D.B. Targeted delivery of antitumoral therapy to glioma and other malignancies with synthetic chlorotoxin (TM-601) Expert Opin. Drug Drliv. (2007) 4(2):175-186.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Classification of glioma. Wikipedia. https://en.wikipedia.org/wiki/Glioma
- ↑ 3.0 3.1 3.2 3.3 3.4 Pathology of gliomas. Libre Pathology. http://librepathology.org/wiki/index.php/Oligodendroglioma
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 DDx of gliomas. Libre Pathology. http://librepathology.org/wiki/index.php/Oligodendroglioma
- ↑ 5.0 5.1 5.2 5.3 5.4 Schwartzbaum JA, Fisher JL, Aldape KD, Wrensch M (2006). "Epidemiology and molecular pathology of glioma". Nat Clin Pract Neurol. 2 (9): 494–503, quiz 1 p following 516. doi:10.1038/ncpneuro0289. PMID 16932614.
- ↑ 6.0 6.1 6.2 6.3 6.4 Ruder, Avima M.; Carreón, Tania; Butler, Mary Ann; Calvert, Geoffrey M.; Davis-King, Karen E.; Waters, Martha A.; Schulte, Paul A.; Mandel, Jack S.; Morton, Roscoe F. (Jun 15, 2009). "Exposure to farm crops, livestock, and farm tasks and risk of glioma: the Upper Midwest Health Study". American Journal of Epidemiology. 169 (12): 1479–1491. doi:10.1093/aje/kwp075. ISSN 1476-6256. PMID 19403843.
- ↑ 7.0 7.1 Ostrom, Quinn T.; Bauchet, Luc; Davis, Faith G.; Deltour, Isabelle; Fisher, James L.; Langer, Chelsea Eastman; Pekmezci, Melike; Schwartzbaum, Judith A.; Turner, Michelle C. (Jul 2014). "The epidemiology of glioma in adults: a "state of the science" review". Neuro-Oncology. 16 (7): 896–913. doi:10.1093/neuonc/nou087. ISSN 1523-5866. PMC 4057143. PMID 24842956.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Prognostic factors of glioma. National Cancer Institute. http://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq
- ↑ 9.0 9.1 9.2 Radiological findings of anaplastic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. http://radiopaedia.org/articles/anaplastic-astrocytoma