Topographic anatomy and CT correlations in the untreated glioblastoma multiforme

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✓ To provide baseline information for the “local” therapy of the glioblastoma multiforme (GBM), whole-brain histological sections of 15 untreated GBM's were studied to determine the distribution of neoplastic cells. These findings were then compared with the computerized tomography (CT) scans in 11 cases in order to determine the extent to which the peripheral portion of the neoplasm can be estimated by the presence of a low-density area without contrast enhancement. The results of the histological study confirmed the marked heterogeneity of GBM's and disclosed a great variability in the geometry, extent, and character of the peripheral “infiltrating” margin. In spite of the widely held concept that glioblastomas are localized within 2 cm of the contrast-enhanced rim, there were three cases in this two-dimensional study in which this distance was exceeded, and it seems likely that three-dimensional reconstructions would have detected additional cases in which neoplastic cells extended beyond this arbitrary limit. Only three of the 15 GBM's were restricted to the distribution of one internal carotid or one vertebral artery. To the extent that the neoplasms in the present series are representative, this suggests that glioblastomas will be difficult to treat successfully by intra-arterial therapy using existing therapeutic agents. Correlations of histological sections with the CT scans revealed that the vast majority of the neoplastic tissue was contained within the contrast-enhancing and “peritumoral” areas of low density, but that in five cases fingers of neoplasm extended for short distances beyond the outer margin of the latter region. This indicates that the distribution of cells of a GBM cannot be inferred from CT images since the “peritumoral” area of low density can over- or underestimate the extent of the lesion.

Article Information

Address for Dr. Shibata: Jinsey Hospital, Department of Neurology and Neuropathology, Toyohashi City, Futagawa, Kitaura 1-17, Japan.

Address reprint requests to: Peter C. Burger, M.D., Department of Pathology, Box 3712, Duke University Medical Center, Durham, North Carolina 27710.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photomicrographs of sections of glioblastoma multiforme in two patients. Left: Case 7. The regions of the glioblastoma that corresponded to zones of contrast enhancement were composed of markedly cellular neoplasm with abnormal vessels (bottom of print) and necrosis (N). H & E, × 40. Right: Case 12. In this individual, neoplastic cells infiltrated the corpus callosum 5 cm from the outer edge of the hypercellular ring. The neoplastic cells (arrows) are identified by their elongated shape, coarse chromatin, and the size greater than that of surrounding glia. H & E, × 400.

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    Topographic distribution of the neoplasms sectioned in the horizontal plane. The centrally located hatched areas represent necrosis, the solid regions indicate the markedly hypercellular region of viable neoplasm, and the stippled regions represent peripheral zones of “infiltration.” Note in this and in Fig. 3 that there is marked variability in the extent and geometry of the peripheral zones of “infiltration.” The numbers indicate case numbers; see Table 1.

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    Topographic distribution of the neoplasms sectioned in the coronal plane. The centrally located hatched areas represent necrosis, the solid regions indicate the markedly hypercellular region of viable neoplasm, and the stippled regions represent peripheral zones of “infiltration.” The numbers indicate case numbers; see Table 1.

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    Comparison of the extent of the neoplasms as defined by histological and computerized tomography (CT) study. The solid regions depict the total extent of the neoplasm (that is, the sum of the necrotic center, cellular rim, and peripheral zone of “infiltration”) as determined by histological examination. The stippled areas represent the extent of the “peritumoral” low-density area as defined by the last CT scan prior to the patient's death. In these six cases, the full extent of the neoplasm determined histologically lies within the radiographic area of low density.

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    Comparison of the extent of the neoplasms as defined by histological and computerized tomography (CT) study. The solid regions depict the total extent of the neoplasm (that is, the sum of the necrotic center, cellular rim, and peripheral zone of “infiltration”) as determined by histological examination. The stippled areas represent the extent of the “peritumoral” low-density area as defined by the last CT scan prior to the patient's death. In these five cases, small tongues of neoplastic tissue extend into regions of the brain in which no CT abnormality was detected. The arrows indicate the points at which the tumors extended beyond the CT areas of “peritumoral” low density.

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