tomographic and pathologic studies of the untreated, quiescent, and recurrent
Burger PC, Dubois PJ, Schold SC Jr, Smith KR Jr, Odom GL, Crafts DC,
Pathological findings in 20 cases of glioblastoma multiforme were correlated
with clinical histories and computerized tomographic (CT) scans.
This was done to define the neoplasm in three stages: before treatment, during
remission, and during recurrence.
The untreated lesions were markedly cellular neoplasms composed predominantly of
small anaplastic cells.
The radiographic central region of low density was necrosis, the enhancing rim
was a cellular zone of viable neoplasm, and the perilesional low-density area
was edema with infiltrating tumor.
In these 20 cases, all of the identifiable neoplasms lay within the zone of
peritumoral edema or contrast enhancement, although small anaplastic cells may
have been present in more distant regions.
The lesions in remission were remarkable for their minimal mass effect, discrete
nature, extensive necrosis, and content of large bizarre glia.
The large cells were confined to the original tumor bed and were consistent with
neoplastic cells inactivated and immobilized by radio- and chemotherapy.
These lesions were accurately localized by CT scanning.
The recurrent lesions were heterogeneous, but most were formed of widely
disseminated small anaplastic cells.
The highly cellular regions of such lesions could be localized by CT scanning,
but CT could not detect less cellular foci in the cerebrum, cerebellum, or brain
In one patient, the contrast-enhancing lesions of "recurrence," were
foci of radionecrosis, underscoring the difficulty in distinguishing this entity
from recurrent neoplasm.
PMID: 6294260 [PubMed - indexed for MEDLINE]