Multicentric gliomas of the cerebral and cerebellar hemispheres. Case report.
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A 62-year-old man presented with acute headache, blurred and double vision, nausea, and ataxia. Magnetic resonance imaging showed an enhancing mass on the inferior aspect of the right cerebellar hemisphere as well as a thin, widespread leptomeningeal enhancement and T2-weighted hyperintense lesions in the left occipital lobe and both thalami. Lumbar puncture revealed clusters of anaplastic cells. Therefore, metastatic tumor of unknown origin was suggested. Despite whole brain irradiation and intrathecal chemotherapy the patient deteriorated gradually and died four months later. Post-mortem examination of the brain revealed a nodular, high-grade astrocytic tumor within the subarachnoid space on the lower portion of the right cerebellar hemisphere. Diffuse leptomeningeal spread was noted, but cerebellar parenchyma was not infiltrated.
The authors present two patients with probable multiple sclerosis with clinical and CT manifestations of cerebral tumour in the first case and cerebellar tumour in the second case.
The rare malignant cerebellar gliomas have been considered as an unusual form of brain glioblastomas. However, different forms have been described which can be divided into three groups: (a) cerebellar astrocytomas with malignant features; (b) undifferentiated tumors mimicking the cerebral glioblastomas; (c) malignant glioblastomatous recurrences of primary benign cerebellar astrocytomas. The present series is composed of four cases studied with silver impregnation or with tissue culture and time-lapse cinematography. It appears from this study that the cerebellar glioblastomas bear no relationship to the cerebral glioblastoma. Silver impregnation shows many astrocytes taking part in the tumor cell population and the behavior in vitro is similar to that of the common benign astrocytomas from which they seem to be derived. Thus, a sequence can be established: benign cerebellar astrocytoma, malignant cerebellar astrocytoma, cerebellar glioblastoma.
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