Carsten Bock, H. Hetschko, A. Jassoy (Halle)  

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3 Months  

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Head-Brain and brain nerves  

neoplastic  

3 month-old infant. In the newborn-screening in an outside clinic, a echogenic - partly cystic - structure in the area ventral to the nucleothalamic groove was seen. This was judged as a finding after cerebral hemorrhage and was called for a follow-up examination in the 6th week of life. There were no other clinical signs.  

This is the most anaplastically modified form of glia cell tumors. Next to solid parts with increased mitotic nuclear morphology, one may see large-scaled necroses, cysts and hemorrhages. Commonly seen are edema around the area, however in this case none were seen.
In scintigraphy or perfusional MRI, hyperperfunded. "Tangled" capillary appearance in angiography.
Classification
I.°: slow-growing, few mitoses, no endothelial proliferation.
II.°: increased mitosis with polymorphic nuclei. No clear demarkation to healthy tissue.
III.°: anaplastic Astrocytoma.
IV.°: Glioblastoma multiforme. Cellular pleomorphism, vascular proliferation, mitoses and multi-nucleated giant cells.  

<- view Ultrasound 1

Ultrasound 1: Sonographic image of the tumor in coronal slice. About 57 x 35 x 42 mm mass with predominantly echogenic, but also areas of low echogenicity and cystic areas. Particularly the knees of the corpus callosum is not clearly distinguishable. The tumor is well-marcated caudally.




<- view Ultrasound 2

Ultrasound 2: Sonographic image of the tumor in saggital slice. About 57 x 35 x 42 mm mass with predominantly echogenic, but also areas of low echogenicity and cystic areas




<- view MRI 1

MRI 1: T1 sagittal native: inhomogenic intensity with very hyperintense areas, which are hypointense in T2, and therefore are classified as hemorrhages. Cranially, you cannot distinguish the corpus callosum. Spans below the corpus callosum into both lateral ventricles.






<- view MRI 2

MRI 2: T1 coronal after contrast: An increased contrast media uptake in the tumor. Both lateral ventricles show compression.




<- view MRI 3

MRI 3: T1 before contrast application, transversal: Obvious widening of the lateral ventricles (right side more than left). Hemorrhage in the TM.




<- view MRI 4

MRI 4: T1 transversal, after contrast. obvious contrast uptake (compare to MRI 3).




<- view MRI 5

MRI 5: T2 transversal: The tumor grew into both lateral ventricles. There are cystic areas and areas of low signal (hemorrhage). Missing perifocal edema.

 

Surgery / Histo  

Other cerebral tumors. Due to the midline position and young age of our patient, a dysembryonal malformation tumor is assumed, which would also explain the missing edema. Furthermore, hemorrhaging with colliquation necrosis. Other tumors: metastases, lymphomas with hemorrhage and necrosis. Cerebral abscess with central necrosis.  

According to literature, glioblastoma multiforme makes up about 4 to 10% of pediatric intracranial tumors. In children, the sex ratio is the same (in other literature, 3:2 boys:girls) and the average age at the time of diagnosis is 9 to 10 years. The peak age lies, however, between the 35th and 60th year of life. In adults, glioblastomas make up about 15 to 30% of all cerebral tumors and is preferential to men in the ratio of 2:1.

The preferred location lies frontally - followed by bifrontal, temporal, parietal, occipital and in the callosal region. The course is rapidly progressing. The first clinical signs are mostly headaches, focal seizures and changes in personality. Later, depending on location, cerebral pressure changes, neuroendocrinal changes and sleepiness.
The primary treatment involves resection and radiation and/or chemotherapy. The prognosis is bad; the 5-year survival rate is under 5%. Only a third of the children survive the first year after diagnosis is made.  

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Glioblastoma multiforme, anaplastic glia cell tumor, anaplastic glioma, brain tumor, child, childhood, pediatric radiology  

Carsten Bock, H Hetschko, A Jassoy. Glioblastoma multiforme in a newborn. PedRad [serial online] vol 2, no. 9.
URL: www.PedRad.info/?search=20020920100326