J Korean Soc Radiol.  2010 Oct;63(4):299-306.

The Radiologic Features of Cystic versus Noncystic Glioblastoma Multiforme as Significant Prognostic Factors

• Choi SJ
• Hwang HY
• Kim NR
• Lee SW
• Kim JH
• Choi HY
• Kim HS

Abstract

PURPOSE
The purpose of this study was to determine the preoperative radiological characteristic and survival differences of glioblastoma multiforme (GBM) with and without cysts.
MATERIALS AND METHODS
Twenty-one GBMs were collected retrospectively; these tumors were pathologic confirmed as GBM. Based on the preoperative MR imaging, we compared the cystic GBMs with the noncystic GBMs according to the the tumor size, the tumor interface, the tumor wall thickness and peritumoral edema.
RESULTS
Seven cases were classified as cystic GBMs and fourteen were noncystic GBMs. The cystic GBMs had a well-defined tumor interface, a less than 2 cm thickness of the tumor wall and less than 40 cm3 thick peritumoral edema as compared to that of the noncystic GBMs. There was a statistically significant difference in age between the patients with cystic tumors and those with noncystic tumors. For the patients with cystic GBMs and noncystic GBMs, median survival time after surgery was 43.8 months and 12.5 months, respectively.
CONCLUSION
The cystic GBMs had a well-defined tumor interface, a thin wall and minimal edema, as compared with that of the noncystic GBMs. The patients with cystic GBMs were significantly younger and they had more favorable survival outcomes than did the patients with noncystic GBMs.

MeSH Terms

Brain Neoplasms
Edema
Glioblastoma
Humans
Magnetic Resonance Imaging

Figure

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  Fig. 1 The axial Gd-enhanced T1-weighted MR images obtained from two patients with cystic GBMs. The cystic portion of the tumor shows an ovoid shape, a well defined interface, homogeneous hypointensity and an enhanced even lining on a thin, smooth wall on the Gd-enhanced T1-weighted MR images.

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  Fig. 2 The axial Gd-enhanced T1-weighted MR images obtained from two patients with non cystic GBMs. The non cystic GBM shows an irregular shape, a poor interface and an enhanced thick and uneven wall on the Gd-enhanced T1-weighted MR images.

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  Fig. 3 A. Micrographs show the cystic GBM with the surrounding brain parenchyma. Bizarre tumor cells with abundant eosinophilic cytoplasm are found in an edematous stroma. B. The pleomorphic tumor cells show variations of size and shape. The large tumor cells have abundant eosinophilic cytoplasm with fibrillary processes.

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  Fig. 4 Kaplan-Meier estimates of overall survival for the patients with cystic GBMs and noncystic GBMs. The differences between the two groups are significant (log-rank test; p=0.003).

Reference

1. Chandler KL, Prados MD, Malec M, Wilson CB. Long-term survival in patients with glioblastoma multiforme. Neurosurgery. 1993; 32:716–720.

2. Salford LG, Brun A, Nirfalk S. Ten-year survival among patients with supratentorial astrocytomas grade III and IV. J Neurosurg. 1988; 69:506–509.

3. Shapiro WR, Green SB, Burger PC, Mahaley MS Jr, Selker RG, VanGilder JC, et al. Randomized trial of three chemotherapy regimens and two radiotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain tumor cooperative group trial 8001. J Neurosurg. 1989; 71:1–9.

4. Hammoud MA, Sawaya R, Shi W, Thall PF, Leeds NE. Prognostic significance of preoperative MRI scans in glioblastoma multiforme. J Neurooncol. 1996; 27:65–73.

5. Gilbert H, Kagan AR, Cassidy F, Wagner J, Fuchs K, Fox D, et al. Glioblastoma multiforme is not a uniform disease! Cancer Clin Trials. 1981; 4:87–89.

6. Ammirati M, Vick N, Liao YL, Ciric I, Mikhael M. Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery. 1987; 21:201–206.

7. Harsh GR 4th, Levin VA, Gutin PH, Seager M, Silver P, Wilson CB. Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery. 1987; 21:615–621.

8. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001; 95:190–198.

9. Maldaun MV, Suki D, Lang FF, Prabhu S, Shi W, Fuller GN, et al. Cystic glioblastoma multiforme: survival outcomes in 22 cases. J Neurosurg. 2004; 100:61–67.

10. Pierallini A, Bonamini M, Pantano P, Palmeggiani F, Raguso M, Osti MF, et al. Radiological assessment of necrosis in glioblastoma: variability and prognostic value. Neuroradiology. 1998; 40:150–153.

11. Lohle PN, Wurzer HA, Seelen PJ, Kingma LM, Go KG. The pathogenesis of cysts accompanying intra-axial primary and metastatic tumors of the central nervous system. J Neurooncol. 1998; 40:277–285.

12. Kleihues P, Ohgaki H. Primary and secondary glioblastomas: from concept to clinical diagnosis. Neuro Oncol. 1999; 1:44–51.

13. Utsuki S, Oka H, Suzuki S, Shimizu S, Tanizaki Y, Kondo K, Tanaka S, et al. Pathological and clinical features of cystic and noncystic glioblastomas. Brain Tumor Pathology. 2006; 23:29–34.

14. von Deimling A, Louis DN, von Ammon K, Petersen I, Hoell T, Chung RY, et al. Association of epidermal growth factor receptor gene amplification with loss of chromosome 10 in human glioblastoma multiforme. J Neurosurg. 1992; 77:295–301.

15. Afra D, Norman D, Levin VA. Cysts in malignant gliomas. Identification by computerized tomography. J Neurosurg. 1980; 53:821–882.

16. Laws ER Jr, Taylor WF, Clifton MB, Okazaki H. Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg. 1984; 61:665–673.

17. Pierallini A, Bonamini M, Bozzao A, Pantano P, Stefano DD, Ferone E, et al. Supratentorial diffuse astrocytic tumours: proposal of an MRI classification. Eur Radiol. 1997; 7:395–399.

18. Scott JN, Rewcastle NB, Brasher PM, Fulton D, Hagen NA, MacKinnon JA, et al. Long-term glioblastoma multiforme survivors: a population-based study. Can J Neurol Sci. 1998; 25:197–201.

19. Lohle PN, Verhagen IT, Teelken AW, Blaauw EH, Go KG. The pathogenesis of cerebral gliomatous cysts. Neurosurgery. 1992; 30:180–185.

20. Lohle PN, van Mameren H, Zwinderman KH, Teepen HL, Go KG, Wilmink JT. On the pathogenesis of brain tumour cysts: a volumetric study of tumour, oedema and cyst. Neuroradiology. 2000; 42:639–642.

21. Sawaya R, Ramo OJ, Shi ML, Mandybur G. Biological significance of tissue plasminogen activator content in brain tumors. J Neurosurg. 1991; 74:480–486.