Glioblastoma Multiforme

A 58 year old male suffers from ataxia and is brought to the emergency room. He has had increasing headaches for the last 5 weeks which are worse in the early morning. At times he has had nausea and vomiting. On physical exam his blood pressure is 170/94, pulse-60, he is afebrile, and exhibits bilateral papilledema (thirty minutes post-ictal). He has a left-sided hyperreflexia and Babinski. Laboratory values reveal a normal CBC, urinalysis, glucose, electrolytes and calcium. An EKG reveals normal sinus rhythm. Below is the CT-scan:

NOTE THAT THIS IS IN AN UNUSUAL LOCATION FOR GLIOBLASTOMA. MORE COMMONLY, THIS TUMOR WOULD BE FOUND IN THE CEREBRAL HEMISPHERES.

1. The next step in the management of this patient is:

A. dexamethasone and a loading dose of an anticonvulsant (phenytoin).

B. perform a spinal tap for CSF cytologic analysis.

C. order an upper GI series, Barium enema, chest x-ray and a CT-scan of the abdomen.

D. Recommend radiation and chemotherapy.

E. start wide spectrum IV antibiotics.

Correct Answer: A

2. The most likely diagnosis of this patient based on the above information (history, physical, laboratory values and CT), is:

A. meningioma

B. cerebritis

C. metastatic tumor to brain

D. primary CNS lymphoma

E. glioblastoma mutiforme

Correct Answer: E

3. A brain biopsy is preformed and the images below represents the histology.

Based on the histologic findings in this image, the diagnosis is:

A. cerebritis.

B. glioblastoma multiforme.

C. meningioma.

D. primary CNS lymphoma.

E. metastastic adenocarcinoma.

Correct Answer: B

4. The following, statement(s) is/are true regarding astrocytomas:

A. Diffuse fibrillary astrocytomas are high-grade poorly differentiated tumors.

B. Pleomorphic xanthoastrocytomas typically occur in elderly patients.

C. Glioblastoma multiform histologically exhibits vascular proliferation and pseudopalisading necrosis.

D. Pilocytic astrocytomas are typically solid, rapidly growing tumors with very poor prognosis.

E. Cystic astrocytomas are typically supratentorial tumors of young adults and represents about 25-35% of adult primary brain tumors.

F. All of the above.

Correct Answer: C

5. The following statement(s) is/are true regarding CNS tumors in general:

A. The most common CNS tumor in adults is metastatic carcinoma.

B. Malignant CNS tumors account for about 20% of all childhood malignancies.

C. Oligodendroglioma generally has a better prognosis than astrocytoma.

D. Homer-Wright rosettes may occur in Medulloblastomas.

E. Ependymomas typically occur in the fourth ventricle in children and in the spinal cord in adults.

F. All of the above.

Correct Answer: F

6. The following statement(s) is/are true regarding radiologic studies (CT, MRI) of patients with glioblastoma multiforme:

A. Tumors are enhanced with contrast media because tumor vessels are abnormal and "leaky".

B. They usually show mass effect.

C. They usually show peritumoral edema.

D. They may exhibit central necrosis.

E. All of the above.

Correct Answer: E