Hening Widjayanti

Lecturer : dr.Sutedjo, SpS

(K)

ABSTRACT
GLIOBLASTOMA MULTIFORME
Hening Widjayanti* Soetedjo **
Background:.Glioblastoma (GBM) is the most common glioma (a type of cancer of the brain) where
the tumor is found most malignant brain that comes from glial cellsAnaplasticastrocytomasaffectmales
slightly more often than females. The symptoms of glioblastoma multiforme vary depending uponthe exactlocation and
sizeofthetumor.Anglioblastomamultiformeusuallydevelopsslowlyovertime,butmaydeveloprapidly.
CaseReport:Reportedcaseofaman,29 years old man, Javannesse, a housewife, right handed, married, came with chief
complaint chronic progressive headache, blurred vision, seizures, nausea and vomiting since 8 months before admission. On
contrast head CT scan appeared SOL in Frontal. A collection of signs and symptoms consistent leading to increased
Intracranial Pressure due to SOL Frontal Region.. From the physical examination found cerebellar signs The
hystopathologicalexaminationwasglioblastomamultiforme.Byanamnesis,physicalexamination,andimagingstudy,tend
to be a SOL in the frontal. The management of patients with symptomatic treatment and resection of the tumor.
HystopathologicexaminationresultssupportthediagnosisofGlioblastomaMultiforme
Conclusion
Reported case a patients with vestibular vertigo, chronic progressive cephalgia, and ataxia accompanied by nausea and
vomitingsince3months.Acollectionofsignsandsymptomsinpatientsconsistentwithincreasedintracranialpressuredue
to the mass in the cerebellum. Management of these patients are sympotamatic medication and tumor resection, with
hystopathologic examination. Hystopathologic examination results is Glioblastoma Multiforme During the postoperative
care,patient'sconditionisthesame,butbetter.
Keyword:GlioblastomaMUltiforme,diagnosis,prognosis,theraphy

INTRODUCTION
Glioblastoma is usually found in adults consists of a
heterogeneous mixture of poorly differentiated neoplastic
astrocytes which are located in the cerebral hemispheres

Primary glioblastoma multiforme majority of cases (60%) obtained

in adults older than 50 years.
Secondary glioblastoma multiforme (40%) typically develops in younger
patients (<45) through the development of malignant low-grade astrocytoma
(WHO grade II) or anaplastic astrocytoma (WHO grade III). The time required
for tumor growth

The etiology of glioblastoma is unknown in many cases. Familial

glioma meet about 5% of malignant glioma, and less than 1% of
glioma associated with genetic syndromes such as
neurofibromatosis, Turcot syndrome or Li-Fraumeni syndrome.

ANATOMY

ma
o
t
s
a
l
b
) is
Glio
M
B
G
(
rme
multifo
y brain
r
a
m
i
r
the p
ith the
w
s
r
o
an d
e
tum
c
n
e
d
i
t inc
ive.
s
highes
s
e
r
g
st ag
the mo

DEFINITION

HO
W
t
s
te
The la ation GBM
IV
fic
classi as Grade
fy
classi toma
y
astroc

Etiology
No definitive cause
Believed to be result of genetic
mutations that
result in uncontrollable growth of
specific types
of brain cells
Family hx accounts for <5% of
causes for
developing these tumors
No direct linkage between lifestyle
factors and
malignant gliomas (alcohol, smoking,
etc)

The Genetic Mutation Sparked GBM

Demographics
-Overall

incidence is very similar among countries.

Glioblastoma multiformes are slightly more
common in the
United States, Scandinavia, and Israel than in Asia.
-Glioblastoma multiforme is the most frequent
primary brain Primary brain tumors are most
tumor
commonly found in older age
-17,000 new cases
of brain tumors diagnosed each
groups
year. 60%
Covering 12-15% of intracranial
GBM
tumors Covering 50-60% of
primary brain tumors
The incidence of GBM will
increase, especially the elderly.
Morbidity depends on tumor
location, progressiveness, and the
effect of the pressure that
appears.

The Incidence of Intracranial

Tumors

GBMs occur most often in the subcortical

white matter of the cerebral
hemispheres. In a series of 987
glioblastomas from University Hospital
Zurich, the most frequently affected sites
were:
temporal lobe (31%)
parietal lobe (24%)
frontal lobe (23%)
occipital lobe (16%)
Combined frontotemporal location is
particularly typical. It is rarely seen in
cerebellum or brain stem (may make up
the remaining 6%)

Types about GBM

1. Primary, or de novo: tumor
originates in brain
tumors tend to form and present
quickly.
more common than secondary GBM
(60% in adults older than 50)
very aggressive
tumors manifest de novo
2. Secondary: tumor cells
metastasize to brain
tumors have a longer, slower growth
history, but still are very aggressive
may begin as lower-grade tumors
(grade II) or anaplastic astrocytoma
(grade III) progression time varies

GBM Pathophysiology
Tumor infiltration often
extends into the adjacent
cortex or the basal
ganglia
- signs & symptoms with basal
ganglia pathology?
Tumors in the frontal cortex
can spread across the corpus
callosum
into the contralateral
hemisphere, creating the
appearance of a
symmetric lesion, called a
butterfly glioma.

Glial cell
in the
brain

provide
nutrients and
energy to
neurons

astrosit
oligodendrosi
t
mikroglia
ependim

Glioma term used to

describe various types of
malignancy that occurs in
glial cells, both astrocytoma,
oligodendroglioma and
glioblastoma

Glioblastoma =
astrositoma grade IV.

The types og
glial cell

Clinical Manifestations
aries depending on the size and location of the tumo
The most common symptoms:
Headache (80%)
Seizure (30%)
Neurological focal deficit
(40- 60%)
Mental status changes (2040%)
Time of onset of symptom
onset and diagnosis is usually
<6 months

HISTOLOGY

The etiology
is unknown

GBM

Genetic pathways in
the development of
GBM
GBM De Novo
(primer)
In the group of
elderly
Overexpression of
Epidermal Growth
Factor Receptor
(EGFR) PTEN
mutations deletions
p16INK4A

GBM Sekunder

The younger
age group
Evolving from a benign
tumor malignant
transformation
TP53 gene mutations
and retinoblastoma

DIAGNOSIS

DIAGNOSTIC EXAMINATION

TREATHMENT

MANAGEMENT
Surgery maximum removal of tumor
tissue is recommended if the tumor can
be removed without causing the loss of
certain functions
Recommended Radiation performed 6 weeks
after surgery with multiple fractions
Admittedly radiation increases the life
expectancy of up to 12-18 months.
chemotherapy given during and after radiation
for 6-12 months. Active Agents: Nitrosurea,
Carmustine, lomustine. Alkilating agents:
procarbazine, temazolamide, and vincristine

KOMPLIKA
SI

PROGNOS
IS

nekrosis radiasi, neuropati krn

kemoterapi
Nitrosurea : mengakibatkan supresi
myelum
Komplikasi krn perjalanan penyakit
rekurensi dan penyebarab
leptomeningeal
Angka harapa hidup rata-rata : 12 bulan
3-5% pasien bertahan > 3 tahun

Usia < 40 tahun : 18 msr 50 %

Usia 40-60 tahun : 18 msr 20 %
Usia > 60 tahun : 18 msr 10 %

PENCEGA
HAN

???

PROGNOSI
S

THANKS YOU

DAFTAR PUSTAKA
Ovedoff, David. 2002. Kapita Selekta Kedokteran Jilid 2.
Binarupa Aksara. Jakarta.
The Oncology Group. 2003. Cancer Management : A
Multidiciplinary Approach.
Oncology. News Interantional. New York.
Curr Top Med Chem. 2005. 5(12) : 1151-1170.
Combining Cytotoxic and Immune Mediated Gene Therapy to Traet Brain Tumors.
Neuro-oncol. 2005. 10. 1215/S1152851704000584.
Well-differentiated Neurocytoma :
What Is The Best Avialable Treatment?