[Multifocal glioma of the brain--an autopsy case]

This is an autopsy case report of a 76 year old woman with multifocal glioblastoma multiforme. CT scan revealed three separate mass lesions in the left temporal lobe, left parietal lobe and right fronto-parietal lobes. CT-guided needle biopsy of the right fronto-parietal mass revealed glioblastoma multiforme. At autopsy, serial horizontal sections of the brain confirmed the CT scan findings and demonstrated extension of the tumor in the left parietal lobe to the subarachnoid space. The lesion in the right fronto-parietal region infiltrated a large area and was not demarcated. Microscopic examination of all three lesions revealed glioblastoma multiforme. The left temporal lobe tumor consisted of gemistocytic astrocytes predominantly. Reaction of the tumor to glial fibrillary acid protein (GFAP) antibody ranged from markedly positive in the gemistocytic astrocytes to negative in the anaplastic cells. The reported incidence of multifocal glioma is about 2-10%. The main pathophysiologic mechanisms invoked for this phenomenon are simultaneous neoplastic transformation and seeding from one tumor. The pathophysiology of this particular case is discussed in reference to the differences in the histopathology of the 3 separate foci of glioblastoma multiforme.