[The traumatic origin of a glioblastoma]

A 56-year-old man is reported who had suffered a frontal, frontobasal open craniocerebral injury four years ago. He presented for treatment with a glioblastoma of which the location and extent precisely corresponded to that of the prior brain injury. After surgical exposure of the tumor, we had the impression that the tumor initially showed granulating growth from the frontal injury site and had then given rise to more highly vascularized and also necrotizing tumor tissue spreading into the frontal medullary layer with typical glioblastoma characteristics. In view of the surgical site, it is logical to consider a tumorigenesis after cerebral trauma, which is also corroborated by the histological results, since more proliferative tumor growth was found near to the injury and more highly vascularized but also necrotizing (i.e. more typical of a glioblastoma) tumor growth far away from the injury. After the comparison of our observation with the corresponding cases in the literature, it is shown that there is at least in part a causal correlation between the trauma and tumorigenesis: in the previously healthy patient, the tumor developed precisely in the region of the injury (with detection of destroyed brain tissue) after a sufficiently long time interval. Near to the site of damage, it showed granulative growth with a low degree of vascularization, and then passed into the typical glioblastoma. Observations of genetic changes in glioblastoma patients is not inconsistent with this possible trauma genesis, but render it probable that trauma is the factor which can give rise to tumor growth in a corresponding susceptibility to tumorigenesis.