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Glial tumourettes (glial microtumours): their clinical and histopathological manifestations
S Nishio1, T Morioka, I Takeshita
1Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Abstract:
This study represents our experience with eight cases (males: 4; females: 4; 13-47 years old, average age 28.5 years) of a "glial tumourette" (minute glioma), which measured less than 15 mm in diameter on an MRI. Four tumours were located in the frontal lobe, one in the rostrum of the corpus callosum, two in the midbrain, and one in the thalamus. The symptoms and signs lasted from two days to 15 months prior to diagnosis, and they consisted of epileptic seizures in five patients and increased intracranial pressure due to hydrocephalus resulting from aqueductal stenosis in three. All patients had a CT scan and an MRI as a part of their initial neuroimaging evaluations. While the CT findings failed to show the lesion in four patients, MRI demonstrated it in all cases. Five tumours were either totally or subtotally removed while the remaining three were biopsied. Histological examinations revealed six tumours to be low-grade gliomas (fibrillary astrocytoma: 4; oligoastrocytoma: 2) and two to be high-grade gliomas (anaplastic astrocytoma: 1; anaplastic oligodendroglioma: 1). Regarding adjuvant therapy, three patients received radiation and/or chemotherapy. One of the patients with midbrain fibrillary astrocytoma died of the disease 38 months after the operation, however, no evidence of progression in the remaining seven has been observed in the follow-up period ranging from five to 65 months after the operation (average: 25.4 months). The histogenesis of benign and malignant gliomas and the importance of surgical exploration in the management of such patients with minute intracerebral tumours are also discussed.
Insights
Minute gliomas, or glial tumourettes, measuring under 15mm are challenging to detect with CT scans but clearly visible on MRI. Surgical exploration is crucial for managing these small, intracerebral tumors.
Area of Science:
- Neurology
- Neurosurgery
- Oncology
Background:
- Minute gliomas, termed "glial tumourettes," are small intracerebral tumors (<15 mm).
- Diagnosis can be challenging due to their size, often missed by CT scans.
- Symptoms vary, including epileptic seizures and increased intracranial pressure.
Purpose of the Study:
- To report on the clinical experience with eight cases of minute gliomas.
- To evaluate diagnostic imaging modalities, particularly MRI versus CT.
- To discuss the management and outcomes of these small tumors.
Main Methods:
- Retrospective analysis of eight patients with minute gliomas.
- Review of neuroimaging (CT and MRI) and histopathological findings.
- Assessment of surgical interventions and adjuvant therapies.
Main Results:
- MRI detected all eight minute gliomas, while CT missed four.
- Histopathology revealed a mix of low-grade (6) and high-grade (2) gliomas.
- Seven of eight patients showed no progression post-surgery, with follow-up up to 65 months.
Conclusions:
- MRI is superior to CT for detecting minute gliomas.
- Surgical exploration is vital for diagnosis and management.
- Minute gliomas, despite potential for malignancy, can have favorable outcomes with timely intervention.