- Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI, USA
- Department of Pathology, Hurley Medical Center, Flint, MI, USA
- Department of Neurology, Lapeer Regional Medical Center, Lapeer, MI, USA
Aftab S. Karim
Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI, USA
DOI:10.4103/2152-7806.83025Copyright: © 2011 Nemer MD. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Nemer MD, Blight C, Yeung JT, Fram KM, Karim AS. Tectal plate glioblastoma multiforme. Surg Neurol Int 18-Jul-2011;2:101
How to cite this URL: Nemer MD, Blight C, Yeung JT, Fram KM, Karim AS. Tectal plate glioblastoma multiforme. Surg Neurol Int 18-Jul-2011;2:101. Available from: http://sni.wpengine.com/surgicalint_articles/tectal-plate-glioblastoma-multiforme/
Background:Tectal plate tumors have traditionally been considered low-grade, indolent lesions. We report a patient who presented with a tectal region glioblastoma multiforme (GBM), a rare pathology in this anatomic location.
Case Description:This is a case report of a 45-year-old female that presented with worsening confusion, memory loss, and loss of bladder control for 3 days. There was no family history of brain malignancy. The patient presented with Parinaud's phenomenon. Pronator drift was not present. The patient had dysarthric speech. An elevated white blood cell count was also noted. Non-contrast CT scan of the head showed the presence of a tectal region mass and hydrocephalus. A follow-up MRI with and without contrast confirmed the presence of a 4.2 × 3.3 × 4.6 cm3 mass. Magnetic Resonance Spectroscopy (MRS) demonstrated an elevated choline/N-acetylaspartate ratio and an increase in lactate suggesting an aggressive neoplasm. A ventriculoperitoneal shunt was initially placed to relieve the hydrocephalus. The patient subsequently underwent a suboccipital craniotomy for debulking of tumor and for tissue diagnosis. Pathology of the lesion was consistent with GBM. The patient declined postoperative treatment with chemotherapy and radiation.
Conclusion:Although tectal region masses are predominantly low-grade lesions, high-grade lesions can present in this anatomical location. Furthermore, MRS can help to differentiate benign lesions from more aggressive lesions in the tectal plate. Biopsy of tectal plate lesions should be considered in select cases to establish diagnosis and prognosis in order to optimize treatment.
Keywords: Glioblastoma multiforme, hydrocephalus, magnetic resonance spectroscopy, tectal plate
Glioblastoma multiforme (GBM) is the most common and lethal intracranial adult brain tumor.[
A 45-year-old female presented with worsening confusion, memory loss, and loss of bladder control for 3 days. She suffered from dizziness for the past year and altered gait for the past few weeks. Her medical history was significant for hypertension, depression, and headaches. Surgical history was limited to two cesarean sections and a tubal ligation. She was a non-smoker with no history of alcohol or drug abuse. There was no family history of brain malignancy. On physical examination, the patient presented with Parinaud's phenomenon, was orientated to person and place, but could not recall the date and relied on her husband to answer most of the questions. The remaining cranial nerves were intact. No pronator drift was present. Strength, sensation, and reflexes in upper and lower extremities were normal. Initial laboratory results were significant for an elevated white blood cell count of 16.7. Non-contrast CT scan of the head showed the presence of a large posterior fossa mass and hydrocephalus. However, it was difficult to discern the boundaries of the mass [Figure
Pre- and postoperative sagittal and axial, noncontrast, CT scans. (a) Preoperative sagittal CT scan illustrating an ill-defined tectal mass. (b) Postoperative sagittal CT scan illustrating partial resection of the lesion, decreased size of the mass, and improvement of hydrocephalus. (c) Preoperative axial CT scan demonstrating marked hydrocephalus and the presence of a midline mass. (d) Postoperative axial CT scan demonstrating improved hydrocephalus and decrease in the mass size after ventriculoperitoneal shunt and debulking of tumor
Histological sections (Hematoxylin and eosin stain): Panels a–d show the histological appearance of a high grade glioma, characterized by areas of necrosis (Panel a, dark arrows), increased mitotic activity (Panel b, white arrow), neovascularization (Panel c, asterisk), nuclear pleomorphism and dense cellularity (Panels d, thin black arrows)
We described a case of a patient that presented with symptoms related to hydrocephalus caused by a tectal plate mass. A CT scan revealed a posterior fossa mass and MRI localized the mass to the tectal plate as MRI is a better modality for visualization of the posterior fossa.[
Overall, tectal gliomas are commonly low-grade astrocytomas with a good prognosis.[
Although tectal plate gliomas are commonly thought to be low-grade neoplasms, MRS correctly suggested aggressive neoplasm in our patient and pathology was confirmed to be GBM postoperatively. This case report suggests that it is important to consider the presence of a high-grade astrocytoma in the differential diagnosis of a tectal plate lesion. Also, MRS may be useful in distinguishing low-grade lesions from high-grade lesions in the tectal region. In select cases, where MRS suggests a high-grade lesion, tissue diagnosis of the lesion should be considered to establish diagnosis in order to optimize treatment.
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