Multicentric glioblastoma multiforme determined by positron emission tomography: a case report.
The actual incidence of true multicentric glioblastoma multiforme (GBM) varies between 2.4 and 4.9% of all GBMs. True multicentric tumors are described as widespread lesions in different lobes or hemispheres, which cannot be explained by spreading along the cerebrospinal fluid or blood pathways. We present here a case of multicentric GBM identified with positron emission tomography.


METHODS
A 73-year-old woman with sudden onset headaches, balance problems, and one episode of syncope was diagnosed as having an irregular, contrast-enhancing, space-occupying lesion in the left-temporal-parietal region on magnetic resonance imaging (MRI). The tissue diagnosis was confirmed as GBM, and she received stereotactic radiosurgery using the Leksell Gamma Knife (Elekta Instruments, Atlanta, GA). A 3-month, follow-up, MRI scan showed a remarkable decrease in the size of the contrast-enhancing area that was targeted during radiosurgery. A suspicious area of enhancement was detected on the right side, although no surrounding edema was evident. Fluorodeoxyglucose (FDG)-PET scanning revealed a large irregular neoplasm extending from the inferior left-temporal lobe into the deep parietal lobe with extremely intense FDG uptake, suggesting a very aggressive tumor. A smaller lesion was also discovered in the deep right-frontal lobe, representing a second neoplastic focus. The patient refused any further treatment.


CONCLUSIONS
PET scans, in conjunction with MRI scans, allow for the best possible and most comprehensive diagnosis and treatment plans.
Jawahar
Ajay
A
Department of Neurosurgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
Weilbaecher
Christina
C
Shorter
Cedric
C
Stout
Nancy
N
Nanda
Anil
A
D000368:Aged; D001706:Biopsy; D004292:Dominance, Cerebral / Q000502:physiology; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010296:Parietal Lobe / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology; D016634:Radiosurgery; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014055:Tomography, Emission-Computed
D019788:Fluorodeoxyglucose F18