title: Glioblastoma multiforme classified as mesenchymal subtype.
abstract: Recently, researchers have been considering as adverse prognostic factors in primary glioblastomas not only clinical indicators but also various cellular, genetic and immunological markers. The aim of the present article was to report a case of primary glioblastoma multiforme with poor survival in a patient after surgical intervention, and to determine the unfavorable prognostic markers.
  
  
  
  We present a 71-year-old man with histologically verified glioblastoma multiforme and a postoperative survival of 48 days. The patient did not receive any radiotherapy and adjuvant therapy with temozolomide because of the short survival. Serum and transcription levels of TNF-α, CD44, YKL-40 and IL-6 were determined by molecular-biological and immunological analyses. We found very high transcription levels of the genes CD44, YKL-40 and IL-6, increased gene expression of TNF-α, and elevated serum concentrations of TNF-α, YKL-40 and IL-6 and reduced serum concentration of CD44.
  
  
  
  Molecular-biological and immunological analyses support the hypothesis that glioblastoma multiforme is presented by a heterogeneous group of glial tumors with different clinical course and prognosis. The high expression levels of TNF-α, CD44, YKL-40, and IL-6 indicate that the tumor can be categorized as mesenchymal subtype of glioblastoma multiforme, which accounts for the rapid clinical course and lethal outcome of the condition.
authors.affiliation: Clinic of Neurosurgery, St. George University Hospital, Plovdiv
authors.forename: Ilian G
authors.initials: IG
authors.lastname: Koev
authors.affiliation: Department of Medical Biology
authors.forename: Yana N
authors.initials: YN
authors.lastname: Feodorova
authors.affiliation: Department of Medical Biology
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kazakova
authors.affiliation: Department of General and Clinical Pathology
authors.forename: Dmitrii G
authors.initials: DG
authors.lastname: Staykov
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
authors.forename: Borislav D
authors.initials: BD
authors.lastname: Kitov
authors.affiliation: Department of Medical Biology
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Sarafian
mesh_terms: D054392:Adipokines / Q000097:blood / Q000235:genetics; D000368:Aged; D000071451:Chitinase-3-Like Protein 1; D005909:Glioblastoma / Q000145:classification* / Q000276:immunology; D006801:Humans; D018960:Hyaluronan Receptors / Q000097:blood / Q000235:genetics; D015850:Interleukin-6 / Q000097:blood / Q000235:genetics; D037102:Lectins / Q000097:blood / Q000235:genetics; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000235:genetics
chemical_list: D054392:Adipokines; C497483:CD44 protein, human; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D018960:Hyaluronan Receptors; C508600:IL6 protein, human; D015850:Interleukin-6; D037102:Lectins; D014409:Tumor Necrosis Factor-alpha