Glioblastoma multiforme: aspectos clínicos, morfológicos e anatomopatológicos

Abstract

glioblastoma multiforme (GBM) is defined as a high grade primary neoplasm of central nervous system with high infiltrative potential, which can be find in brain, brainstem and spinal cord. Objective: The objective of this research was morphological characterization of glioblastoma multiforme with clinical correlation and establishment of possible prognostic factors. Patients and Method: A total of 78 patients with glioblastoma multiforme underwent microsurgical resection by the Neurosurgery Service of Hospital de Base of São José do Rio Preto (HB), SP, from january 2014 to december 2018 were retrospectively studied. 8 patients were excluded due lack of information necessary for the research. Univariate and multivariate statistical analyzes were used to verify associations between demographic (gender, age), clinical (headache, seizure, motor deficit, sensory deficit, speech disorders, mental confusion, Karnofsky performance scale, time to onset symptoms, arterial hypertension, diabetes, smoking, alcoholism, heart disease), radiological (laterality, cystic form, affected lobe, number of affected lobes, presence of midline deviation, size of midline deviation, total volume, volume of edema / hypersignal, hypercaptation volume region), and anatomopathological (ki67 proliferative index, presence of synaptophysin). Results: GBM was more common found between sixth and eighth decades of life, the most frequent clinical manifestation were motor deficit (22%), headache (20%), sensory deficit (20%), seizure (15%), speech disorders (12%) and visual impairment (3%). The GBM distribution by location was more common in temporal lobe (25%), frontal lobe (21%), parietal (21%), occipital (20%), central core (11%) and posterior fossa (2%). There was a significant association of age with arterial hypertension (p=0,004), heart disease (p=0,002), occipital lobe (p=0,05), total volume (p=0,04) and edema/hypersignal volume (p=0,02). Regarding clinical data, there were associations between mental confusion and volume of edema/hypersignal region (p=0,04) Karnofsky performance scale and from midline shift (p=0,015) and motor deficit with midline shift (p=0,03). The volume of FLAIR edema/hypersignal region showed a significant association with proliferative index ki67 (p=0,02). Conclusions: GBM is mor common in male patients aged between six and eight decades of life with motor deficit being most frequent clinical manifestation, There was an association between clinical (arterial hypertension and heart disease) and radiological findings (tumor location in occipital lobe) with age, in addition, mental confusion was associated with volume of edema and midline shift and motor deficit was associated with midline shift. There was an inverse association between Karnofsky performance scale and midline shift. There was an association between volume of edema / hypersignal and ki67 proliferative index.