Third Ventricular Glioblastoma Multiforme: Case Report and Literature Review

Abstract

BackgroundGBM is an intra-axial mass, localized to the frontotemporal region that accounts for 50 to 60% of astrocytomas and 12 to 15% of intracranial tumors. It is found most commonly as a primary tumor, with secondary tumor characteristics as result of transformation from low-grade glioma. 1-8 Intraventricular tumors represent only 10% of central nervous system neoplasms. Of those, the reported malignancy rate is 13% of all cases. Lee and Manzano enumerated the most frequently found ventricular system tumors, presented in ►Table 1. 9 The rarest lesions of the intraventricular region are GBM, ependymomas, gangliocytomas, and gliosarcomas. 10 Ependymomas occur at a frequency of 0.25% 11 and gangliocytomas with a frequency of 0.1 to 0.5%. 12 When AbstractBackground Glioblastoma multiforme (GBM) typically presents in the supratentorial white matter, commonly within the centrum semiovale as a ring-enhancing lesion with areas of necrosis. An atypical presentation of this lesion, both anatomically as well as radiographically, is significant and must be part of the differential for a neoplasm in this anatomical location. Case Description We present a case of a 62-year-old woman with headaches, increasing somnolence, and cognitive decline for several weeks. Magnetic resonance imaging demonstrated mild left ventricular dilatation with a well-marginated, homogeneous, and nonhemorrhagic lesion located at the ceiling of the third ventricle within the junction of the septum pellucidum and fornix, without exhibiting the typical radiographic features of hemorrhage or necrosis. Final pathology reports confirmed the diagnosis of GBM. Conclusion This case report describes an unusual location for the most common primary brain neoplasm. Moreover, this case identifies the origin of a GBM related to the paracentral ventricular structures infiltrating the body of the fornix and leaves of the septum pellucidum. To our knowledge this report is the first reported case of a GBM found in this anatomical location with an entirely atypical radiographic presentation.

A peculiar case of pure intraventricular glioblastoma

“…The peculiar distribution following only the ependymal lining instead of white matter tracts is anecdotic, but it may support the hypothesis that the glioblastomas’ cell of origin (COO) is a neural precursor cell located in the subventricular zone (SVZ) along the lateral ventricular walls. Lee and Manzano stated that possible alternative origins of intraventricular glioblastomas could be the septum pellucidum or the fornix, both components of the limbic system [ 2 ]: the involvement of these structures could explain the growing number of amnesic episodes in the clinical history of our case, neurological finding which is, in fact, characteristic of other intraventricular glioblastoma cases reported in literature [ 3 ]. However, the most common symptoms associated with intraventricular glioblastomas appear to be related to obstructive hydrocephalus, which surely could be a cause or a concurrent cause to both the initial symptoms of our case.…”

High-intensity focused ultrasound: past, present, and future in neurosurgery

“…29,30,39,46,47 Glioblastoma multiforme (GBM) is the most common and most aggressive of malignant primary CNS tumors 37 and has been the center of attention for multiple HIFU trials. In an article published in 2006, Ram et al 69 reported on 3 patients with GBM who underwent MRgHIFU thermal ablation.…”