Glioblastoma Multiforme (GBM)

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Glioblastoma Multiforme (GBM)

Last updated on Saturday, April 4 2009 by jdmiles

Glioblastoma Multiforme (GBM) is a WHO Grade IV primary brain tumor with a very poor prognosis.

Related images:

Glioblastoma Multiforme involving cerebellar white matter, H&E Stain X 40
A glioblastoma multiforme in the cerebellum. Note the disorganized tissue with the pale area of necrosis.

Glioblastoma multiforme involving cerebellum, H&E stain x 100
Similar to cortical invasion, malignant glial tumors of the cerebellum may demonstrate subpial spread quite distant from the main tumor mass.

Glioblastoma multiforme, intraoperative smear preparation of drop metastasis, H&E x 100
This patient presented with radiculopathy secondary to an intradural extramedullary mass. Investigation subsequent to the spinal surgery demonstrated a supratentorial ring enhancing mass lesion consistent with glioblastoma.

Glioblastoma multiforme presenting as extramedullary spinal tumor
This patient presented with radiculopathy secondary to an intradural extramedullary mass. Investigation subsequent to the spinal surgery demonstrated a supratentorial ring enhancing mass lesion consistent with glioblastoma.

Glioblastoma multiforme, coronal section at level of posterior thalamus
Glioblastoma demonstrates a multiforme appearance, with areas of hemorrhage and necrosis. Mass effect leads to transtentorial herniation.

Gliosarcoma (glioblastoma multiforme with prominent spindle cell differentiation), H&E stain x200
Abundant spindle cell differentiation has been designated gliosarcoma, although the spindle cells are generally clonal with the astrocytic appearing elements. Gliosarcoma is made appear markedly circumscribed, grossly resembling metastatic carcinoma.

Gliosarcoma , H&E stain x400
Abundant spindle cell differentiation has been designated gliosarcoma, although the spindle cells are generally clonal with the astrocytic appearing elements. Gliosarcoma is made appear markedly circumscribed, grossly resembling metastatic carcinoma.

Glioblastoma multiforme with granular cell differentiation, intraoperative smear x 400.
Granular differentiation and malignant astrocytic tumors may resemble macrophages on intraoperative smear preparations. Macrophages generally demonstrate more foamy cytoplasm, while granular cells demonstrate coarse eosinophilic granularity such as is seen here.

Glioblastoma multiforme, microvascular proliferation, H&E stain x 400.
Microvascular proliferation is, along with tumor necrosis, a defining feature of glioblastoma multiforme.

Monstrocellular Glioblastoma
Monstrocellular Glioblastoma

Glioblastoma multiforme, small cell variant, H&E stain x 200
Glioblastomas composed predominantly of small undifferentiated glial elements must be distinguished from anaplastic oligodendrogliomas. The presence of necrosis with peripheral palisading of tumor cells is very useful in this regard. Small cell glioblastoma is often demonstrate EGFR amplification.

Glioblastoma multiforme involving cervical spinal cord, gross photograph.
Glioblastoma multiforme rarely disseminates along leptomeningeal pathways.

Glioblastoma multiforme, spinal metastasis, GFAP immunohistochemical staining.
Strong cytoplasmic staining for GFAP supports the astrocytic rather than ependymal differentiation in this extra medullary spinal cord tumor

Glioblastoma multiforme demonstrating pseudopalisading Necrosis H&E stain x 400
H&E preparation of a GBM, showing pseudopalisading necrosis.

Glioblastoma multiforme, pseudopallisading Necrosis, H&E stain x 200
H&E preparation of a GBM, showing pseudopallisading necrosis.

Normal Neuropil for Comparison
One of the features characteristic of a GBM is the cellular disorganization. Compare this slide showing normal neuropil to the slides of GBM.

GBM - MRI with contrast
This is a coronal view of an MRI (T1 with GAD contrast) of a child with a glioblastoma multiforme (GBM). This image is courtesy of Wikimedia Commons, and was created by Wikipedia user Christaras A. This file is licensed under Creative Commons Attribution 2...

GBM - MRI with contrast sagittal
This is a sagittal view of an MRI (T1 with GAD contrast) of a child with a glioblastoma multiforme (GBM). This image is courtesy of Wikimedia Commons, and was created by Wikipedia user `Christaras A.` This file is licensed under Creative Commons Attribution 2...