gms | German Medical Science

Objective: Differential diagnosis of unclear contrast-enhancing cerebral lesions includes cerebral metastases as well as malignant glioma. In the majority of cases, a definite preoperative diagnosis by neuroradiological assessment cannot be established. Since the introduction of fluorescence-guided resection in the treatment of glioblastoma (GBM), the preoperative putative diagnosis of metastasis vs. GBM has triggered a specific preoperative preparation of the patients. We analyzed the patient population with known cancer outside the central nervous system who underwent surgery for an assumed cerebral metastasis and for whom the intraoperative diagnosis was corrected to malignant glioma.

Methods: We performed a retrospective observational analysis of patients with a known primary cancer outside CNS who were operated for an assumed cerebral metastasis, and for whom intraoperatively the diagnosis was corrected to a malignant glioma by frozen section. The patients were treated at a tertiary care center between January 2008 and June 2011.

Results: We identified 10 patients with the co-diagnosis of cancer and GBM. The median age was 68 years (41–82 y). The female to male ratio was 2:8. In all patients, final histopathological analysis proved a GBM, whilst the patients suffered from diverse primary tumors. In the same period, 53 patients underwent surgery for a cerebral metastasis and 60 patients for a newly diagnosed glioblastoma

Conclusions: According to our data a malignant glioma should always be considered as differential diagnosis of any unclear contrast-enhancing cerebral lesion even for patients with a known cancer outside the CNS. Consequently, fluorescence guided resection should be considered for these patients.