gms | German Medical Science

Objective: Glioblastoma (GBM) is the most frequent malignant neoplasm in the adult brain. Arteriovenous malformations (AVM), in contrast, are believed to be congenital lesions, usually presenting with haemorrhage or seizures. Reports about GBM associated with AVM are rare. Here we present three cases of AVM within a previously undiagnosed cerebral GBM.

Method: Three patients are presented who were treated for Glioblastoma in which the histopathological criteria of an AVM were present. All patients underwent surgery with aim of gross total tumour resection or removal of the intracerebral haemorrhage, respectively. The cases were analyzed regarding initial presentation, clinical findings, tumour localization and histopathological results.

Results: The first patient, a young man, had been operated on a spinal glioblastoma 2006 followed by radiochemotherapy. In a follow-up MRI of the brain an arteriovenous malformation in the left frontal lobe with contact to the Sylvian fissure was found but no tumour manifestation. In 2008 the patient presented with headache and changes in character. Another follow-up MRI revealed a contrast-enhanced tumour in the left frontal and temporal lobe. The histopathological analysis depicted an AVM within a GBM. The second patient was hospitalized with an acute left-sided hemiparesis. CT scan showed a contrast enhancing mass of the basal ganglia and thalamus. A few hours later, the patient deteriorated, a control CT scan revealed an intracerebral haemorrhage. An emergent surgery with removal of the blood clot and decompression of the tumourous mass was performed. In the histological analysis an arteriovenous malformation and a glioblastoma was found again. The third patient presented with character changes and amnesic aphasia for three weeks. In the MRI, a contrast-enhancing tumour in the left frontal lobe radiating into the basal ganglia and the corpus callosum was found. Subtotal resection was performed. Intraoperatively, a vascular convolute in the tumour was discovered. Histopathologically a GBM with AVM was described.

Conclusions: Up to now, only a few cases of glioblastoma with associated arteriovenous malformations have been reported in the literature. These cases were assumed to be mere coincidence. However, the presence of pathological vessels within malignant gliomas is well known and an angiogenic activity has been proven. Therefore, it seems possible that the tumour activity itself might be a factor contributing to the pathogenesis of a vascular malformation.