GBMultiforme - what does the multiforme stand for

[jenugl]

Hi all, I accidently posted this in another section - but met to put it in here. Anyway here's my question if someone can help.
I read somewhere (cant' remember where) that the cells from GBM can take the form of other things (that's why it's called multiforme) and thats why they can't pick up certain things in MRI and when they do surgery. Is this true?? Jen

[brainman]

Hi Jen, no problem with you having posted this in the "wrong place." I think you need support in coping with GBM in addition to getting some basic information.

I am not sure what you mean by "can't pick up certain things in MRI and when they do surgery." Certainly, there are resolution limits to MRIs and, by its very nature, GBMs are extremely difficult to totally remove surgically. My mother's oncologist described it as a ball of cotton with little strands going out in all directions from the bulk of the cancer. This is why the surgeons need to remove so much "good brain cells" just in order to make sure they have removed all those strands.

As for its name, (guys, correct me if I am wrong about this), multiforme does not mean the cells take on the form of other cells; it means that, when viewed under a microscope, the cells are different in size and shape for each other. They do not look like normal glial cells; they look like distorted, mutated glial cells of many different shapes. You can see side-by-side views of normal cells versus GBM cells at the following link:

http://www.sd-neurosurgeon.com/disea...oblastoma.html

[jenugl]

Hi Brainman, thanks for your reply. My understanding from our surgeon was he took out the tumour and told us that what was left looked to him to be normal brain tissue - which for us is great news. He couldn't see any roots leading into the brain. After reading this article(which I will try and find again) I became worried thinking it might have been tricking him and was taking on the shape of normal brain tissue (I had never heard of this before) This is what I meant to explain (sorry - sometimes I think people are on the same wave length as me - must be the blonde in me . My understanding of GBM is (in our case) tumour was fully removed - radio and chemo treatment is to slow down cancer cells that remain in the brain (for how long we don't know. I do have a great family and council support team - but it is very hard and being in rural australia medical people are quite some distance away in larger cities. Anyway - thanks for clearing that up for me - just goes to show you never believe everything you read. I appreciate everything you are doing Brainman especially since you are going through tough times at the moment. I - like I am sure most people who visit this forum are sending you our love and thoughts. Jen

[brainman]

Jen, did the surgeon use the term "clear margins" with you? I was not talking about anything that the surgeon could see with his eyes during surgery but they can be fairly certain that they got all (or at lest most) of it if they cannot see any using a microscope. The pathologist is the one who would examine the tumor they removed and would say that he/she could not find any cancer on the surface of the section they removed, i.e. clear margins. Just another term you might hear or ask about.

Thank you for your kind words. This is the only way I can keep from really going nuts

[jenugl]

Hi Jim, Dont remember the term "clear margin" used. The report said - Microscopic - section shows densely cellular malignant neoplasm. This meoplasm has a somewhat spindle cell appearance in some areas. Frequent large giant cells are identified and there are also frequent large bizzare cells. A glomeruloid appearance to certain clusters of the tumour cells is apparent. Areas of necrosis ae identified and in certain parts of the neoplasm necrosis is frequent. The appearances are entirely consistent with the clinical diagnosis of glioblastoma multiforme.
Summary - right temporal pole: Glioblastoma multiforme. Supplementary report: glial fibrillary acid protein is strongly POSITIVE in this neoplasm. The glioblastoma is also POSITIVE for S100 protein. In lay-man terms what would you make of this - or anyone qualified. Thanks for all your help. Jen

[brainman]

The pathologist writing the report is just describing the "multiforms" I talked about: there are spindle cells (rather large neurons), large giant cells and large deformed looking cells. "Glomeruloid appearance" I think means a bundle of cells that look like the are capillary cells in nature (i.e. have a blood supply) but don't quote me... do a google search on that term. "Areas of necrosis" are areas of dead cell... in GBMs the cancer has grown faster than the blood supply and some of the cancer has therefore died. I do not know what the glial fibrillary acid protein is nor the S100 protein. I am just guessing that they are other signs of a glial cell cancer and might help the oncologist with treatment options. Do you know if any genetic studies have been done? Some gliomas show mutations of certain, specific gens. If these are present or mutated or absent will affect what effect chemotherapy will have on the cancer.

Hope, Love, Joy

[jenugl]

Hi Jim, I tell you what, you've got to praise these drs / pathologists / surgeons etc. (and yourself). Just trying to learn about a few things is doing my head in. I looked up "Glomeruloid appearance" and from what I could decipher I think you are right. I also looked up "glial fibrillary acid protein" and it says This protein is a member of the intermediate filament family, it provides support and strength to cells. From what I can gather if nerve cells are damaged or diseased they rapidly produce more of this protein. I couldn't understand what the S100 is. The brain is such a complex organ and unfortunately it is also so hard to treat for disease. But I want to thank you so much for your time and effort in helping me to understand this more. I don't ask too many questions at the drs as my partner is just concentrating on keeping his spirits and health up and really doesn't want to go into too much detail. He knows that it will eventually rear its ugly head again but hoping it will be awhile. When he was first treated for this we started of in our local hospital then went 400kms away for surgery then back home then went 2000kms for radio/chemo then more chemo back home. Having been seen by quite a number of drs and the distance between everyone makes it hard sometimes. Anyway - enough rambling for the time being. Love to you and all. Jen

[jenugl]

Me again, I forgot to answer your question about genetic studies. I don't know if they have been done. I will endeavour to phone the hospital where they did this and see if his surgeon or the pathologist can tell me. It's really only now that I think I can start to learn more about the medical side of this (besides the basics). The first year I was concentrating more on the psychological side of it and coming to grips with it all (and probably in a state of denial). Anyway thanks once again. Jen.

[brainman]

Jen, hopefully, understanding the facts of this disease will help you come to terms with it psychologically. It helps me anyhow. I don't mean to flood you with information. Take in what you can.

The brain is a fantastically complex organ, isn't it?

[jenugl]

Jim, don't worry - you havn't flooded my brain too much. I am enjoying (if I can use that term) learning more about the brain and how this disease works. It does help me understand and cope more. Hopefully people that are reading this are also learning more. Fortunately at this stage my partner Andrew is still going strong and so far no sign of GBM returning. His next MRI is 26th July so we are keeping our fingers crossed that it will still be clear. We do try to stay positive and its probably a bit easier for us compared to some people because Andrew doesn't have any complications (beside eyesight in one eye). My thoughts and love are with everyone going through this and hopefully you all will stay in contact. I will be reading everyone's posts and posting my own thoughts and questions as well. Love to all. Jen

[brainman]

Jen, I am glad to hear that Andrew is doing so well! I hope you are finding ways to build good memories. God bless you.

[jenugl]

WOW! talk about building good memories. Andrew & I have been together for 8yrs and we have been true soul mates. We are in a fortunate situation were we are both off work and spending our time together and also with family and friends. We have been going on camping trip & fishing (which are Andrews passions) catching up with friends who live quite a distance away. We are just as happy to sit around and talk, watch TV or play cards/board games. We are the sort of couple who are always holding hands, giving each other a kiss when we pass each other (the kind that alot of people say - cut it out when they see us - I think they're jelous ). We have always done most things together and will continue to do so for as long as possible. All I can say to anyone who is going through this (and for people that aren't) is - don't take anyone for granted - love them as if it is their last day. Nobody knows when that person (whether they are sick or not) is going to pass on. Love to all. Jen