Glioma
A glioma is a type of tumor that starts in the brain or spine. It is called a glioma because it
arises from glial cells. The most common site of gliomas is the brain.
Classification
Gliomas are classified by cell type, by grade, and by location.
By type of cell
Gliomas are named according to the specific type of cell they share histological features with,
but not necessarily originate from. The main types of gliomas are:
Ependymomas — ependymal cells.
Astrocytomas — astrocytes (glioblastoma multiforme is the most common
astrocytoma).
Oligodendrogliomas — oligodendrocytes.
Mixed gliomas, such as oligoastrocytomas, contain cells from different types of glia.
By grade
Gliomas are further categorized according to their grade, which is determined by pathologic
evaluation of the tumor.
Low-grade brain glioma in a 28 year-old male. (Taken on 10 July 2007)
Low-grade gliomas [WHO grade II] are well-differentiated (not anaplastic); these are
NOT benign but still portend a better prognosis for the patient.
High-grade [WHO grade III-IV] gliomas are undifferentiated or anaplastic; these are
malignant and carry a worse prognosis.
Of numerous grading systems in use, the most common is the World Health Organization
(WHO) grading system for astrocytoma, under which tumors are graded from I (least
advanced disease — best prognosis) to IV (most advanced disease — worst prognosis).
By location
Gliomas can be classified according to whether they are above or below a membrane in the
brain called the tentorium. The tentorium separates the cerebrum (above) from the cerebellum
(below).
supratentorial: above the tentorium, in the cerebrum, mostly found in adults (70%).
infratentorial: below the tentorium, in the cerebellum, mostly found in children (70%).
pontine: located in the pons of the brainstem. The brainstem has three parts (pons,
midbrain and medulla); the pons controls critical functions such as breathing, making
surgery on these extremely dangerous.
Symptoms
Symptoms of gliomas depend on which part of the central nervous system is affected. A brain
glioma can cause headaches, nausea and vomiting, seizures, and cranial nerve disorders as a
result of increased intracranial pressure. A glioma of the optic nerve can cause visual loss.
Spinal cord gliomas can cause pain, weakness, or numbness in the extremities. Gliomas do
not metastasize by the bloodstream, but they can spread via the cerebrospinal fluid and cause
"drop metastases" to the spinal cord.
A child who has a subacute disorder of the central nervous system that produces cranial nerve
abnormalities (especially of cranial nerve VII and the lower bulbar nerves), long-tract signs,
unsteady gait secondary to spasticity, and some behavioral changes is most likely to have a
pontine glioma.[2]
