Giant-celled glioblastoma of brain. A clinico-pathological and radiological study of ten cases (including immunohistochemistry and ultrastructure).

Giant-celled glioblastoma multiforme is characterized by bizarre multinucleated giant cells with abundant eosinophilic cytoplasm, paucity of vascular endothelial proliferation, and increased reticulin fibers. It is considered by Rubinstein to be a variant of glioblastoma multiforme and by Zülch to be of mesenchymal origin. We studied retrospectively ten cases of giant-celled glioblastoma to correlate clinical and pathological features including immunohistochemistry and ultrastructure, radiology and survival time. Seven men and three women ranging in age from 23-75 years had variable clinical presentations and well defined lesions on computed tomography (eight patients). Well-defined at surgery, the tumor was located in temporal (six patients), frontal (three patients), and parieto occipital (one patient) lobes. Besides characteristic histology, glial-fibrillary acidic protein was positive in all, along with intracytoplasmic fibrils on electron microscopy. Three patients died within 3 days of surgery. Of the surviving seven treated with radiation and/or chemotherapy, three had a survival time of more than 36 months and four less than 15 months. Our study identifies this tumor to be of astrocytic lineage, with temporal lobe predilection, and overall a longer survival rate than glioblastoma multiforme.