Differential Diagnosis

Chapter 2 - Clinical Presentation, Differential Diagnosis and Response Assessment of Gliomas

Brain tumours are often overlooked in differential diagnosis. Most physicians/general practitioners meet very few patients with a brain tumour. The confusion of tumour symptoms with other disease symptoms is a challenge.

The most effective means of ensuring early identification is to bear the possibility of a brain tumour constantly in mind in differential diagnosis.

A varied spectrum of different conditions, from benign lesions to more severe neurological associated disorders, have to be considered in the differential diagnosis of glioma.

When analysing a potential brain tumour, many questions arise:

  • different tumours occur in different age groups
  • the location of the lesion
  • solitary mass or multifocal disease?

Less malignant gliomas occur at any age, but glioblastoma is mostly seen in older people.

Multiple tumours in the brain indicate metastatic disease. Some primary brain tumours like lymphomas, multicentric glioblastomas and gliomatosis cerebri can be multifocal.

Cerebral metastasis may look identical to malignant gliomas, multifocal or as a solitary lesion. Metastases are much more common, especially infratentorially.

Functional MRI and magnetic resonance spectroscopy (MRS) can provide important information about the tumour, such as metabolic phenotyping, microvasculature and cellularity.

Positron emission tomography (PET) using various tracers (transmitter ligands) for molecular evaluation are of value to characterise tumours, and also to differentiate between low-grade glioma and non-tumour causes.

Revision Questions

  1. Give examples of differential diagnoses to malignant glioma
  2. Why may a brain tumour be overlooked in daily practice?
  3. What can be a clue to the diagnosis of malignant glioma?

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Last update: 18 September 2017