Gliomas múltiplos: casos ilustrativos de quatro formas de apresentação

CLÉLIA MARIA RIBEIRO FRANCO, SUZANA MARIA FLEURY MALHEIROS, ROBERTO GOMES NOGUEIRA, MARCUS AZZAR SABRY BATISTA, ADRIALDO JOSÉ SANTOS, NITAMAR ABDALA, JOÃO NORBERTO STÁVALE, FERNANDO ANTÔNIO PATRIANI FERRAZ, ALBERTO ALAIN GABBAI

Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.