Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2014, vol. 20, issue 2
Subject Collection: Medicine
Pages: 502-505
DOI: 10.5272/jimab.2014202.502
Published online: 17 June 2014

J of IMAB 2014 Jan-Jun;20(2):502-505
Ilian Koev1 Corresponding Autor, Emil Slavov2, Hristo Zhelyazkov1,3, Dmitrii Staikov4, Krasimira Halacheva2, Victoria Sarafian5.
1) Clinic of Neurosurgery, University Hospital St. George, Plovdiv, Bulgaria,
2) Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
3) Department of Neurosurgery, Medical Faculty, Medical University - Plovdiv, Bulgaria
4) Department of General and Clinical Pathology, Medical Faculty, Medical University - Plovdiv, Bulgaria
5) Department of Medical Biology, Medical Faculty, Medical University - Plovdiv, Bulgaria.

Glioblastoma multiforme (GBM) is known to be the most common malignant form of astroglial brain tumors. The etiology, cellular and molecular pathogenic mechanisms remain unclear to a great extent. Recent research indicates the role of the immune system in malignant glioma and especially in triggering the mechanisms of local resistance and systemic immune suppression. There is accumulating evidence that the concept of the CNS as an immune-privileged organ is no longer valid.  Recent advances demonstrate that it is an immunologically active site, with complex immune responses mostly based on innate immune processes.
Multifocal gliomas with varying histopathological appearance are extremely rare. We report the only case of GBM preceded by a gemistocytic astrocytoma with a very short survival time of just 3 months after the onset of complaints. Interestingly, a normal CD4/CD8 ratio but prominent change in the regulatory T cell lineage was recorded. The elevation of the suppressor CD8+CD11b+ cells and the reduction of cytotoxic CD8+CD11b- cells indicate the prevalence of a suppressor phenotype which provides an explanation for the occurrence of the second malignant tumor, the rapid tumor progression and fatal outcome.

Key words: Multifocal gliomas, gemistocytic astrocytoma, immune response,

- Download FULL TEXT /PDF 626 KB/
Please cite this article as:
Koev I, Slavov E, Zhelyazkov H, Staikov D, Halacheva K, Sarafian V. MULTIFOCAL GLIOBLASTOMA MULTIFORME PRECEDED BY A GEMISTOCYTIC ASTROCYTOMA AND DYSREGULATED IMMUNE RESPONSE. J of IMAB. 2014 Jan-Jun;20(2):502-505. doi: 10.5272/jimab.2014202.502.

Correspondence to: Dr. Ilian Koev, Clinic of Neurosurgery, St. George University Hospital - Plovdiv; 66, Peshtersko shose Blvd. Plovdiv, Bulgaria; E-mail:

1. Waziri A. Glioblastoma-derived mechanisms of systemic immunosuppression. Neurosurg Clin N Am. 2010 Jan;21(1):31-42. [PubMed] [CrossRef]
2. Kempuraj D, Devi RS, Madhappan B,  Conti P, Nazer MY, Christodoulou S,  et al. T lymphocyte subsets and immunoglobulins in intracranial tumor patients before and after treatment, and based on histological type of tumors. Int J Immunopathol Pharmacol. 2004 Jan-Apr;17(1):57-64. [PubMed]
3. Tihan T, Vohra P, Berger MS, Keles GE. Definition and diagnostic implications of gemistocytic astrocytomas: a pathological perspective. J Neurooncol. 2006 Jan;76(2):175-183. [PubMed] [CrossRef]
4. Kaku S, Terao T, Taya K,  Ohtuka T, Tanaka T, Sawauchi S,  et al. [A multicentric glioma presenting different pathological appearances: a case report.] [Article in Japanese] No Shinkei Geka. 2004 May;32(5):501-506. [PubMed]
5. Dix AR, Brooks WH, Roszman TL, Morford LA. Immune defects observed in patients with primary malignant brain tumors. J Neuroimmunol. 1999 Dec;100(1-2):216-232. [PubMed]

Received: 16 April 2014
Published online: 17 June 2014

back to Online Journal