{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:24:32Z","timestamp":1793316272568,"version":"4.5.0"},"reference-count":20,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground:<\/jats:title>\nAlthough glioblastoma has been shown to be able to disseminate widely in the intracranially after treatment with bevacizumab without any significant radiological findings, reports on such cases with subsequent autopsy findings are lacking.<\/jats:p>\n<\/jats:sec>\n\nCase Description:<\/jats:title>\nA 36-year-old man presented with a general seizure and a mass of the right frontal lobe, which was diagnosed as diffuse astrocytoma (WHO Grade II). The patient underwent a total of four surgeries from 2005 to 2017. He showed tumor recurrence, progression, and malignant transformation to glioblastoma (GBM) (WHO Grade IV) despite repeated tumor resections, radiotherapy, and chemotherapies with temozolomide and carmustine wafers. Bevacizumab (10 mg\/kg body weight) was started following the fourth surgery. After bevacizumab administration, the patient\u2019s clinical condition improved to a Karnofsky performance status (KPS) score of 50\u201360, and he was stable for several months before finally deteriorating and passing away. Although sequential magnetic resonance imaging (MRI) showed shrinkage of the lesion and a reduction of edema, an autopsy showed widespread tumor invasion that was not revealed on MRI. Neoplastic foci were identified extensively in the cerebral cortex, basal ganglia, pituitary gland, cerebellum, and brainstem, imposing as gliomatosis cerebri.<\/jats:p>\n<\/jats:sec>\n\nConclusion:<\/jats:title>\nImaging follow-up of malignant gliomas needs to be interpreted with caution as marked improvement in radiological response after bevacizumab treatment may not be indicating tumor regression. Despite the notable lack of evidence to increase overall survival in GBM patients with bevacizumab, the increase in progression-free survival and the observed relief of symptoms due to a decrease in edema should be considered relevant for patient management.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni-183-2019","type":"journal-article","created":{"date-parts":[[2019,8,25]],"date-time":"2019-08-25T11:46:18Z","timestamp":1566733578000},"page":"137","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["An autopsy case of widespread brain dissemination of glioblastoma unnoticed by magnetic resonance imaging after treatment with bevacizumab"],"prefix":"10.25259","volume":"10","author":[{"given":"Ridzky Firmansyah","family":"Hardian","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Shinshu University, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Goto","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruki","family":"Kuwabara","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Hanaoka","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Departments of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kanno","sequence":"additional","affiliation":[{"name":"Pathology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Shimojo","sequence":"additional","affiliation":[{"name":"Pathology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuyoshi","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Hongo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2019,7,5]]},"reference":[{"key":"10.25259\/SNI-183-2019\/ref-1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.lfs.2011.04.022","article-title":"Glioblastoma cells: A heterogeneous and fatal tumor interacting with the parenchyma","volume":"89","author":"Alves","year":"2011","journal-title":"Life Sci"},{"key":"10.25259\/SNI-183-2019\/ref-2","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s11060-016-2065-5","article-title":"Bevacizumab and temozolomide versus temozolomide alone as neoadjuvant treatment in unresected glioblastoma: The GENOM 009 randomized phase II trial","volume":"127","author":"Balana","year":"2016","journal-title":"J Neurooncol"},{"key":"10.25259\/SNI-183-2019\/ref-3","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ccr.2006.11.021","article-title":"AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients","volume":"11","author":"Batchelor","year":"2007","journal-title":"Cancer Cell"},{"key":"10.25259\/SNI-183-2019\/ref-4","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2014.9.FOCUS14516","article-title":"Bevacizumab for glioblastoma: Current indications, surgical implications, and future directions","volume":"37","author":"Castro","year":"2014","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI-183-2019\/ref-5","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJMoa1308345","article-title":"Bevacizumab plus radiotherapy temozolomide for newly diagnosed glioblastoma","volume":"370","author":"Chinot","year":"2014","journal-title":"N Engl J Med"},{"key":"10.25259\/SNI-183-2019\/ref-6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1200\/JCO.2015.64.7685","article-title":"Randomized, double-blind, placebo-controlled, multicenter phase II study of onartuzumab plus bevacizumab versus placebo plus bevacizumab in patients with recurrent glioblastoma: Efficacy, safety, and hepatocyte growth factor and O6methylguanine-DNA methyltransferase biomarker analyses","volume":"35","author":"Cloughesy","year":"2017","journal-title":"J Clin Oncol"},{"key":"10.25259\/SNI-183-2019\/ref-7","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.ccr.2009.01.021","article-title":"Accelerated metastasis after short-term treatment with a potent inhibitor of tumor angiogenesis","volume":"15","author":"Ebos","year":"2009","journal-title":"Cancer Cell"},{"key":"10.25259\/SNI-183-2019\/ref-8","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1038\/s41598-018-19420-z","article-title":"The direction of tumour growth in glioblastoma patients","volume":"8","author":"Esmaeili","year":"2018","journal-title":"Sci Rep"},{"key":"10.25259\/SNI-183-2019\/ref-9","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMoa1308573","article-title":"A randomized trial of bevacizumab for newly diagnosed glioblastoma","volume":"370","author":"Gilbert","year":"2014","journal-title":"N Engl J Med"},{"key":"10.25259\/SNI-183-2019\/ref-10","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3389\/fonc.2013.00066","article-title":"Modeling tumor-associated edema in gliomas during anti-angiogenic therapy and its impact on imageable tumor","volume":"3","author":"Hawkins-Daarud","year":"2013","journal-title":"Front Oncol"},{"key":"10.25259\/SNI-183-2019\/ref-11","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1038\/nrn2175","article-title":"Angiogenesis in brain tumours","volume":"8","author":"Jain","year":"2007","journal-title":"Nat Rev Neurosci"},{"key":"10.25259\/SNI-183-2019\/ref-12","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1126\/science.1104819","article-title":"Normalization of tumor vasculature: An emerging concept in antiangiogenic therapy","volume":"307","author":"Jain","year":"2005","journal-title":"Science"},{"key":"10.25259\/SNI-183-2019\/ref-13","doi-asserted-by":"crossref","first-page":"6222","DOI":"10.1158\/1078-0432.CCR-04-0823","article-title":"Antiangiogenic therapy of cerebral melanoma metastases results in sustained tumor progression via vessel co-option","volume":"10","author":"Leenders","year":"2004","journal-title":"Clin Cancer Res"},{"key":"10.25259\/SNI-183-2019\/ref-14","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1200\/JOP.2017.025536","article-title":"Treatment of glioblastoma","volume":"13","author":"Nam","year":"2017","journal-title":"J Oncol Pract"},{"key":"10.25259\/SNI-183-2019\/ref-15","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ccr.2009.01.027","article-title":"Antiangiogenic therapy elicits malignant progression of tumors to increased local invasion and distant metastasis","volume":"15","author":"P\u00e0ez-Ribes","year":"2009","journal-title":"Cancer Cell"},{"key":"10.25259\/SNI-183-2019\/ref-16","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/sj.neo.7900102","article-title":"Anti-VEGF antibody treatment of glioblastoma prolongs survival but results in increased vascular cooption","volume":"2","author":"Rubenstein","year":"2000","journal-title":"Neoplasia"},{"key":"10.25259\/SNI-183-2019\/ref-17","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/ncponc1204","article-title":"Response criteria for glioma","volume":"5","author":"Sorensen","year":"2008","journal-title":"Nat Clin Pract Oncol"},{"key":"10.25259\/SNI-183-2019\/ref-18","doi-asserted-by":"publisher","DOI":"10.1007\/s11307.018.1289-5","article-title":"Predicting glioblastoma response to bevacizumab through MRI biomarkers of the tumor microenvironment","author":"Stadlbauer","year":"2018","journal-title":"Mol Imaging Biol"},{"key":"10.25259\/SNI-183-2019\/ref-19","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1158\/1055-9965.EPI-14-0275","article-title":"Epidemiologic and molecular prognostic review of glioblastoma","volume":"23","author":"Thakkar","year":"2014","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"10.25259\/SNI-183-2019\/ref-20","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1186\/1471-2407-9-444","article-title":"Concerns about anti-angiogenic treatment in patients with glioblastoma multiforme","volume":"9","author":"Verhoeff","year":"2009","journal-title":"BMC Cancer"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/an-autopsy-case-of-widespread-brain-dissemination-of-glioblastoma-unnoticed-by-magnetic-resonance-imaging-after-treatment-with-bevacizumab\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/an-autopsy-case-of-widespread-brain-dissemination-of-glioblastoma-unnoticed-by-magnetic-resonance-imaging-after-treatment-with-bevacizumab\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,25]],"date-time":"2019-08-25T11:46:23Z","timestamp":1566733583000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/an-autopsy-case-of-widespread-brain-dissemination-of-glioblastoma-unnoticed-by-magnetic-resonance-imaging-after-treatment-with-bevacizumab\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,5]]},"references-count":20,"alternative-id":["10.25259\/SNI-183-2019"],"URL":"https:\/\/doi.org\/10.25259\/sni-183-2019","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,5]]},"article-number":"137"}}