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May 21st, 2008
11:46 AM ET
Inside a senator's brain
Somewhere deep inside the brain of Sen. Edward Kennedy, the neurons in his left parietal lobe were becoming angry. This is an area of the brain at about eye level just behind the ear. Something had invaded their space, a foreign mass of some type, and they were about to react in a way that would frighten the senator and those around him. It was this past Saturday when the brain had a sudden burst of electrical activity and caused a seizure, also known as a convulsion. Certain parts of his body would first become rigid, and then start to shake. He would lose consciousness. In most people, including the senator, there was really no way he could've known it was about to happen. Warning signs in the past may have been a vague headache, possibly some numbness in his right arm, maybe even the loss of a word when he was speaking. Any of those things may have been quickly forgotten or dismissed. A seizure, on the other hand, is a stern warning that the brain has reached a break point. While the seizure can be a frightening thing to witness, for doctors it is a call to action. It spurs those in my field of neurosurgery immediately into medical mystery-solving mode. The seizure itself in most cases will eventually stop, leaving doctors in a quandary. What exactly caused the seizure in the first place? One of the dictums of medicine is that you imagine the worst things of all and immediately try and rule those out. In this case, an electroencephalogram, or EEG, was performed measuring the electrical activity of the brain and perhaps most importantly, an MRI scan of the brain showed that angry foreign mass to the outside world for the first time. It probably looked like an octopus with tentacles reaching into the surrounding areas of the brain. (Watch Dr. Gupta explain how doctors examined Sen. Kennedy's brain here) Now, doctors had to figure out what it was. The only way to know for sure was to cut the skin above this tumor, drill a hole in the skull and insert a probe through the brain square into the middle of this mass. The goal here is to remove small pieces of the fibrous tough tissue and examine it under a microscope. It’s likely that the pathologist looked up from the microscope with a concerned expression when he saw the telltale cells that are consistent with a malignant glioma, a brain tumor of the very worst kind. They account for more than half of the primary brain malignancies that are diagnosed in the U.S. every year, and in the last 20 years, the grim survival statistics have barely budged. For the very worst type of malignant glioma, also known as glioblastoma, neurosurgeons are often forced to tell their patients that even with the best therapies, chances are they won't live longer than a year. Some things have changed over the past several years. This is where it gets more optimistic. Nowadays, doctors can perform what is known as a functional MRI scan. While in an MRI scanner, doctors may ask the senator to raise his right arm or even just think about moving his right arm. The resulting scans will show if the tumor is located in areas of the brain responsible for movement. They will ask the senator to speak or think about speech, and again the speech areas of the brain will light up and their relationship to the tumor can be seen directly. (Read more about Sen. Kennedy's diagnosis here) If the tumor is close to these motor or speech areas, doctors may choose not to operate or they may decide to forge ahead with the operation, keeping the patient awake. The whole time, while operating, they would ask the senator to move his arm and talk. As soon as anything seemed abnormal, that would send a message to the surgeon that it was time to stop. Unfortunately, more times than not, operations, chemotherapy and radiation, also known as the conventional therapies, simply aren’t that effective. Patients and their doctors then have the option of turning to some of the most cutting edge therapies that have been developed in decades. Nowadays, there is such a thing as a brain tumor vaccine. Doctors would take the patient's own tumor cells and combine them with their own white blood cells, which are part of the immune system. This concoction, according to Dr. Michael Gruber, chief of neuro-oncology at Overlook Hospital and a neuro-oncologist at the New York University Langone Medical Center, offers a 50 percent two-year survival in a small group of patients, almost double the survival rate without the vaccine. There is also a type of gene therapy, where specially engineered viruses are injected directly into tumor cells that may cause the tumor to die or at least be more susceptible to radiation. While the doctors figure out the best options to present to the Kennedy family, the senator will likely rely on the fighting spirit, for which he is so well known. Dr. Sanjay Gupta is a practicing Neurosurgeon at Emory University Hospital in Atlanta Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation. |
  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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By Dr. Sanjay Gupta
As a young navy hospital corpsman stationed at Bethesda I had a patient that was a glioblastoma patient. He took almost a year to die and it was not pretty. I hope we can do better for the good senator. Your explanation of the condition and prognosis is the best I have ever seen. I also admire your work in Iraq.
What a nicely written article!
It had to be a senator and celebrity disease to form this community. Dr Gupta, why dont you lead an e-based community. This portal can have major parts of body as its "silos". You dont have to answer questions, rather post a weekly written article and like above let the community connect with each other. I am sure someone in the Technology group at CNN can host this. This could be different from Web MD or other pharma based portals out there under your name which is become a significant brand name. Make it non-commercial. Please ask CNN to go easy with the pharma ads that this site will get swarmed with.
My best friend AT died in 2005 at Johns Hopkins, of oligo dendro glioma. He was 38 and fought this disease for 8 years. I wish such information was available out there easily on famous web sites.
SP
A good source of information is the American Brain Tumor Association. They are on the web and will send information free of charge. Dr. Gupta's article is good, but doesn't go into much depth. My father died of an inoperable brain stem GBM three years ago.
If Senator Kennedy's tumor was biopsied it may be operable or can have gliadel or other chemo implanted at the tumor site. His age is working against him. I am sure he will get the best care available. Cedar Sinai in California is one hospital that is doing some more advanced brain surgeries.
Yeah I feel bad the guy has a brain tumor but here's the rub... Thousands and thousands will be spent without abandon on his medical care but if it were you or I, Joe citizen you KNOW the insurance companies and hospitals would all be having a field day with how much MONEY should be spent on someone close to 80 and who is most likely going to die in a few years anyway.
I really appeciate Dr. Gupta's explanation as well as the thoughtful responses in this forum. My heart goes out to everyone who has or has had this disease and their loved ones. I hope we make some progress in dealing with it soon.
Regarding the Radio Frequency treatment being tested >The newest procedure is still in it's last stages of testing BUT...I am sure the Senator would be willing to try this. It is a radio wave treatment and is located at:
M.D. Anderson Hospital (Texas?) and there is more info at: http://www.kanziuscancerresearch.org/
I'm 57, I was diagnosed with Thyroid disease, Graves disease, Hodgkin's disease, diabetis, Parkinson's and now it looks like Hodgkin's again. Please give the senators my best.
Mark .
Dayton Ohio
Count your blessings every single day. Nothing is guaranteed in life. You have something today…poof…it can go away tomorrow.
Everyday I come to realize that we need to be thankful and grateful for what we already have
My mother was diagnosed with Hodgkins Lymphoma on February 13,2006, my birthday. Luckily, they got it diagnosed and treated in time..she was in remission by July of '06, and is currently still in remission. We are so thankful, that she has a doctor that knew what signs to look for, and the advancements in medicine. My prayers are with Senator Kennedy and his family.
i would like to know if in fact when the original operation was done on the senator back in the fall and various diagnostic tests were done including i am sure visual...was not the tumor apparent at that time i understand that it was on the same side of the present tumor and just above the area
can someone answer or comment
all our good thioughts and strength for the senator and for what lies ahead for him
I am sorry to hear of Senator Kennedy's diagnosis of a brain tumor.
It will no doubt be a difficult time for the Senator and his family.
My sixteen year old daugther was diagnosised with a grade II glioma three years ago, a tumor located in the same area and similar to Senator Kennedy's. She has been through two surgeries and now beginning her second year of temodar chemo. The size and location of the tumor makes it extremely risky to remove anymore of the tumor as it would certainly affect major brain functions.
The news of a brain tumor is devastating news to a family.
Brain tumors are the leading cause of solid tumor cancer death in children under the age of 20, and the third leading cause of cancer death in your adults ages 20-39.
In light of this news, I hope our government will come to know how horrible this disease. This is a cancer that so needs to receive the publicity it deserves. Most of all awareness!
Let's continue to support research and NIH.
It's ironic that Ted's situation has come up in the same time as my mother's. She was just diagnosed with a GBM 11 days ago, and luckily we are pursuing treatment at Mass General Hospital's Brain Tumor Center in Boston. It's been a very rough several weeks as we've waited to find out what kind of "growth" was seen on an MRI in March after what we thought was a mild stroke. Unfortunately my mother put off initial surgery for several weeks because brain surgery is scary in itself. Plus, it was a small 'lesion' or growth in March that seemed to merit a re-look in 6 weeks to see if anything changed. Unfortunately, it must have changed quickly: a subsequent brain bleed episode rushed her recent a brain surgery/ partial tumor resection and our family has been given the diagnosis. I've read such horrid stories about GBM and it's frankly very overwhelming. Having it on news headlines is good and bad for us all right now. Good because it raises awareness, but bad because it adds to the feelings of being barraged with gloom and morbidity.
My family members are Massachusetts people who've loved the Kennedy's for decades. You can't NOT if you are from the state. 🙂
I feel for the Senator and his family right now- I can certainly relate to what they are going through.
On this site, it's good to hear lots of different stories about people who have been down this road. Some stories are more hopeful, but I am also trying to wrap my head around the realities of Gioblastoma Multiforme. I know it's about location and size of the tumor when caught, so I can't help but be worried. Nobody wants to see loved ones suffer in this way.
In Canada last week, a robot at the University of Calgary removed a brain tumor from a 21 yr old. It was developed by the same people who made the Space Shuttles robotic arm. Here is a quote. "The neuroArm met all our expectations," said Dr. Garnette Sutherland, professor of neurosurgery at the University of Calgary's faculty of medicine and a Calgary Health Region neurosurgeon, in a statement about last week's surgery. "The manipulators and controls performed flawlessly, providing extraordinary control and extreme accuracy. The success of this procedure is expected to revolutionize neurosurgery." All Canadians are praying for a speedy recovery of Senator Kennedy and hope this technology will be of some help for the Senator.
After my father was diagnosed with a glioblastoma multiforme, he lived only three months. During the final weeks, he could not speak or swallow and was completely immobile.
Having hope and wishing for a miracle are only natural, but no one should underestimate the severity, virulence and aggressiveness of this type of brain tumor. The decline in quality of life is very rapid.
I know there are many things that my father wanted to say or pencil out to us, as well as questions that we had for him, but he lost those abilities virtually overnight. My point is for a loved one to not delay any communication that they wish to have.
How common are primary brain tumors such as malignant glioma? Is brain cancer more often the result of metastasis from breast or other form of cancer?
In November 2004, my husband Tim had a seizure and was diagnosed with GBM (glioblastoma multeforme) and was given 10 months to live. His tumor was also on the left side of the brain, but sounds like further back than Senator Kennedy's. After surgerical removal of tumor, chemotherapy, and radiation treatments, in February 2005, they said the tumor was back and was in fact larger than before. They shortened his life expectancy to weeks and told us to get our affairs in order. We were recommended to M.D. Anderson Cancer Center in Houston, Texas where Tim was part of a surgical trial using a drug "IL-13". The team at M.D. Anderson is absolutely great and I would recommend it to anyone! Tim is now cancer free – over three years and no signs of the cancer returning. There are doctors that say GBM never completely goes away and it will return. There are other doctors that say, if it were still there, it would have shown itself by now. Either way, Tim has beat the odds, and plans on being part of the 5% that only live 5 years after GBM diagnosis. Although, all the doctors were fantastic, the real credit goes to God and all the prayers lifted on Tim's behalf. There is power in prayer!
After caring and treating cancer patients for over 20 years as a Radiation Therapist I want to express my concern that one must stay very positive and look at all the options very carefully. Radation Therapy has proven to be a success for many patients and one must remember that technology has revelutionized the options when it comes to treating patients. Ultimately it is our creator that decides when and how we move form this world to the next. While we wait for that calling we must remember our past, live for the present and still dream about tomorrow. God bless Mr Kennedy and keep his family strong to support him through this journey.
Dear Good People
Just go to the bottom first to the other news story if my long verbal rant seems like too much hot air I am very sorry for the man BIG TED and his combined families, two of his kids have cancer so he and they have to know how serious it is. He is the last of the family and he has always had other family members and paid helpers to ease the burden that often falls entirely on one person or a small family in the ordinary world of brain tumors, He is without a doubt, a great man of our times and big part of American history the past 40 years, I pray for him to have a full recovery, I know several aggressive bt survivors who have survived now for 5 and 10 years thanks to advances in treatment options that he and his family will automatically have full access to get for him. .
The problem I see with all the press blitz of Kennedy's possible malignant diagnosis as a international story was they kept reporting it as the most prevelant type of primary brain tumor, and that is simply not acccurate. I am probably the only one besides Samantha Jane bothered by this common reporting mistake...and maybe they will correctly diagnosis him later on, I do hope he lives a lot longer, and I do hope he can mantain a good quality of lifeas long as he lives. I didn't know he just had heart surgery six months ago, if he had a head MRI then, they might have another clue about how fast it is growing and what grade it is now.
However, ordinary hard working folks in America do not have access to the same quality of care. and I wish the media would focus on the so called "benign" low grade primary brain tumors, because like in this story below where a dozen large primary benign brain tumors were diagnosed in seven months in one small town of 8500 and they still didn't know they needed to report it to public health officials there.
This other terrible story got no national coverage at all in the USA GGRRRH! And benign primary brain tumors get little or no medical research funding either cuz they are low grade, because no one want to use the word cancer, but they are usually either grade I or grade 2 according to WHO the World Health Organization classification. Therefore the needs of the chronically ill annd their family members for direct patient home caregiver health care and relief, like a visiting nurse, longterm care, family counseling and cognitive retraining services for reemployment and community reentry services are not covered by ordinary health insurance and are less generous because they still claim it is not brain cancer when there is recurrence of tumor or gradual progression of chronic disease.
First, I want to express my own concern and sorrow to the family and friends of Ted Kennedy and to the families and citizens of Cameron, MO, and everyone around the world who has lost someone to a malignant primary or secondary brain tumor, I focus most particularly on those diagnosed with a low grade primary brain tumor and their families who have to continue to fight and deal with our broken health care system for enough care as long as they live, I've been there and done that myself. the past twenty-two years. Second, because of the small population of Cameron (8,312), 12 brain tumors newly diagnosed over a period of 7 months is not due to chance. In other words, there is something hidden in Cameron causing these tumors...and no one knows what is affecting the central nervous systems of all these folks of all different ages. We ought to be checking their medical history, their genes and cognitive behavior and sleep patterns too, not just take more soil and water samples. What else do they have in common? What about their drug use or personal stress levels in relationships at home and on the job that can effect their body chemistry and immune system or behavior? What about the old analogue phones, everyone only reads about controversy over modern cell phone use now, including excessive dental x rays from forty years ago or medical use of diagnositic x rays anything that disrupt the electrical/chemical balances inside our bodies and can cause certain cells to mutate and grow abnormally.
The 2004 USA brain tumor incidence rate (latest available data from http://www.CBTRUS.org) was 16.52 brain tumors per 1,000,000 people per year. Therefore according to the available data, Cameron, MO would see about 1.4 brain tumors per year. And so in a 7 month period this would be 0.80 brain tumors, or less than one. The observed to expect ratio = 15 (12/0.8). The probability that this ratio is due to chance is 6.4 x 10-11! (I got these numbers from my dear friend Llyod Morgan, a board member of CBTRUS)
THIS STORY ought to get IMMEDIATE MEDIA ATTENTION, there is only one chance in 738 MILLION that this number of brain tumors in a small rural town of 8,312 people in 7 months is due to chance. And it is happening in other places too, and still we lack reliable medical data about incidence and prevalance of this disease and military and indian hospitals do not have to contribute their medical data to the national cancer registry..
I want to know why there aren't thousands and thousands of other longterm bt survivors like me, in more than twenty years I have only met a handful of others online and at conferences that are still functionally alive after standard treatment of more surgery and then more radiation , even if this is a benign condition, it certainly is not harmless and neither are the only available standard treatments.
We need to change our dictionaries or at least our vocabulary in order to even begin to understand the real risks to us and our family members of mutations of abnormal central nervous system cell growth in this country. And why do hospital errors still kill more people than breast cancer in this country?
There are 5 states, and Missouri is one, that is not certified by the North American Association of Central Cancer Registries (www.naaccr.org) and Missouri brain tumor incidence data is not included in the brain tumor data set (45 states) sent by the Center of Disease Control (CDC) to CBTRUS. But only nineteen USA states have published completed 2004 reports on all CNS central nervous system and benign brain tumors. ,Arizona where I live was one of the first dozen to comply with the federal law.
The KMBC TV news article below incorrectly states, "Doctors are only required to report cancerous brain tumors to the Health Department. Most of the tumors in Cameron are large, but benign. So there is no official agency collecting the data." Apparently, even the local MO State Rep. the Honorable Jim Guest had the wrong information.
Years ago, I helped introduce the Benign Brain Tumor Cancer Registries Amendment Act into both USA Houses of Congress. It finally became law in 2002. This law requires every state cancer registry to collect all brain tumors ("benign" and malignant). US Federal law requires the Missouri Cancer Registry collect all brain tumors, "benign" and malignant so the news report is probably incorrect. There are still many problems with funding, data quality, computer glitches and lack of timely reports, to be more polite.
According to the most reliable data I know of (only 19 states have published 2004 reports on all the low-grade brain and spinal cord tumors even though it is the LAW) and we are still waiting patiently (not me, I am practically jumping up and down now, a decade after we marched on Washington DC ) to have copies of the fully analyzed results proving terminal malignant primary brain tumors are not nearly as prevelant as the many other types of slow growing so called benign central nervous sytsem tumors by a long shot (still only documented by a small majority as far as I can find, and IMHO they have begun to reduce the WHO grades assigned to some of the other gliomas and former death sentences and thankfully some of those folks are now living longer too)
Even a benign brainor spinal cord tumor can totally disrupt your family life, if you are treated locally by a mostly back or spine surgeon without a skilled neurology intensive care unit staff, and especially if it happens to the famly bread winner, or perhaps a single or divorced working mother? If she has neurological deficits and can't go back to full time work at the same job level, the whole family suffers financially and after the breadwinner loses a job, then the family all lose health insurance (how can you pay Cobra if you can't pay your rent etc etc) so begins the downward emotional and financial tumble spiraling down for many folks and their families onto public welfare, and the other spouse has to try to become both caregiver and breadwinner, what an enormous burden to carry alone without suffering from caregiver burnout and it is mostly women who find themselves caring day to day for a parent or a child and/or working too, no wonder women have higher rates of depression.
Then they can't get public health care insurance from medicare for two years because of the 2 year waiting period, even if it is a high grade primary tumor, or traumatic brain injury, well a lot can happen in two years if your spouse or partner leaves you when you have survived a brain tumor, even if you survive the initial treatment and you look fine to everyone else, but they send you home without any cognitive retraining for mild brain injury or the emotional trauma you may have suffered. Talk about wounded warriors, these folks in Cameron ought to qualify for the health care they want to pass right now for our soldiers on Tricare, but ordinary health insurance is not required to fully cover all the acquired brain injuries from low grade primary brain tumors or mild brain injuries so we struggle along trying to be normal even with mild acquired head injury when it takes us longer to mentally process our thoughts or focus well enough to write them down and find a logical solution.
Did you see a news story I saw last month about a benign primary meningioma brain tumor patient Kathi Goertzen? She is a popular Seattle Washington news anchor woman who has returned to work after two surgeries and two types of radiation and just had a third surgery in ten years for a small golf ball size meningioma,and may still need more brain radiation treatment now GOD Bless HER and HER HUSBAND who has stayed by her side!
In a small town in Missouri they will not be getting the state of the art care that Sen.Kennedy gets automatically as a celebrity etc etc I hope he has a full recovery and I hope the dozen folks in Missouri can get to a regional brain tumor center, like U of Birmingham, Alabama so they will have a better chance of full recovery too like Kathi Goertzen who may not be able to return to work this time for a while longer . I almost could go on writing forever I am so passionate about this "not harmless" issue, and I know you don't have enough time to read everything I ramble on about, but thanks for reading this far to find out how I am handling the big news of Kennedy's terrible illness. To be completely honest, I still remember TED for his cowardly behavior after Mary Jo K died in the bridge accident many years ago which certainly isn't Christian or even politically correct to bring it up now as he fights for his life from brain cancer. He continued to lead Congress in civil rights and immigration issues that are important to me etc . He was no lion in those days, but he has grown up and he is certainly no stranger to family tragedy on a grand scale. I pray for all since it is not my job to judge others . His whole family has sacrificed for this country regardless they will always be part of our great American history.. . Thankfully, I saw on TV he went out on the water as soon as he left the hospital to get away from it all. . I also love the quiet power of the ocean off Cape Cod. I still remember the feeling of absolute power and control I get on the water with the wind behind me in a tiny sailboat traversing over and through the waves of Cape Cod Bay. I have been truly blessed by the roots and wings of my own large Irish Catholic family in this country and the support my family provides me. Too often I take my own loving family for granted. God works in strange ways we will never understand, Sen Kennedy, is a true lion now, I wish him well and will continue to pray for him and his family.
Here is the tiny article from Cameron Missouri i got from dear young brave Samantha Jane Scolamiero, founder of the http://www.Braintrust,org in 1993, The article came out about the same time as Kennedy's possibly malignant diagnosis. Please read this Missouri news article God bless em.... God bless us all
http://www.kmbc.com/health/16330197/detail.html
GBYAY Anne McGinnis Breen
President of a local tucson group of adult survivors of brain injury, part of the BIAAZ , a Chapter of the Brain Injury Association of America
See my smiley face winking at you? &;>)
Keep your faith, cherish your reason, treasure your mind, hold to your own good purposes...and be not afraid.
If you would like to visit my Aol journal pages to read more about me and 28 questions to ask you medical team about any low grade primary brain tumor and other grey matters about brain tumors of great importance to me go to
http://journals.aol.com/anne91547/anne-mcginnis-breens-articles
Please see that Senator Kennedy is evaluated for the possibility of the use of the Harvard Cyclotron to treat the tumor.
Let's start focusing on prevention. I'm convinced that proper diet and lifestyle can forestall nearly 100% of all cancers and heart disease. I have just gotten the GBM dx after nearly 2 years of clean MRI scans. after anaplastic astrocytoma IIII dx in 2005 and chemo, radiarion, & surgery.
Dr. Gupta,
I have heard that the Anthrax Vaccine can cause brain tumors. Is it true that not only our military, but also our government officials have had the vaccine, if so, is this being monitored to see if it has been causing brain cancer in anyone who has been given the vaccine?
James
I have a question about being deprived of sleep, if Dr. Gupta is right and most people fall asleep after just ten minutes then what does it mean when it takes you hours to get to sleep every night?
Even with a patient awake and talking, how do you know that you are going too far without going too far. Do you touch cells and if the patient's speech slurs, you don't cut? ..know what I mean? .. I doubt you can undo... How do you know where to draw the line without impairing the person to some point?
Also, did you notice when Senator Kennedy raised his right hand, his left arm was at his side and hidden, and he seemed to limp a bit favoring his right side. Could there be a deception and this affects his right brain? And if so, is the brain the same on both sides?
Thanks, Doug
Although only an ignorant layman on this subject, I'm interested to know how widely know it is that although these very skilled brain surgeons are often able to remove all or part of cancerous tumors, they have not solved the problem...here is why.
There is now mounting evidence amongst very prominent cancer stem cell researchers that the cancer stem cells which are the real drivers of the tumors, cannot and are not able to be removed through surgery and can easily regrow the tumors at some later stage, so until researchers discover a cancer stem cell targeted drug, the cancers will probably not be cured.
I wonder too if surgeons such as the highly rated Dr.Liau are fully aware of this and inform their patients about the surgery limitations.
IS IT POSSIBLE CANCER COULD BE CONTAGIOUS? I HAVE SEEN THE SAME CANCER, NAMELY PANCREATIC, AFFECT BOTH A WIFE AND A HUSBAND!
Nice quality blog post, very usefull information. thanks
I wasvery impressed withyour reportsand I decided to ask a question from Dr Gupta My wife is 85 years old and suddenly after an mri she was diagnosed with a meningioma.benign . She has to take Trazadone and zanax to sleep. Is this the meningiomacausing it.and do you think we should leave it alone as she also has High blood Pressure and cataract . your comments will be appreciated and not binding.. Ralph Bardowell
Great post! Just wanted to let you know you have a new subscriber- me!
The only way to know for sure was to cut the skin above this tumor, drill a hole in the skull and insert a probe through the brain square into the middle of this mass. The goal here is to remove small pieces of the fibrous tough tissue and examine it under a microscope. It’s likely that the pathologist looked up from the microscope with a concerned expression when he saw the telltale cells that are consistent with a malignant glioma, a brain tumor of the very worst kind.
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