June 6, 2011 -- Wall Street billionaire Ted Forstmann is fighting for his life -- reportedly against the same virulent form of brain cancer that felled Sen. Edward Kennedy in 2009 -- and has reportedly told friends that his treatment was delayed by a doctor's misdiagnosis.
A spokesman for Forstmann's sports marketing company IMG, says only that Forstmann has a serious illness. But others, including Forstmann himself in an interview the New York Times, call it brain cancer.
"Yes, it's brain cancer," someone familiar with Forstmann's condition told ABC News. "He was operated on to remove the tumor. He's undergone radiation and chemotherapy. The first phase of his treatment has had positive results."
Nonetheless, the prognosis for people with this type of tumor remains bleak. Kennedy died 15 months after his diagnosis.
About 9,000 people a year in the U.S. are diagnosed with Kennedy and Forstmann's type of cancer, a tumor called malignant glioma. Among people aged 15 to 44, such tumors are the second most common cause of cancer-related death.
"Glioma is a generic term," says Dr. John Ohlfest, associate professor of neurosurgery at the University of Minnesota, "It refers to a class of brain tumors of different types, some very aggressive."
Patients with the least aggressive type can live 10 years. Others like Kennedy, with the most aggressive type, called a glioblastoma, typically live no longer than 18 months.
Forstmann's chances for living even that long may have been compromised by his doctors' reported slowness to diagnose his condition correctly. According to Fox Business News, Forstmann has complained to friends that his doctors misdiagnosed his cancer for a year, thinking it was various illnesses, including meningitis.
Asked if Forstmann would take any recourse against his doctors, his spokesman said, "Ted has more important things to worry about at this point."
How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?
Experts told ABC News that while they had no familiarity with the specifics of Forstmann's case, including whether his illness was indeed originally misdiagnosed, they found it perplexing how brain cancer could be mistaken for meningitis.
Patients with brain cancer typically come to their doctors complaining of headaches, seizures, loss of vision or sensation, or changes in personality, says Dr. Harald Sontheimer, professor of neurobiology at the University of Alabama at Birmingham. If the symptoms persist and become more serious, doctors may order an MRI or CT scan, which detect the presence of lesions on the brain. If a lesion is detected, the next step, says Sontheimer, would be to perform a "needle biopsy."
To perform a needle biopsy, a small hole is made in the skull and a syringe is inserted to take a sample the suspect tissue. That sample is then analyzed to determine if it's cancerous. As an alternative to -- or a preliminary to -- a needle biopsy, the physician can inject dye into the arteries.
A brain tumor, being more vascular than the surrounding tissue, will absorb more of the dye, causing it to appear "enchanced" in the MRI image. "I would suspect that if you went to a neurologist and complained of severe headaches not responsive to medicine, in almost all medical centers in the U.S. you'd get an MRI," says Sontheimer.
Ohlfest says it's conceivable that a doctor reading an MRI could mistake a glioblastoma for something else, since there's some degree of subjectivity involved in interpreting the scan. "That's why we do the biopsy," he says. "An MRI is never foolproof." A biopsy, in Forstmann's case, could have ruled out meningitis and confirmed cancer.
So, was one done? Neither Forstmann, his doctors, nor anybody else is saying.
Dr. Matthew Hunt, a neurosurgeon and assistant professor at the University of Minnesota, is less inclined to give Forstmann's doctors benefit of the doubt.
"Part of what I do every day is making these diagnoses," he says. Relying on MRI alone, a doctor might mistake a glioblastoma for, say, a brain abscess. "But it would be extremely unusual for a glioblatoma to look like meningitis."
As to why a billionaire can't get a perfect diagnosis, Hunt notes that health care "is provided by people, to people. So, without taking the human beings out of the system, you're never going to get perfection. Why can't a man with billions get perfect care? How about a country with trillions?"
No matter how much money you have, he says, it's still hard to know, even in the information age, where to go to get the best care for your particular illness: "It's still a bit of a crap shoot."
Now, the defiant financier -- famous for having turned around such companies as Dr. Pepper and Gulfstream Aerospace -- is struggling to make IMG's success his crowning achievement. The reason, as he told the Times, is "to make a bunch of money, stick it in a charitable trust and give it away." Beneficiaries would be the world's children, especially those in Africa.
He still comes to his office every day and does business as usual. IMG oversees the careers of Tiger Woods, Roger Federer and many other sports stars. Forstmann bought the company seven years ago for $750 million and has built it into a global licenser of entertainment.
Forstmann is keeping up his social schedule as well, seeing friends for dinner nearly every night, according to his spokesman. Over the years those friends have included actress Elizabeth Hurley, Princess Diana, and most recently Padma Lakshmi, host of TV cooking show "Top Chef."