Presentation
Right upper limb weakness.
Patient Data
Expansion of the splenium of the corpus callosum and extending into the parietal lobe on the left by a mass which is slightly hyperdense pre contrast and is surrounded by vasogenic edema, particularly on the left. Following administration of contrast it demonstrates minor irregular enhancement.
MRI better characterizes the lesion, and shows it to be of low signal intensity on T1 weighted sequences and heterogeneous intensity on T2 weighted images with ares of high signal centrally (necrosis).
Contrast enhancement is prominent but heterogeneous and predominantly peripheral. The solid components demonstrate restricted diffusion, suggesting high cellularity.
Case Discussion
The patient went on to have a biopsy which confirmed the diagnosis of GBM.
Pathology
MICROSCOPIC DESCRIPTION: The sections show fragments of cerebral cortex and white matter with reactive changes. In addition, however, there are fragments of a densely hypercellular astrocytic glioma. Within these fragments, tumor cells show marked nuclear and cellular pleomorphism. Frequent mitotic figures are identified and there are prominent foci of endothelial cell hyperplasia. Both palisaded and confluent necrosis are also identified. Some of these areas of necrosis include thin walled necrotic and thrombosed blood vessels. The features are of glioblastoma.
DIAGNOSIS: Glioblastoma (WHO Grade IV).
Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as a glioblastoma NOS.
Case discussion by Frank Gaillard, consultant neuroradiologist, Royal Melbourne Hospital.
Unable to process the form. Check for errors and try again.