The patient proceeded to repeat surgery.
PATHOLOGY: Diffusely infiltrating pleomorphic astrocytic tumour with mucinous stroma. Mitotic figures are easily identified. Intrinsic necrosis and microvascular proliferation are seen. Some vessel walls are hyalinised consistent with previous radiotherapy. GFAP and IDH1 are expressed (mutant). ATRX is lost (mutant), with associated upregulation of P53. High MIB1 index proliferation. No expression of H3K27M. No evidence of 1p19q co-deletion. MGMT is methylated (34%).
--> diffuse astrocytoma, IDH1 mutated, WHO CNS grade 4