Patient Data
Enhancing cortical mass near the central sulcus.
Heterogeneously enhancing right parietal mass with diffusion restriction suggesting high cellularity.
Case Discussion
The patient went on to have a craniotomy and excision.
Histology
Microscopic Description:
Sections show multiple fragments involved by a very cellular neoplastic process. For the most part, the tumor cells are spindly with significant pleomorphism and hyperchromasia accompanied by microvascular proliferation. Geographic areas of necrosis are seen. There are a significant number of neutrophils at the interface between viable tumor and necrosis. The tumor cells also assume a microgemistocytic appearance in some areas. Mitotic figures are identified, particularly in the frozen sections. In some areas, the tumor is seen within the Virchow-Robin spaces. Special stains (reticulin and Masson trichrome) show that the collagen fibers are limited to blood vessels, and there is the absence of reticulin fibers around individual tumor cells.
Immunohistochemically, the malignant cells react strongly to GFAP with a significant number labeled by MIB-1 nuclear stain.
Final Diagnosis: glioblastoma
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.
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