The patient went on to have surgery.

HISTOLOGY

MICROSCOPIC DESCRIPTION: Sections show a hypercellular glial tumor with areas of palisaded tumor necrosis and microvascular proliferation. Tumor cells demonstrate marked nuclear pleomorphism with angulated hyperchromatic nuclei, coarsely granular chromatin and inconspicuous nucleoli. There are >20 mitoses per 10 high-power fields

Immunohistochemical results show tumor cells stain: 

• GFAP Positive. 
• Nestin High. 
• NogoA Negative. 
• IDH-1 Negative (not mutated). 
• ATRX Positive (not mutated). 
• MGMT Negative (likely methylated). 
• p16 Negative. 
• p53 Positive. 
• Topisomerase proliferation index 30%.

FINAL DIAGNOSIS: IDH-1 wild-type Glioblastoma, WHO grade IV.