The patient went on to have a resection confirming the diagnosis. 

Histology

The section shows small fragments of tissue. All except one of the fragments are entirely necrotic. The viable fragment is composed of a moderately hypercellular astrocytic glial tumor. Tumor cells show moderate nuclear pleomorphism. Scattered mitotic figures are identified. The features are of glioblastoma (Grade IV). 

Neither oligodendroglioma or primitive neuroectodermal tumor (PNET)  components are
identified.   

 Immunohistochemistry pending. 

• ATRX: positive (not mutated)
• IDH-1 R132H: negative (not mutated)
• p53: positive
• MGMT: negative (likely methylated)
• Nestin: positive
• Topoisomerase labeling index: Approximately 5%  (NB: the specimen fragments are extremely small and this index may not reflect the true proliferation status of the tumor)

FINAL DIAGNOSIS:   Glioblastoma (WHO Grade IV).