This case illustrates typical imaging features of a high-grade glial tumor: extensive FLAIR abnormalities with mass effect and vasogenic edema, irregular contrast enhancement, restrict diffusion, elevated areas of CBV and tumor trace on spectroscopy. 

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION: The sections show features of a densely cellular astrocytic tumor. The tumor cells have elongated, angulated and hyperchromatic nuclei. Scattered mitotic figures are identified. There are foci of microvascular proliferation. Areas of palisaded necrosis are present. The features are those of glioblastoma. The tumor cells are focally p53 positive. They are IDH-1 and MGMT immunostains negative. There is no loss of ATRX staining.

FINAL DIAGNOSIS: Glioblastoma (WHO Grade IV).

Note: Although this tumor is entirely consistent with IDH wild-type molecular subtype, strictly speaking, to conclusively establish this, IDH would need to be sequenced to ensure that a non-IDH1 R132H mutation was present. In practice, however, an IDH1 R132H negative tumor in an elderly individual makes the possibility of this actually being IDH mutant remote, and sequencing is not felt to be necessary by many institutions.