The patient went on to have a biopsy.

Histology

Sections show fragments of an extensively necrotic hypercellular astrocytic glioma with a focal gemistocytic tumor cell morphology. Tumor cells show marked nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is focal microvascular proliferation with multilayering of atypical cells around vessel lumen.

Immunohistochemistry results show tumor cells stain:

• GFAP: Positive
• Nestin: Positive (high)
• NogoA: Negative
• IDH-1 R132H: Negative
• ATRX: Positive
• p53: Positive
• p16 CDKN2A: Positive
• Topoisomerase labeling index: 15%

FINAL DIAGNOSIS: glioblastoma, IDH wild-type (WHO Grade IV).