Glioblastoma NOS (subtle abnormality on CT)

Discussion:

Patient presenting to the emergency department with acute symptoms that lead the treating team to consider stroke. CT non-contrast revealed a subtle left temporal lobe hyperdensity that could be easily missed and was spotted with the help of sagittal and coronal reformattings.  

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION: The sections show fragments of a moderately hypercellular glial tumor mixed with fragments of a blood clot. Tumor cells have fibrillary astrocytic morphology and show moderate nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is microvascular proliferation with multi-layering of atypical cells around vessel lumena. A small focus of necrosis is present at the edge of one fragment. The features are of glioblastoma (WHO grade IV).

DIAGNOSIS: Glioblastoma (WHO Grade IV).

 

Glioblastomas are the most common primary brain tumor at this age group and usually present as an irregular enhancing masses with central necrotic components. 

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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