Glioblastoma NOS (documented rapid growth)

Discussion:

This case illustrates the rapid progression of a high-grade tumor.

Due to a left temporal seizure, the patient was submitted to an MRI scan that revealed a left middle temporal gyrus T2/FLAIR hyperintense cortical lesion with mild expansion. Those findings were favored to represent a low-grade glioma, with post-seizure change being the less likely differential. A new scan follow-up was performed in two months and then showed important progression, acquiring typical features of a glioblastoma: rapid growth, contrast enhancement, necrosis, diffusion restriction, choline peak and high rCBV values. 

The patient was treated with the Stupp protocol: maximum resection on surgery followed by radiotherapy and temozolamide. 

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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