The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION: Sections show fragments of a moderately hypercellular astrocytic glioma. Tumour cells show moderate nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is prominent microvascular proliferation with multilayering of atypical cells around vessel lumena. Areas of palisaded tumour necrosis are also identified.
Immunohistochemistry results show tumour cells stain:
- GFAP Positive (moderate)
- Nestin Positive (high)
- NogoA Negative
- IDH-1 R132H Negative (not mutated)
- ATRX Positive (not mutated)
- MGMT Positive (likely non-methylated)
- p53 Positive
- p16 CDKN2A Negative
- Topoisomerase labelling index: Approximately 30%.
FINAL DIAGNOSIS: IDH-1 wild type glioblastoma (WHO Grade IV).