The patient went on to have a resection, followed by Stupp protocol

Histology

MICROSCOPIC DESCRIPTION:

Paraffin sections show fragments of a densely hypercellular glial tumour. This is composed predominantly of moderately pleomorphic fibrillary astrocytes arranged in diffuse sheets. A small
component of gemistocytic cells is noted. There are moderate numbers of mitotic figures. Foci of microvascular proliferation with multilayering of atypical cells around vessel lumena are also noted and there is prominent pallisading and confluent necrosis. Several of the latter areas incorporate thin-walled necrotic blood vessels. 

IMMUNOHISTOCHEMISTRY:

  • GFAP : positive
  • Nestin : positive (high)
  • IDH-1 R132H : negative (not mutated)
  • ATRX : positive (not mutated)
  • MGMT : negative (likely methylated)
  • p53 : positive
  • p16 CDKN2A : negative

Topoisomerase labelling index:  Approximately 35%

FINAL DIAGNOSIS: 

IDH-1 wild type glioblastoma (WHO Grade IV)

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