Presentation
Presents with growing headaches and first episode loss of consciousness.
Patient Data
There is a heterogeneous lesion located at the left tempo-parietal lobe. It has heterogenous signal intensities: mainly hyper on T2 and FLAIR images, iso-hypo on T1, no diffusion restriction.
Moderate vasogenic edema more pronounced posteriorly.
Positive mass effect to the left basal ganglia, left lateral ventricle, midbrain and pons with midline shift 5mm.
After contrast injection it shows typically thick peripheral ring and irregular enhancement, with central non-enhancing large component, suggesting central necrosis, mild dural enhancement is also evident at the inferior part of left frontal lobe, well seen on coronal T1 fat suppressed images; the left lacrimal gland homogenous enhancement.
Small peripheral signal loss on axial EPI DWI with b=0 and slightly high signal on T1 at the small round area within tumor reflecting hemorrhagic component.
Conclusion:
The above finding are highly suspicious for a high grade primary brain neoplasm (GBM).
Case Discussion
This patient underwent craniotomy with tumor resection and postoperative both chemo and radiotherapy.
Pathology of resected tumor confirmed glioblastoma (WHO grade IV).
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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