Presentation
Headache, confusion, and memory dysfunction associated with nausea. No history of fever, seizures, or vomiting.
Patient Data
An ill-defined mixed density lesion (peripheral hyperdense/solid and central hypodense/cystic/necrotic components) is seen in the left temporoparietal region adjacent to the temporal horn & atrium of the left lateral ventricle. The lesion is involving the splenium of the corpus callosum and extending through it to the right side of the midline. The peripheral hyperdense/solid components show mild enhancement on the post-contrast scan. This space-occupying lesion is likely a high-grade glioma (e.g. glioblastoma multiforme). Another possible differential diagnosis is CNS lymphoma.
Two cortical/subcortical hypodensities are seen in the left parieto-occipital and left posterior frontal regions, which are likely old watershed infarcts.
Status post left temporal mini-craniotomy with biopsy of the left temporoparietal region space-occupying lesion. Post-surgical changes are appreciable in the underlying left temporal lobe. No significant interval change is appreciable in the space-occupying lesion when compared with the previous CT brain.
Case Discussion
Procedure: Craniotomy and biopsy of the tumor.
Diagnosis: Glioblastoma multiforme.
Comment: The tumor cells stain uniformly positive for GFAP, CKAE1/3, S100, and vimentin. Ki-67 stain 80% of tumor cells.
Note: This case predates the recent WHO classification of CNS tumors (2016) and IDH status is not available. As such, this tumor would now be classified as a glioblastoma NOS.