Case illustrating an extensive left cerebral hemisphere that has the imaging characteristic of a glioma. The features demonstrated in the last MRI, enhancing foci with restricted diffusion and elevated CBV, favours a high-grade glioma. Spectroscopy was performed at that time (not shown), and was of elevated choline peak and decreased NAA.
The patient was submitted to a brain biopsy:
MICROSCOPIC DESCRIPTION: The sections show features of a moderately cellular glial tumour. Most of the cells appear morphologically astrocytic with elongated, angulated and hyperchromatic nuclei. Occasional tumour cells have round nuclei and perinuclear haloes. Scattered mitoses are seen. No microvascular proliferation or necrosis is present. Sparse calcified deposits are present in the background. The features are consistent with anaplastic astrocytoma. The tumour cells are focally p53 positive. The topoisomerase index is about 10%. IDH1-R132H immunostain is negative. MGMT is also negative (likely methylated). ATRX shows no loss of staining (non-mutated).
- 1p36: NO DELETION DETECTED
- 19q13.3: NO DELETION DETECTED
- Number of sites scored: 10
- Number of cells scored: 200
- 1p36/1q25 ratio 0.982
- 19q13.3/1p13 ratio: 0.962
- REFERENCE CRITERIA:
- 1p36/1q25 ratio <0.8 Deletion detected
- 19q13.3/19p13 ratio <0.8 Deletion detected
DIAGNOSIS: Features consistent with anaplastic astrocytoma (WHO Grade III), IDH wild-type.