Presentation
First episode of partial seizure involving the right upper and lower limbs.
Patient Data
Large lesion centered at the left cingulate gyrus with significant cortical expansion. There is mass effect with deviation of the falx cerebri towards the right side and effacement of the third and left lateral ventricles. Corpus callosum is depressed with scalloping of the superior margin. It demonstrates homogenous T1 hypointensity relative to the grey matter and high T2/FLAIR signal. Mild surrounding T2/FLAIR hyperintensity along the adjacent white matter.
No abnormal signal of the corpus callosum or the right cerebral hemisphere. There is no intra- or extra-axial collection. No hydrocephalus.
Conclusion:
Large predominantly cortically based lesion centered at the left cingulate gyrus with homogenous T1 hypointensity and T2/FLAIR hyperintensity. The appearance is consistent with astrocytoma or infiltrative oligodendroglioma.
Case Discussion
Stereotactic needle biopsy of the lesion centered at the left cingulate gyrus was performed.
Histology
Sections show cores of brain tissue containing a moderately cellular glial tumor. The tumor cells have enlarged, angulated, moderately pleomorphic nuclei, and are set in a fibrillary background. There is no area of oligodendroglial morphology. There is perineuronal satellitosis. Mitoses are not identified. There is no microvascular proliferation or necrosis.
- Positive
- GFAP
- IDH1 R 132H (mutated)
- ATRX
- Negative
- p53
- p16
- Ki67 1-2%
FINAL DIAGNOSIS: Diffuse glioma favoring diffuse astrocytoma IDH mutant (WHO grade II).