Case contributed by Jack Ren



Patient Data

Age: 70
Gender: Female
Modality: CT

Pre and post contrast CT brain


Comparison with external CTB unchanged. Irregular ring enhancing lesion in the left frontal parietal occipital lobe abutting left lateral ventricle with moderate surrounding edema and mass effect with mild left uncal herniation. No second lesion identified. Possible 4mm ACOM aneurysm.


Findings would be in keeping with glioblastoma, but metastasis is a differential. Further evaluation with MRI (& MRA) would be helpful.

Modality: MRI

Centred in the deep white matter of the posterior temporoparietal region on the left there is a 3 cm heterogeneous peripherally enhancing mass which abuts the ventricles and appears to have a degree of subependymal spread.

Nodular restricted diffusion is demonstrated around the margins of the lesion corresponding to the enhancing component, with no central restricted diffusion.

The mass has surrounded by a large amount of oedema which results in local positive mass effect, but no midline shift.

MR spectroscopy predominantly demonstrates elevated lactate but probably also has some elevation of choline and reduction in NAA, although the trace is sub optimal.

MR perfusion demonstrates elevation of cerebral blood volume (CBV) in the enhancing component and reduction within the oedema.

A single small focus of T2 hyper intensity in the superior gyrus of the right frontal lobe is located the grey white matter junctions.

This only measures are few millimetres in size, it is not have any associated enhancement and is of uncertain significance. The remainder of the brain is unremarkable with no intra or extra-axial abnormality.


Left sided lesion most likely represents a high grade glioma (GBM, WHO grade 4).

The differential is of a metastasis although this is felt less likely.

Imaging features are not those of an abscess.

Pathology findings


All the sections show features of a moderately cellular astrocytic tumour. The tumour cells have pleomorphic and hyperchromatic nuclei. Scattered gemistocytes are seen with moderate amounts of eosinophilic cytoplasm. Mitotic figures are identified.

There are foci of endothelial cell hyperplasia. Some of the blood vessels are surrounded by mature lymphocytes. Areas of necrosis are present. The features are those of glioblastoma.


Left cerebral lesion: Glioblastoma (WHO Grade IV).

Case Discussion


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Case Information

rID: 29493
Case created: 30th May 2014
Last edited: 25th Nov 2015
Inclusion in quiz mode: Included

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