Case contributed by Dr Mohammad A. ElBeialy


Right sided hemiparesis and headache.

Patient Data

Age: 74 years
Gender: Male
Modality: CT

A left frontotemporoparietal haemorrhagic mass lesion with compression of the left lateral ventricle. 

Modality: MRI

A large right fronto-temporo-parieto-occipital heterogeneous mass lesion seen demonstrating predominantly hypointense T1 as well as hyperintense T2 and FLAIR signal intensity with restricted diffusion, the lesion is showing small foci of T1 hyperintensity as well as mixed T2 hypo and hyperintensity compatible with subacute blood, the lesion shows heterogeneous predominantly marginal or peripheral post contrast enhancement with thick rind of irregular enhancement as well as large necrotic core. 

The lesion is associated with vasogenic brain oedema with compression of the left lateral ventricle and contra-lateral midline shift. 

Atrophic brain changes with periventricular arteriosclerotic leukoencephalopathy as well as bilateral cerebral patchy and confluent demyelinating lesions with high T2 FLAIR signal intensity. 

The right medial cerebellum shows a small crescentic shaped area of T2 hypointensity as well as mild T1 hypointensity likely related to hemosiderosis of chronic haemorrhage. 

Normal sellar and juxta sella region.

Normal cervico-medullary junction.

Case Discussion

Large left fronto-temporo-parieto-occipital malignant haemorrhagic mass lesion as described most likely high grade glioma or glioblastoma (GBM) with significant mass effect.

The differential diagnosis of such a malignant cerebral mass lesion would be a metastatic deposit and primary CNS lymphoma. This case was proved histopathologically as a high grade glioma or glioblastoma (GBM).   

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Case Information

rID: 38587
Case created: 26th Jul 2015
Last edited: 9th Sep 2015
Inclusion in quiz mode: Included

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