Glioblastoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache

Patient Data

Age: 60 years
Gender: Male
CT

A mass adjacent to the right trigone is present with central heterogenous hyperdensity surrounded by edema. It demonstrates peripheral contrast enhancement and moderate localized mass effect. 

MRI

A mass abutting the right ventricular trigone is present with peripheral enhancement and central non-enhancement suggesting necrosis. It is surrounded by edema. The solid components demonstrate low ADC values suggesting high cellularity. Features are those a high-grade glioma with necrosis, almost certainly a GBM. 

Case Discussion

The patient went on to have a resection confirming the diagnosis. 

Histology

The section shows small fragments of tissue. All except one of the fragments are entirely necrotic. The viable fragment is composed of a moderately hypercellular astrocytic glial tumor. Tumor cells show moderate nuclear pleomorphism. Scattered mitotic figures are identified. The features are of glioblastoma (Grade IV). 

Neither oligodendroglioma or primitive neuroectodermal tumor (PNET)  components are
identified.   

 Immunohistochemistry pending. 

  • ATRX: positive (not mutated)
  • IDH-1 R132H: negative (not mutated)
  • p53: positive
  • MGMT: negative (likely methylated)
  • Nestin: positive
  • Topoisomerase labeling index: Approximately 5%  (NB: the specimen fragments are extremely small and this index may not reflect the true proliferation status of the tumor)

FINAL DIAGNOSIS:   Glioblastoma (WHO Grade IV).  

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Case information

rID: 37092
Published: 19th Jun 2018
Last edited: 19th Jun 2018
Inclusion in quiz mode: Included

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