Case contributed by Dr Hidayatullah Hamidi



Patient Data

Age: 70 years
Gender: Male

There is an aggressive mass lesion centered on the splenium of corpus callosum extending to the left temporal lobe showing T1 low signal, T2 high signal, with peripheral irregular diffusion restriction and avid post-contrast enhancement, central necrosis and hemorrhagic changes.
Similarly featured lesion is also noted in the grey-white matter junction of the right frontal lobe.

There is perilesional edema surrounding both lesions. No hydrocephalus. No infratentorial lesions.

Case Discussion

The MR features and the nature of involvement are suggestive of high grade primary CNS neoplasm most likely glioblastoma (GBM).

When there are several areas of enhancing tumors, the lesions than can be categorized as either multicentric or multifocal.

When there are multiple discrete areas of contrast-enhancing tumors without connecting T2/FLAIR signal abnormality, they are called as multicentric (considered as separate synchronous tumors), while if there are connecting T2/FLAIR signal abnormality between the enhancing lesions, they are called multifocal (considered as spread of tumor along white matter tracts).

This case is more likely to be multicentric than multifocal.

Unfortunately, no histological confirmation is available. 

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