The patient went on to have an MRI (movement degraded, not shown) and a craniotomy and debulking of the tumour.
Paraffin sections show fragments of a densely hypercellular astrocytic glioma. Tumour cells show marked nuclear and cellular pleomorphism. Frequent mitotic figures are identified. There is multifocal microvascular proliferation with accumulation of endothelial-like cells in vessel walls. Foci of necrosis are also identified. Tumourcells show patchy strong immunostaining for GFAP and strong diffuse staining for nestin. No staining for IDH-1 is seen. The features are of glioblastoma multiforme. The topoisomerase labelling index is >50%.
FINAL DIAGNOSIS: Glioblastoma multiforme (WHO Grade IV)