Presentation
MVA with seizure. ?seizure or MVA first
Patient Data
Area of swelling, T2/FLAIR hyperintensity involving the right temporoparietal region in a subcortical and cortical location. Mild restricted diffusion and postcontrast enhancement.
This case is a good example of TSE C+ more sensitive than MPRAGE C+ 1.
Case Discussion
The patient went on to have surgery.
Histology
Microscopy: Sections of brain tissue show features of glioblastoma multiforme (this was reported before the update in brain WHO classification). The tumor has a diffuse growth pattern and is composed of mitotically active intermediate-sized astrocytic cells with ovoid, coarsely granular nuclei within a fibrillary background. Palisaded geographic necrosis and foci of endothelial proliferation are readily seen. A lower grade component is not identifiable.
Summary: glioblastoma (WHO grade IV).
Note
In a 50-year-old, this tumor has not been fully classified thus remains a "Glioblastoma NOS" according to current (2016) WHO classification. It requires IDH status (IDH 1 and 2 sequencing if R132H immunohistochemistry is negative) to evaluate for non R132H and IDH2 mutations before being called an IDH-wt GBM.