Presentation
3 tonic clonic seizures that morning (never had seizures before). First episode preceded by speech disturbance and some decreased right upper limb movement. Lacunar infarct?
Patient Data
Swelling of cortical and subcortical area of left temporal lobe with T2/FLAIR changes.
Mild restricted diffusion in this area.
Also mild swelling and hyperintensity within left pulvinar of the thalamus and left parietal lobe.
MRI repeated three months later demonstrate more typical appearances of GBM.
Case Discussion
Histology
Microscopy: malignant glioma with astrocytic morphology showing frequent mitoses (up to 8 per high power field) as well as early vascular proliferation but no necrosis is identified.
Immunohistochemistry:
- GFAP: positive
- IDH1-R132H: negative
- ATRX: positive
- P53: Equivocal (variable weak to moderate in at least two-thirds of the tumor).
Summary: Glioblastoma (WHO grade IV)