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Glioblastoma - early

Case contributed by Jennie Roberts
Diagnosis certain

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

Age: 75 years
Gender: Male
mri

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.

3 months later

mri

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)

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