Presentation
First seizure
Patient Data
Cortical and subcortical T2/FLAIR hyperintensity with mild mass effect left frontal lobe posteriorly at the vertex. Mild contrast enhancement appreciated on TSE post contrast (not the MPRAGE post contrast). Restricted diffusion. Spectroscopy is consistent with a glial tumor. No abnormality on CBV perfusion study.
Selected images from DWI, ADC and T1 C+ TSE sequences demonstrating restricted diffusion and contrast enhancement within the left frontal tumor.
Now the intra axial lesion has the typical appearance of GBM - central necrosis, enhancing rim with hemorrhage (seen on SWI).
Case Discussion
Histology
Left frontal tumor: Glioblastoma (WHO grade IV)
- IDH1-R132H mutation antibody negative
- normal P53 immunohistochemistry
- 1p/19q co-deletion negative (1p deletion only identified)
Immunohistochemical stains show that the tumor is negative for the IDH1-R132H mutation antibody and staining for P53 is normal. The Ki67 proliferation is very variable, but in areas approaches 10%.
Note
In a 45-year-old, this tumor has not been fully classified thus remains a "Glioblastoma NOS" according to WHO classification. It requires IDH 1 and 2 sequencing to evaluate for non R132H and IDH2 mutations before being called an IDH-wt tumor.