Glioblastoma IDH wild-type

Case contributed by A.Prof Frank Gaillard

Presentation

Seizure resulting in car crash.

Patient Data

Age: 60 years
Gender: Female
CT

Pre-contrast (not shown) and post contrast CT obtained at another institution demonstrates an irregular region of enhancement in the left parietal lobe white matter. Unfortunately the follow up scan was delayed for a number of months. 

MRI

A heterogeneously enhancing mass is present on the left, in the posterior temporal / parietal lobe white matter. There is associated non-enhancing tumour adjacent to it, particularly extending anteriorly into the temporal lobe. Within the enhancing mass, prominent SWI signal loss and blooming is present consistent with hemorrhage. The solid enhancing components demonstrate reduced ADC values. 

Case Discussion

The patient went on to have surgery.

HISTOLOGY

MICROSCOPIC DESCRIPTION: Sections show a hypercellular glial tumour with areas of palisaded tumour necrosis and microvascular proliferation. Tumour cells demonstrate marked nuclear pleomorphism with angulated hyperchromatic nuclei, coarsely granular chromatin and inconspicuous nucleoli. There are >20 mitoses per 10 high-power fields

Immunohistochemical results show tumour cells stain: 

  • GFAP Positive. 
  • Nestin High. 
  • NogoA Negative. 
  • IDH-1 Negative (not mutated). 
  • ATRX Positive (not mutated). 
  • MGMT Negative (likely methylated). 
  • p16 Negative. 
  • p53 Positive. 
  • Topisomerase proliferation index 30%.

FINAL DIAGNOSIS: IDH-1 wild-type Glioblastoma, WHO grade IV.

PlayAdd to Share

Case information

rID: 42874
Case created: 12th Feb 2016
Last edited: 21st May 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.