Glioblastoma (IDH wild-type)

Case contributed by Dr Derek Smith

Presentation

New onset headache, with progressive slurring of speech and confusion. Left leg weakness reported.

Patient Data

Age: 70 years
Gender: Male
CT

5 x 5 x 4 cm ring enhancing lesion in the right frontal lobe, with extension across the corpus callosum.

Moderate perilesional reduced attenuation and mass effect with effacement of the anterior right lateral ventricle. Patent basal cisterns.

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Body CT performed at the same time did not demonstrate malignancy elsewhere.

MRI

Same day MRI (no interval treatment)

Solitary 5 cm right frontal lobe mass, crossing the anterior corpus callosum. The mass also extends to the ependymal surface at the right lateral ventricle.

Thick enhancing wall with non-enhancing centre, probable necrosis. No central increased diffusion signal, excluding abscess formation.

Local white matter FLAIR hyperintensity with mass effect as on CT.

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Appearances, with unremarkable staging CT and with the lesion crossing the midline, favour a high grade glial series tumour.

Case Discussion

Initial treatment was with oral steroids and the case was referred for tertiary opinion.

Surgical biopsy confirmed unmethylated glioblastoma WHO grade IV, IDH1 wild-type.

This case was subsequently managed by radiotherapy, with partial response.

 

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Case information

rID: 55422
Case created: 5th Sep 2017
Last edited: 6th Sep 2017
Inclusion in quiz mode: Included

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