Glioblastoma IDH wild-type
Cognitive decline and dysphasia over weeks.
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An ill-defined defined irregularly-shaped area of FLAIR hyperintensity measuring up to 5 cm in the left parietal temporal white matter extends from the subcortical/juxtacortical white matter to the ventricular surface, with relative sparing of overlying cortex. Relatively mild local mass-effect with prominent linear traversing vessels that are radially oriented from the ventricular surface. A punctate focus of micro haemorrhage is noted at its medial margin. This lesion demonstrates peripheral diffusion restriction with central T2 shine through. The diffusion restricting rim correlates with increased CBV and the rim of fine linear and nodular enhancement. Central fine linear and nodular enhancement corresponds to the linear traversing vessels on SWI. At the superolateral posteromedial margin are several slightly larger round nodules of enhancement. MR spectroscopy demonstrates prominent elevated lipid-lactate, elevated choline and reduced NAA.
No other lesion identified, with the 2 apparent nodules of enhancement at the left temporal pole thought to be more likely phase artefact.
The patient went on to have surgery.
MICROSCOPIC DESCRIPTION: The sections show features of a moderately cellular astrocytic tumour. The tumour cells have elongated, angulated and hyperchromatic nuclei. Scattered mitotic figures are identified. There are sparse foci of microvascular proliferation. Areas of vaguely palisaded necrosis are present. The features are those of glioblastoma. The tumour cells are focally p53 positive. IDH-1 is negative (wild-type). MGMT is negative (likely methylated). There is no loss of TRX staining (non-mutated).
FINAL DIAGNOSIS: Brain tissue: Glioblastoma (WHO Grade IV).