Presentation
Seizure.
Patient Data
Solitary rounded peripherally enhancing right temporal lobe mass with surrounding edema.
Solitary rounded peripherally enhancing right temporal lobe mass is centered near the grey-white matter junction, but is associated with non-enhancing high T2 thickening of the cortex anterior to it. This strongly suggests that this lesion represents a glioblastoma rather than a metastasis.
Case Discussion
The patient went on to have a resection.
Histology
MICROSCOPIC DESCRIPTION:
Sections show fragments of a moderately hypercellular astrocytic glioma. Tumor cells show moderate nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is prominent microvascular proliferation with multilayering of atypical cells around vessel lumena. Areas of palisaded tumor necrosis are also identified.
IMMUNOHISTOCHEMISTRY:
- GFAP: positive
- Nestin: positive (high)
- NogoA: positive
- IDH-1 R132H: negative (not mutated)
- ATRX: positive (not mutated)
- MGMT: negative (likely methylated)
- p53: positive
- p16 CDKN2A: positive
- Topoisomerase labeling index: Approximately 20%
FINAL DIAGNOSIS: Glioblastoma IDH wild-type (WHO Grade IV).
Discussion
Presence of non-enhancing tumor is an excellent way to distinguish metastases from glioblastomas.
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