Glioblastoma IDH wild-type

Case contributed by Dr Bruno Di Muzio

Presentation

Seizure.

Patient Data

Age: 75-year-old
Gender: Male
MRI

MRI Brain

Centred on the left frontal lobe is a peripherally enhancing lesion. The central component of this mass demonstrates hyperintense T2 signal suggestive of necrosis. Abnormal FLAIR hyperintense signal extends to the left basal ganglia and deep white matter, across and expanding the genu and anterior body of the corpus callosum, and into the right frontal lobe. Mass effect results in subfalcine herniation to the right, significantly distorts the lateral ventricles and effaces the left frontal cerebral sulci.

Patchy foci of predominantly peripheral diffusion restriction correlate with low ADC values and represent highly cellular regions of tumour.

MRS demonstrates reversal of choline:creatine ratio, elevated lipid/lactate peak and decreased NAA.

Increased cerebral blood volume (CBV) within the enhancing component of the tumour.

Other smaller foci of white matter FLAIR hyperintense signal throughout the cerebral white matter, without enhancement, are likely to represent chronic small vessel ischaemia, within normal limits for age.

Conclusion: Findings are those of a left frontal high-grade glioma (WHO IV, GBM).

Pathology

 

MICROSCOPIC DESCRIPTION: The sections show features of a densely cellular astrocytic tumour. The tumour cells have elongated, angulated and hyperchromatic nuclei. Scattered mitotic figures are identified. There are foci of microvascular proliferation. Areas of palisaded necrosis are present. There is no oligodendroglial component. 

  • IDH-1 is negative (wild type)
  • MGMT is negative (likely methylated)
  • p53 is negative in the tumour cells
  • ATRX positive (non-mutated)

FINAL DIAGNOSIS: glioblastoma (WHO Grade IV).

Case Discussion

This case illustrates typical MRI features of a high-grade glioma that was confirmed to be a glioblastoma

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Case information

rID: 41335
Case created: 26th Nov 2015
Last edited: 21st May 2017
Tag: rmh
Inclusion in quiz mode: Included

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