Glioblastoma IDH wild type (butterfly morphology)

Case contributed by Dr Bruno Di Muzio

Presentation

Altered mental state.

Patient Data

Age: 60-65 years
Gender: Male

There is a hypodense mass involving the splenium of the corpus callosum bilaterally, with a bulkier component on the left, where it is associated with vasogenic oedema. 

MRI confirms the mass involving the splenium of the corpus callosum in a butterfly appearance, demonstrating areas of restricted diffusion and patchy linear enhancement. 

MRI

MRI Brain (brainlab protocol)

Volumetric T1 post contrast has been acquired as per brainlab protocol for preoperative planning. Note how the enhancement is shown more diffuse and vivid. 

Case Discussion

This case is an example of a high-grade glioma crossing the midline through the splenium of the corpus callosum in a so called "butterfly" morphology. 

MICROSCOPIC DESCRIPTION: Sections show fragments of a moderately hypercellular astrocytic glioma. Tumour cells show moderate nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is focal microvascular proliferation with multi layering of atypical cells around vessel lumen. No tumour necrosis is identified. Immunohistochemistry results show tumour cells stain:

  • GFAP Positive
  • Nestin Positive (intermediate)
  • NogoA Positive
  • IDH-1 R132H Negative (not mutated)
  • ATRX Positive (not mutated)
  • MGMT Positive
  • p53 Positive
  • p16 CDKN2A Negative
  • Topoisomerase labelling index: Approximately 20%.

DIAGNOSIS: 1&2. Brain, left corpus callosum lesion: IDH-1 wild type Glioblastoma (WHO Grade IV).

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Case information

rID: 54684
Case created: 22nd Jul 2017
Last edited: 25th Jul 2017
Inclusion in quiz mode: Included

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