Presentation
Altered mental state.
Patient Data
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 edema.
MRI confirms the mass involving the splenium of the corpus callosum in a butterfly appearance, demonstrating areas of restricted diffusion and patchy linear enhancement.
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. Tumor 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 tumor necrosis is identified. Immunohistochemistry results show tumor 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 labeling index: Approximately 20%.
DIAGNOSIS: 1&2. Brain, left corpus callosum lesion: IDH-1 wild type Glioblastoma (WHO Grade IV).
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