Glioblastoma IDH wild-type - crossing the corpus callosum
Updates to Freetext Attributes
The patient proceeded to open biopsy.
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. The features are those of glioblastoma. The tumour cells are focally p53 and MGMT (about 20%) immunostains positive. There is no loss of ATRX staining. IDH-1 immunostain is negative.
DIAGNOSIS: Brain tumour: Glioblastoma (WHO Grade IV).
Updates to Case Attributes
Glioblastomas, along with CNS lymphoma, are one of few tumours tumours that cross the midline via the corpus callosum. Cerebral metastases rarely have this pattern of spread.
The patient proceeded to open biopsy.
Histology
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. The features are those of glioblastoma. The tumour cells are focally p53 and MGMT (about 20%) immunostains positive. There is no loss of ATRX staining. IDH-1 immunostain is negative.
DIAGNOSIS: Brain tumour: Glioblastoma (WHO Grade IV).
Note: Although this tumour is entirely consistent with IDH wild-type molecular subtype, strictly speaking, to conclusively establish this, IDH would need to be sequenced to ensure that a non-IDH1 R132H mutation was present. In practice, an IDH1 R132H negative tumour in an older individual makes the possibility of this being IDH mutant remote, and sequencing is not felt to be necessary by many institutions.
-<p>Glioblastomas, along with CNS lymphoma, are one of few tumours that cross the midline via the corpus callosum. Cerebral metastases rarely have this pattern of spread. </p>- +<p>Glioblastomas, along with CNS lymphoma, are one of few tumours that cross the midline via the corpus callosum. Cerebral metastases rarely have this pattern of spread. </p><p>The patient proceeded to open biopsy.</p><p><strong>Histology</strong></p><p>MICROSCOPIC DESCRIPTION:</p><p>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. The features are those of glioblastoma. The tumour cells are focally p53 and MGMT (about 20%) immunostains positive. There is no loss of ATRX staining. IDH-1 immunostain is negative.</p><p>DIAGNOSIS: Brain tumour: Glioblastoma (WHO Grade IV).</p><p><strong>Note:</strong> Although this tumour is entirely consistent with IDH wild-type molecular subtype, strictly speaking, to conclusively establish this, IDH would need to be sequenced to ensure that a non-IDH1 R132H mutation was present. In practice, an IDH1 R132H negative tumour in an older individual makes the possibility of this being IDH mutant remote, and sequencing is not felt to be necessary by many institutions. </p><p> </p>
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