Glioblastoma IDH wild-type (multifocal with non-enhancing component)

Case contributed by A.Prof Frank Gaillard

Presentation

Generalised tonic-clonic seizure.

Patient Data

Age: 45 years

Multiple areas of increased T2 signal involving the cortex are seen on the right with a number of much smaller areas of contrast enhancement, the largest of which is superficial and associated with probable leptomeningeal enhancement. 

Presence of non-enhancing cortical tumor is consistent with a diffuse glioma. 

Repeat MRI a few months later demonstrates a large area of FLAIR hyperintensity involving cortex and extending to the peritrigonal white matter. Several areas of mass like enhancement within the FLAIR hyperintensity are present. Prominent elevated CBV with prominent elevated choline and lactate with reduced NAA. Local mass effect, with distortion of the trigone

Conclusion: Findings are most in keeping with a multifocal glioblastoma.

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: The sections show features of a densely cellular astrocytic tumor. The tumor 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 tumor cells are:

FINAL DIAGNOSIS: glioblastoma (WHO Grade IV), IDH-wildtype.

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Case information

rID: 48101
Published: 28th Mar 2017
Last edited: 21st May 2017
Inclusion in quiz mode: Included

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