Presentation
Seizure resulting in car crash.
Patient Data
Pre-contrast (not shown) and post contrast CT obtained at another institution demonstrates an irregular region of enhancement in the left parietal lobe white matter. Unfortunately the follow up scan was delayed for a number of months.
A heterogeneously enhancing mass is present on the left, in the posterior temporal / parietal lobe white matter. There is associated non-enhancing tumor adjacent to it, particularly extending anteriorly into the temporal lobe. Within the enhancing mass, prominent SWI signal loss and blooming is present consistent with hemorrhage. The solid enhancing components demonstrate reduced ADC values.
Case Discussion
The patient went on to have surgery.
HISTOLOGY
MICROSCOPIC DESCRIPTION: Sections show a hypercellular glial tumor with areas of palisaded tumor necrosis and microvascular proliferation. Tumor cells demonstrate marked nuclear pleomorphism with angulated hyperchromatic nuclei, coarsely granular chromatin and inconspicuous nucleoli. There are >20 mitoses per 10 high-power fields
Immunohistochemical results show tumor cells stain:
- GFAP Positive.
- Nestin High.
- NogoA Negative.
- IDH-1 Negative (not mutated).
- ATRX Positive (not mutated).
- MGMT Negative (likely methylated).
- p16 Negative.
- p53 Positive.
- Topisomerase proliferation index 30%.
FINAL DIAGNOSIS: IDH-1 wild-type Glioblastoma, WHO grade IV.
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