Glioblastoma NOS

Case contributed by Jack Ren

Presentation

N/A

Patient Data

Age: 70 years
Gender: Female
CT

Irregular ring enhancing lesion in the left frontal parietal occipital lobe abutting left lateral ventricle with moderate surrounding oedema and mass effect with mild left uncal herniation. No second lesion identified.

Conclusion

Findings would be in keeping with glioblastoma, but metastasis is a differential. Further evaluation with MRI (& MRA) would be helpful.

MRI

Centred in the deep white matter of the posterior temporoparietal region on the left there is a 3 cm heterogeneous peripherally enhancing mass which abuts the ventricles and appears to have a degree of subependymal spread.

Nodular restricted diffusion is demonstrated around the margins of the lesion corresponding to the enhancing component, with no central restricted diffusion.

The mass has surrounded by a large amount of oedema which results in local positive mass effect, but no midline shift.

MR spectroscopy predominantly demonstrates elevated lactate but probably also has some elevation of choline and reduction in NAA, although the trace is sub-optimal.

MR perfusion demonstrates elevation of cerebral blood volume (CBV) in the enhancing component and reduction within the oedema.

A single small focus of T2 hyperintensity in the superior gyrus of the right frontal lobe is located the grey-white matter junctions.

 

 

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION:

All the sections show features of a moderately cellular astrocytic tumour. The tumour cells have pleomorphic and hyperchromatic nuclei. Scattered gemistocytes are seen with moderate amounts of eosinophilic cytoplasm. Mitotic figures are identified.

There are foci of endothelial cell hyperplasia. Some of the blood vessels are surrounded by mature lymphocytes. Areas of necrosis are present. The features are those of glioblastoma.

DIAGNOSIS:

Left cerebral lesion: Glioblastoma (WHO Grade IV).

Case Discussion

Note: This case predates the recent (2016) revision WHO classification of CNS tumours and IDH status is not available. As such, this tumour would now be classified as a glioblastoma NOS.

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Case information

rID: 29493
Case created: 30th May 2014
Last edited: 21st May 2017
Inclusion in quiz mode: Included

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