Glioblastoma NOS

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Left sided weakness, headache and unsteady gait.

Patient Data

Age: 65 years
Gender: Female
CT

CT Brain (selected images)

A right frontoparietooccipital thick irregular walled marginally enhancing mass lesion with patchy hyperdensities of its margin and central necrosis is seen. The mass lesion is seen surrounded by vasogenic brain oedema with compression of the right lateral ventricle’s body and occipital horn. The mass is seen infiltrating the corpus callosum and crossing the midline.

MRI

MRI Brain

A right temopro-parieto-occipital thick irregular walled marginally enhancing mass lesion with patchy hyperdensities of its margin and central necrosis is seen. The mass demonstrates predominantly hypointense T1 signal with patchy hyperintensities (met Hb signal) and hyperintense T2/Flair signal with restricted diffusion predominantly of its thick irregular margin. The ass measures about 7 X 6.5 X 5 cm in its main CC and axial diameters respectively. The mass is seen infiltrating the right splenium of the corpus callosum and crossing the midline to the contralateral side as well as transependymal spread along the temporal horn of right lateral ventricle. The mass lesion is seen surrounded by vasogenic brain oedema with compression of the right lateral ventricle’s body and occipital horn as well as slight contralateral midline shift.

MR Spectroscopic examination of the lesion shows: 

  • shooting lipid/lactate peak; predominantly within the necrotic portion of the lesion with depression of other metabolites
  • significantly elevated choline within the thick rind of irregular enhancement with marked depression of the neuronal markers; N-acetyl aspartate (NAA) and creatine (Cr) as well as elevated Cho/NAA and Cho/Cr ratios. Similar metabolite changes are noted within the perilesional oedema indicative of the infiltrating nature of the lesion.
  • marked reduction of the myoinisitol (MI) with reduced MI/Cr ratio= 0.24.

A small right inferior frontal focus of restricted diffusion is seen demonstrating high DWI and low ADC signal.  

Case Discussion

Right temopro-parieto-occipital haemorrhagic and marginally enhancing malignant mass lesion with central necrosis, highly suggestive of a high-grade glioma (glioblastoma ). A small right inferior frontal acute lacunar infarction.

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 probable glioblastoma NOS.

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Case information

rID: 23473
Case created: 18th Jun 2013
Last edited: 21st May 2017
Inclusion in quiz mode: Included

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