Presentation
Right sided hemiparesis and headache.
Patient Data
A left frontotemporoparietal hemorrhagic mass lesion with compression of the left lateral ventricle.
A large right fronto-temporo-parieto-occipital heterogeneous mass lesion seen demonstrating predominantly hypointense T1 as well as hyperintense T2 and FLAIR signal intensity with restricted diffusion, the lesion is showing small foci of T1 hyperintensity as well as mixed T2 hypo and hyperintensity compatible with subacute blood, the lesion shows heterogeneous predominantly marginal or peripheral post contrast enhancement with thick rind of irregular enhancement as well as large necrotic core.
The lesion is associated with vasogenic brain edema with compression of the left lateral ventricle and contra-lateral midline shift.
Atrophic brain changes with periventricular arteriosclerotic leukoencephalopathy as well as bilateral cerebral patchy and confluent demyelinating lesions with high T2 FLAIR signal intensity.
The right medial cerebellum shows a small crescentic shaped area of T2 hypointensity as well as mild T1 hypointensity likely related to hemosiderosis of chronic hemorrhage.
Normal sellar and juxta sella region.
Normal cervico-medullary junction.
Case Discussion
Large left-sided malignant hemorrhagic mass lesion as described most likely high-grade glioma or glioblastoma (GBM) with significant mass effect.
The differential diagnosis of such a malignant cerebral mass lesion would be a metastatic deposit and primary CNS lymphoma.
This case was proved histopathologically as glioblastoma.
Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as a glioblastoma NOS.
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