Glioblastoma NOS

Case contributed by Assoc Prof Frank Gaillard

Presentation

Visual disturbances, headaches and expressive dysphasia. Visual disturbances thought to be secondary to lymphoid hyperplasia within the right the right orbit. Past medical issues include: seizures, HBV, HCV, crack cocaine and speed use, pack-a-day smoker.

Patient Data

Age: 60 years
Gender: Female

MRI brain

MRI

A small subcortical region of high T2 signal is seen in the left frontal lobe.

The patient was lost to follow-up for 5 years and represented with a further seizure. A CT demonstrated an abnormality which prompted further MRI imaging. 

MRI brain - 5 years later

MRI

The region has increased in size and now vividly enhances. 

The patient refused treatment and again failed to attend follow-up visits. They were homeless and unable to be located. 6 months later they presented with increasing headaches and seizures. 

CT Brain - 6 months later

CT

A peripherally enhancing lesion is located within the left frontal lobe. 

Case Discussion

Finally, the patient consented to surgery. Histology demonstrated a glioblastoma (GBM).

It is uncommon to watch a brain tumor grow for 5 years, but when complicated psychosocial issues are present following up patients or convincing them to have treatment can be difficult. 

Note: This case predates the recent (2016) revision WHO classification of CNS tumors and IDH status is not available. Although with such a protracted documented history this is likely a secondary GBM and thus likely IDH mutated, as this has not been established this tumor would now be classified as a glioblastoma NOS.

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