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Glioblastoma NOS

Case contributed by Amr Farouk
Diagnosis almost certain

Presentation

Complaining of headache of 2 months duration. Patient underwent MRI brain revealing a brain tumor. MRI examination postoperative.

Patient Data

Age: 60 years old
Gender: Female

MRI Brain

mri

Evidence of operative interference with high parietal osteoplastic flap and focal metallic artefact.

An ill-defined lobulated intracerebral mass is seen in the right temporal-parieto-occipital region. It appears of low signal on T1 and heterogeneous high signal on T2 weighted images, with cystic areas of breakdown as well as areas of blood signal within.

Infiltration of the corpus callosum namely body and splenium is seen crossing midline.

Surrounding peri-focal edema and exerted mass effect in the form of effacement of the adjacent cortical sulci and compression of the right lateral ventricle with shift of the midline structures to contra-lateral side.

Case Discussion

An intra-axial cerebral mass with central necrosis, marked mass effect, surrounding vasogenic edema and intralesional hemorrhage, in addition to corpus callosum infiltration and midline crossing are criteria in keeping with a highly aggressive tumor.

Pathologically proven glioblastoma multiforme (WHO grade IV).

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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