Presentation
Seizure.
Patient Data
MRI of the brain demonstrates a large heterogeneously enhancing tumor in the left parietal lobe extending down towards the ventricle. It has a non-enhancing central fluid signal component suggesting central necrosis. There is surrounding edema with mass effect.
Case Discussion
This case illustrates typical appearances of a glioblastoma. The patient went on to have surgery and the diagnosis was confirmed.
Histology
MICROSCOPIC DESCRIPTION: The sections show cerebral tissue containing a diffusely infiltrating moderately cellular tumor, with scattered areas of necrosis. There is associated microvascular proliferation, with thrombosed vessels evident. The tumor cells are generally elongated, with inapparent cytoplasmic outlines and associated with eosinophilic glial processes. Nuclei are oval or elongated, generally with hyperchromatic chromatin and frequent mitotic figures seen. Tumor cells show variable perineuronal satellitosis. No oligodendroglial component is recognized.
FINAL DIAGNOSIS: Astrocytoma, WHO grade 4 (glioblastoma).
Note: This case predates the recent (2016) revision WHO classification of CNS tumors and IDH status is not available. As such, this tumor would now be classified as a glioblastoma NOS.
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