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MRI of the brain demonstrates a large heterogeneously enhancing tumour 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 oedema with mass effect.
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This case illustrates typical appearances of a glioblastoma. The patient went on to have surgery and the diagnosis was confirmed.
MICROSCOPIC DESCRIPTION: The sections show cerebral tissue containing a diffusely infiltrating moderately cellular tumour, with scattered areas of necrosis. There is associated microvascular proliferation, with thrombosed vessels evident. The tumour 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. Tumour cells show variable perineuronal satellitosis. No oligodendroglial component is recognised.
FINAL DIAGNOSIS: Astrocytoma, WHO grade 4 (glioblastoma).