Presentation
Headache. Seizure.
Patient Data
Within the right frontal lobe, there is a cluster of multiple adjacent peripherally enhancing lesions. This is surrounded by a large amount of FLAIR hyperintensity which extends across the genu of the corpus callosum into the left frontal lobe, and involves the right internal capsule, lentiform nucleus and thalamus. The signal abnormality and enhancement involve the right frontal cortex as well as white matter. Within the right frontal lobe just superior to the sylvian fissure, there is a separate 10 mm nodule of enhancement. There is a large amount of mass effect, characterized by right frontal cortical sulcal effacement, compression of the right lateral and third ventricles and 11 mm of right to left shift and subfalcine herniation. There is a slight dilatation of the left lateral ventricle consistent with early hydrocephalus. Within the right frontal lobe, there is mild diffusion restriction and increased CBV. Spectroscopy demonstrates increased choline, decreased NAA and a lactate/lipid peak. The paranasal sinuses are clear.
Conclusion:
Findings are strongly favored to represent a high-grade glioma.
Case Discussion
Typical appearances of a large glioblastoma (GBM)
The patient went on to have a craniotomy which confirmed the diagnosis of a WHO grade IV astrocytoma (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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