Presentation
Sudden onset seizure and reduced level of consciousness.
Patient Data
There is a 25*30*45 mm right parietal lobe lobulated thick wall enhancing intra-axial mass with surrounding marked perifocal cytotoxic edema and extended mass effect in the form of effacement of the adjacent cortical sulci and compression of the right lateral ventricle.
High signal foci in T2 and flair sequences at subcortical and periventricular white matter of both cerebral hemispheres depict microvascular ischemic events.
Partially empty sella is noted.
Right parietotemporal craniotomy and fluid signal cavity (14*26 mm) are seen at the site of surgery.
In comparison with the previous brain MRI, the size ( 35* 45*50 mm), extension and perifocal edema of the tumor has markedly increased.
The subtle midline shift (about 5 mm) to the contralateral side also is seen.
Case Discussion
Pathology report
Microscopic:
The brain glial tumor is extensively necrotic with palisading of tumor cells, areas of hemorrhage and microvascular proliferation. The tumor is moderately cellular, composed of atypical cells and many gemistocytes.
Diagnosis: Glioblastoma, NOS, WHO grade IV.