Glioblastoma NOS

Case contributed by Naim Qaqish


Weakness, decreased level of consciousness, and dysarthria.

Patient Data

Age: 55 years
Gender: Male



There is evidence of peripherally broad-based extensive ill-defined heterogeneously enhancing right parieto-occipital mass extending into the corpus callosum and into the right basal ganglia with severe mass effect causing left midline shift and sub-falcine herniation.

There is also evidence of extensive perifocal edema around this lesion.

The lesion contain areas of cystic necrosis as well as areas of hemorrhages likely representing aggressive type grade IV tumor (variant of GBM).

This kind of tumor has the propensity to metastasize outside the brain to the lungs and lymph nodes.

Case Discussion

This patient with history of cerebrovascular accident presenting with weakness, decreased level of consciousness and dysarthria. MRI was requested by the treating team to rule out stroke, revealing a mass with areas of hemorrhage and cystic necrosis, occupying the right parieto-occipital region without evidence of dural invasion.

The three recognized unusual and uncommon variants of GBM are recognized. 

  1. giant cell glioblastoma
  2. gliosarcoma
  3. epithelioid glioblastoma

Hemorrhage and necrosis are common findings in GBM.


TISSUE BIOPSY: Right occipital lobe mass.

MACROSCOPIC DESCRIPTION: Few pieces of soft tissue with multiple blood clots measuring 2 x 1.5 x 0.2 cm in aggregate.

MICROSCOPIC DESCRIPTION: The tumor is formed of cellular proliferation of astrocytic cells in fibrillary background. The cells have pleomorphic large nuclei with frequent mitotic figures. Focal necrosis with many apoptotic bodies is seen. The cells are positive for GFAP immunohistochemical stain. The Ki-67 proliferative index is 10%.

FINAL DIAGNOSIS:  Glioblastoma

Unfortunately, unavailable IDH mutation status and so considered as Glioblastoma NOS.

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