Glioblastoma NOS (butterfly morphology)

Case contributed by Dr Henry Knipe

Presentation

Altered conscious state.

Patient Data

Age: 50 years
Gender: Female

Large mass that appears centred on the genu of the corpus callosum with associated oedema and haemorrhage. 

The mass demonstrates enhancement post contrast. 

Large mass centred on the genu of the corpus callosum and extends into both frontal lobes. It is heterogeneously enhancing with central areas of non-enhancement suggestive of necrosis, and intralesional haemorrhage.

Cerebral blood volume (CBV) increased corresponding to the enhancing portions. MR spectrscopy demonstrates reversal of the Cho:Cr, NAA depression, and lactate elevation. 

Histopathology

MICROSCOPIC DESCRIPTION: Sections show fragments of a moderately hypercellular astrocytic glioma. Tumour cells show marked nuclear and cellular pleomorphism. Focally tumour cells demonstrate gemistocytic morphology. Frequent mitotic figures are identified. There is prominent microvascular proliferation and areas of pallisaded tumour necrosis present. 

DIAGNOSIS: Glioblastoma (WHO Grade IV).

Case Discussion

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION: Sections show fragments of a moderately hypercellular astrocytic glioma. Tumour cells show marked nuclear and cellular pleomorphism. Focally tumour cells demonstrate gemistocytic morphology. Frequent mitotic figures are identified. There is prominent microvascular proliferation and areas of palisaded tumour necrosis present. 

DIAGNOSIS: Glioblastoma (WHO Grade IV).

Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumours, this tumour would, therefore, be designated as a glioblastoma NOS

 

Discussion

Gliomas that involve the midline structures (i.e. corpus callosum) and extend into the cerebral hemispheres are colloquially given the name "butterfly glioma", being somewhat reminiscent of the shape of a butterfly. 

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Case information

rID: 47302
Case created: 11th Aug 2016
Last edited: 21st May 2017
Inclusion in quiz mode: Included

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