Presentation
Altered conscious state.
Patient Data
Large mass that appears centered on the genu of the corpus callosum with associated edema and hemorrhage.
The mass demonstrates enhancement post contrast.
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Large mass centered 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 hemorrhage.
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. Tumor cells show marked nuclear and cellular pleomorphism. Focally tumor cells demonstrate gemistocytic morphology. Frequent mitotic figures are identified. There is prominent microvascular proliferation and areas of pallisaded tumor 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. Tumor cells show marked nuclear and cellular pleomorphism. Focally tumor cells demonstrate gemistocytic morphology. Frequent mitotic figures are identified. There is prominent microvascular proliferation and areas of palisaded tumor 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 tumors, this tumor 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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