Presentation
Breast cancer 3 years ago. No known metastases. Now headache.
Patient Data
A large right temporal lobe mass is present, predominantly cystic, is noted. There is extensive irregular enhancement, with solid components demonstrating reduced ADC values suggestive of high cellularity.
Importantly the cortex of the temporal pole is also involved.
Conclusion
Features are most consistent with a high grade cystic glioma (glioblastoma). Cystic metastasis could have similar appearance, however involvement of the cortex makes this much less likely.
Case Discussion
The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION: Sections show multiple excisions from brain parenchyma which has a mass lesion. The mass lesion consists of pleomorphic irregular cells with large irregular nuclei and a moderate amount of eosinophilic cytoplasm. The cells are mitotically active and extensive areas of necrosis is seen. It is difficult to determine the exact differentiation of the cells however there are focal areas which raise the possibility of glial differentiation.
Immunohistochemistry show tumor cells stain positive with GFAP. Negative Cam5.2 and AE1/AE3. Features support the diagnosis of a glioblastoma.
FINAL DIAGNOSIS: Glioblastoma (WHO 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.
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