Glioblastoma NOS (cystic)

Case contributed by Frank Gaillard
Diagnosis certain


2 week history of headaches not alleviated by analgesics.

Patient Data

Age: 65 years
Gender: Female

CT Brain (selected images)


Selected pre and post-contrast images of brain showing a large cystic and well-defined lesion located in the right temporoparietal junction. Its content is homogeneously hypoattenuating and there is enhancement of the entire wall. The tumor promotes an expressive local mass effect characterized sulci effacement, peri-lesional edema, right lateral ventricle partial collapse and midline shift to the left.

MRI Brain


Large intraaxial mass at right temporoparietal junction. It is largely cystic/necrotic, has ring enhancement and solid heterogeneous enhancement posteroinferiorly. It extends to the subependymal of trigone and posterior temporal horn. Bright FLAIR signal extends into right anterior temporal pole and internal capsule posterior limb as well as the overlying cortex. Diffusion restriction and increased CBV of the thin enhancing rim and solid component. MRS suboptimal but shows increased choline at the margin (despite elevated baseline) and center shows increased lactate.

There is transtentorial herniation with midbrain distortion and midline shift to left.

Scattered foci of bright FLAIR signal in the rest of white matter (centrum semiovale) and periventricular deep white matter probably reflect chronic small vessel ischemia.

Conclusion: Right temporoparietal lesion, with overall findings favoring a cystic high-grade glioma.

Case Discussion

This case demonstrates yet another appearance of GBMs. Often the peripheral enhancement is nodular and irregular representing heterogeneous necrosis of a solid tumor. In this case, the appearances are more those of a cystic tumor, with thin regular contrast enhancement. 


MICROSCOPIC DESCRIPTION: The sections show features of a densely cellular astrocytic tumor. The tumor cells show elongated, angulated and hyperchromatic nuclei. Scattered tumor giant cells are identified. Mitoses are present. There is focal mild endothelial cell hyperplasia. One area of palisaded necrosis is present. The features are those of glioblastoma multiforme.

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

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