Glioblastoma NOS (large cystic component)
Headache and seizures.
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Intra-axial space occupying lesion measuring 7 cm in diameter, noted involving the cortex, subcortical and deep white matter regions at the left frontal lobe, extending to the genu of corpus callosum and showing modest extension to the contralateral region. It is T1 hypointense, T2 hyperintense with peripheral ring enhancement and enhancing mural nodule at the inferior aspect. Blooming is noted at SWI. It exerts mass effect in the form of moderate perifocal oedema, compression upon left lateral ventricle, subfalcine herniation and midline shift by 1.5 cm. Mild hydrocephalic changes at the right lateral ventricle with CSF permeation near the occipital horn. The enhancing mural nodule inferiorly demonstrates reduced ADC values, lower than normal white matter. Spectroscopy showed Cho/Cr ratio= 8.1 (not shown).
The patient went on to have a resection.
Microscopic picture: Infiltrative richly cellular new growth composed of pleomorphic astrocytes having hyperchromatic nuclei with brisk mitotic activity. Areas of tumour necrosis observed. Glomeruloid vascular proliferation is noted.
Diagnosis: Glioblastoma (WHO Grade IV).