Glioblastoma NOS (multicentric)

Case contributed by Dr Jack Ren

Presentation

Headache and weakness.

Patient Data

Age: 45 years
Gender: Male
CT

CT brain

Multiple irregularly shaped lesions with hypodense centers in both hemispheres. Most of the lesions have an irregular hyperdense rim.

Small calcified nodule (or rather, cluster of nodules) immediately left of superior sagittal sinus near the torcula, probably meningioma(s).

Incidental cavum veli interpositi.

MRI

MRI brain

Multiple lesions with a T1-hypointense/T2-hyperinense center, likely representing necrosis or cystic degeneration. Extensive high T2 signal surrounds the lesions, suggestive of edema.

Following contrast administration, most of the lesions demonstrate intense rim enhancement.

CT

CT brain several weeks later

There is substantial disease progression compared to the last investigation. The lesions in the left cerebral white matter have grown and are exerting mass effect manifesting as subfalcine herniation and partial 3rd ventricle effacement. Following contrast administration, these lesions demonstrate intense rim enhancement.

MRI

MRI brain

In addition to the findings on the contrast-enhanced CT, the lesions and perilesional edema on the left can clearly be seen (particularly on the T2 and FLAIR sequences) extending across the corpus callosum to the right.

Case Discussion

This patient went on to have a craniotomy which confirmed the diagnosis of glioblastoma (grade IV). In this case, as areas of enhancement do not appear bridged by abnormal T2/FLAIR signal, the term multicentric glioblastoma is justified.

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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Case information

rID: 23205
Published: 28th May 2013
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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