Glioblastoma NOS (multicentric)
Seizure refractory to medical treatment.
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Multiple intra-axial space-occupying lesions of varying size and shape are seen in the left frontotemporal and parietal lobes, right frontal lobe as well as cerebellar hemispheres.
The largest lesion is seen in the left frontotemporal lobes measuring about 40*65 mm causing marked vasogenic edematous changes, mild pressure effect on the lateral ventricle and mid-line shift measuring about 5 mm.
There is intratumoral hemorrhage from a previous biopsy.
Most of the lesions display marginal enhancement after contrast administration.
The diagnosis of glioblastoma was confirmed on microscopic examination. Sections showed astrocytic neoplastic tissue composed of highly pleomorphic cells with dysplastic nuclei, some bizarre nuclei, high mitotic activity, foci of spindling of tumor cells and fascicular pattern, foci of epitheliod appearance with gemistocytes features and infiltration of lymphohistiocytic and plasma cells between tumor cells. Vascular proliferation with glomeroloid pattern was noted. Large foci of necrosis with peripheral palisading also seen.
The diagnosis was a brain tumor at the left temporoparietal lobe resection with features suggestive of glioblastoma multiform with foci of sarcomatoid feature invading to bone tissue, WHO grade IV.