Presentation
Headache, vertigo, and recurrent vomiting. Previous MRI revealed multiple intracranial mass lesions and biopsy was taken from the largest one
Patient Data
There are multiple variable size and shape intra-axial space occupying lesions seen in the left frontal lobe and the parietal lobes bilaterally. The largest lesion is seen in the right parietal region and extends through the splenium of the corpus callosum to the contralateral side. There is intratumoral hemorrhage from a previous biopsy and extracranial herniation through a craniotomy defect. All lesions display marginal enhancement after contrast administration.
Case Discussion
Histopathology of the largest lesion revealed WHO grade IV glioblastoma with pleomorphic astrocytes and marked atypia and mitotic figures. The frontal lesion does not appear to be connected to the occipital lesions by abnormal T2 signal, and thus the term multicentric glioblastoma would be favored over multifocal.
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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