Glioblastoma NOS (multifocal)
Headaches and left sided weakness.
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A large mass involves the right temporal and occipital lobes. It is of high T2 signal with marked positive mass effect and has numerous enhancing components within it. There is involvement of the cortex and extension to the ependymal surface. On diffusion weighted imaging the enhancing components demonstrate restricted diffusion.
This case demonstrates typical appearances of a large glioblastoma (astrocytoma grade IV) which was confirmed on histology. It is important not to confuse a multifocal glioblastoma (single tumour with multiple regions of discrete enhancement embedded within it, with the much rarer multicentric glioblastoma, where enhancing foci are not linked together by tumour oedema / non-enhancing tumour.
Note: This case predates the recent (2016) revision WHO classification of CNS tumours and IDH status is not available. As such, this tumour would now be classified as a glioblastoma NOS.