Presentation
History of seizures and right-sided weakness.
Patient Data
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There is a round-to-oval lesion in the left frontal lobe, hypointense on T1WI and FLAIR and hyperintense on T2WI, surrounded by perilesional edema. Multiple small lesions are closely connected to the larger lesion by the hyperintense signal. Post-contrast images reveal peripheral discrete enhancement within both the larger and smaller lesions.
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Histopathological images show two morphologic features essential for the diagnosis: necrosis and endothelial proliferation. The tumor shows serpiginous necrosis with palisading around necrotic foci.
Case Discussion
Multifocal glioblastomas are tumors which have multiple discrete areas of contrast-enhancing tumor connected by T2/FLAIR signal abnormality. They are considered to be part of one tumor.
The tumor in this case was excised and sent for histopathological confirmation, proved to be glioblastoma.
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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