The patient went on to have a biopsy which confirmed the diagnosis of GBM.
MICROSCOPIC DESCRIPTION: The sections show fragments of cerebral cortex and white matter with reactive changes. In addition however there are fragments of a densely hypercellular astrocytic glioma. Within these fragments, tumour cells show marked nuclear and cellular pleomorphism. Frequent mitotic figures are identified and there are prominent foci of endothelial cell hyperplasia. Both palisaded and confluent necrosis are also identified. Some of these areas of necrosis include thin walled necrotic and thrombosed blood vessels. The features are of glioblastoma.
DIAGNOSIS: Glioblastoma (WHO Grade IV).
This case was part of Royal Melbourne Hospital Radiology Department Quiz (May 2011).
Case discussion by: Dr Frank Gaillard, consultant neuroradiologist, Royal Melbourne Hospital.