Glioblastoma with pseudoresponse (bevacizumab)
- Radiopaedia Australia Pty Ltd, Founder and CEO (ongoing)
- Biogen Australia Pty Ltd, Investigator-Initiated Research Grant for CAD software development in multiple sclerosis (past)
Updates to Case Attributes
Histology
This histology is from the original resection (prior to the first study shown).
ectionsSections show pieces of a moderately cellular diffusely infiltrating tumour. The tumour cells are enlarged and pleomorphic, with angulated nuclei, relatively fine chromatin and a central nucleolus. In some areas there appears to be some perinuclear clearing, while in other areas the tumour has a microcystic appearance. There are plentiful calcifications. Mitoses are not seen. There is no necrosis or microvascular proliferation.
- GFAP: positive
- OLIG2: positive
- IDH1 R132H: negative (not mutated)
- ATRX: positive (not mutated)
- p53: mosaic (probably not mutated)
- p16: positive
- Ki67: 1-2%
- BRAF V600E: negative
- Synaptophysin: negative
- NFP: negative
- NeuN: negative I
Next-genereation sequencing
- 1p/19q codeletion: Not detected
- EGFRamplification: Not detected
- IDH1codon 132: No pathogenic variant detected
- IDH2codon 172: No pathogenic variant detected
- BRAFcodon 600: No pathogenic variant detected
- H3F3Acodons 27 and 34: No pathogenic variant detected
- TERTpromoter Chr5:1295228 (C228T) and chr5:1295250 (C250T): PATHOGENIC VARIANT DETECTED
FINAL INTEGRATED DIAGNOSIS: Glioblastoma (IDH-wildtype).
Discussion
This case demonstrates the profound blood-brain-barrier reconstitution effects of bevacizumab that can result in a dramatic reduction in oedema and enhancement without necessarily having an actual treatment effect on the tumour. This is best appreciated on rCBV and ADC.
-<p><strong>Histology</strong></p><p>This histology is from the original resection (prior to the first study shown). </p><p>ections show pieces of a moderately cellular diffusely infiltrating tumour. The tumour cells are enlarged and pleomorphic, with angulated nuclei, relatively fine chromatin and a central nucleolus. In some areas there appears to be some perinuclear clearing, while in other areas the tumour has a microcystic appearance. There are plentiful calcifications. Mitoses are not seen. There is no necrosis or microvascular proliferation.</p><ul>- +<p><strong>Histology</strong></p><p>This histology is from the original resection (prior to the first study shown). </p><p>Sections show pieces of a moderately cellular diffusely infiltrating tumour. The tumour cells are enlarged and pleomorphic, with angulated nuclei, relatively fine chromatin and a central nucleolus. In some areas there appears to be some perinuclear clearing, while in other areas the tumour has a microcystic appearance. There are plentiful calcifications. Mitoses are not seen. There is no necrosis or microvascular proliferation.</p><ul>
-</ul><p>FINAL INTEGRATED DIAGNOSIS: <a title="Glioblastoma" href="/articles/glioblastoma">Glioblastoma</a> (IDH-wildtype).</p><p><strong>Discussion</strong></p><p>This case demonstrates the profound blood-brain-barrier reconstitution effects of bevacizumab that can result in a dramatic reduction in oedema and enhancement without necessarily having an actual treatment effect on the tumour. This is best appreciated on rCBV and ADC. </p>- +</ul><p>FINAL INTEGRATED DIAGNOSIS: <a href="/articles/glioblastoma-idh-wildtype">Glioblastoma</a> (IDH-wildtype).</p><p><strong>Discussion</strong></p><p>This case demonstrates the profound blood-brain-barrier reconstitution effects of bevacizumab that can result in a dramatic reduction in oedema and enhancement without necessarily having an actual treatment effect on the tumour. This is best appreciated on rCBV and ADC. </p>