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Select images from MRI study depicting multiple foci of T2/FLAIR cortical and white matter signal abnormalities involving the left parietal and occipital lobes, as well as the basal ganglia and insula. There is no contrast enhancement.
This patient underwent a brain biopsy that revealed: infiltrating glioma, consistent with gliomatosis cerebri.
Based upon the histologic features noted in the small biopsies, this glioma would only qualify as an astrocytoma grade II/IV using the Dumas-Duport grading system. Because of the diffuse pattern of infiltration, and sampling, this probably does not accurately reflect the actual grade of this malignant glioma.
Importantly, whereas gliomatosis was previously considered a distinct entity, since the 2016 update to the WHO classification of CNS tumors it is now merely thought of as a growth pattern.