Presentation
Four week history of walking into objects on the left side. Left sided homonymous hemianopia on examination.
Patient Data
Large lesion measuring up to 45mm located in the right occipital lobe. Intrinsic areas of increased T1 signal consistent with hemorrhage. It is abutting the medial aspect of the right transverse sinus and torcula but no evidence of extension into the dural venous sinuses. There is intrinsic and peripheral enhancement especially at the inferior aspect close to the tentorium cerebelli. Extensive surrounding edema with increased T2/FLAIR signal.
Occipital horn of the right lateral ventricle is compressed. Remaining ventricles remain patent and no hydrocephalus.
Conclusion: Large hemorrhagic lesion in the right occipital lobe with appearance consistent with high grade glioma or hemorrhagic metastasis.
Case Discussion
The patient underwent stereotactic craniotomy and excision of the right occipital lesion.
Histology
MICROSCOPIC DESCRIPTION: Sections of brain show a moderately cellular glioma consisting of crowded, elongate hyperchromatic nuclei in a fibrillary background, with occasional gemistocytic cells. There are small vessels in the background. Some necrosis may be secondary to hemorrhage, however there are thrombosed vessels and associated necrosis which is most consistent with tumor necrosis. There is focal microvascular proliferation. Ki67 30%
- Positive
- GFAP
- Negative
- IDH-1 R132H
- p16 CDKN2A
FINAL DIAGNOSIS: Glioblastoma (WHO grade IV).