Multicentric glioblastoma

Case contributed by Jack Ren

Presentation

Headache and weakness.

Patient Data

Age: 45
Gender: Male

CT Brain

Modality: CT

Multiple irregular shaped lesions with hypodense centres can identified across both hemispheres. Most of the lesions have irregular hyperdense margins. 

There is no significant midline line shift. Incidental note is made of a cavum septum pellucidum. 

A small hyperdense lesion can be identified just to the right of the superior sagittal sinus near the torcula. 

MRI Brain

Modality: MRI

Multiple lesions with hypointense centre on T1 signal and hyperinense on T2 in keeping of cystic degeneration or more likely necrosis. Extensive high T2 signal surrounds lesions suggestive of oedema.

Following administration of contrast, most of lesions demonstrated a well defined enhancing edge with heterogeneous centre.

CT brain a few weeks later

Modality: CT

There is huge progression compare to last investigation. The lesions near left 3rd ventricle have large progress in size. With administration of contrast, these lesion demonstrate a enhancing irregular thick edge with hetergenous centre.

The distortion of 3rd ventricle has been progressively worsen with definitive evidence of mid-line shift 

MRI brain

Modality: MRI

With comparison to the last MRI image, the lesion has greatly progressed in size with increasing mass effect. The lesions and oedema on the left are expanding across the corupus collosum to the right, best seen on T2 signal and FLAIR.

Case Discussion

This patient went on to have a craniotomy and confirmed the diagnosis of glioblastoma (grade IV). In this case, as areas of enhancement do not appear bridged by high T2 signal the term multicentric glioblastoma is justified. 

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Case Information

rID: 23205
Case created: 28th May 2013
Last edited: 31st Aug 2015
Inclusion in quiz mode: Included

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