Presentation
Seizures
Patient Data
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Two lesions are demonstrated, one in the right parietal lobe and the second in the left temporal lobe. No connecting T2 signal abnormality.
Case Discussion
The patient went on to have a resection.
Histology
The sections show features of a densely cellular astrocytic tumor. The tumor cells show elongated, angulated and hyperchromatic nuclei. Some of the cells are smaller with rounder nuclei. Nuclear molding is not seen. Scattered mitotic figures are identified. There are foci of endothelial cell hyperplasia. Areas of necrosis are present. Clusters of foamy macrophages and some hemosiderin deposits are present.
The tumor cells are diffusely GFAP and CD56 positive. They show patchy weak staining with synaptophysin and chromogranin, suggestive of primitive neuroectodermal-like differentiation. The Ki-67 index is about 20%.
Final diagnosis: glioblastoma NOS
Discussion
As there is no visible connection between the two lesions this would be best described as a multicentric glioblastoma. Lack of IDH mutation status (older case) means that this is currently (under the 2016 WHO classification) considered a glioblastoma not otherwise specified (NOS).
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