Multifocal glioblastoma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache

Patient Data

Age: 60
Gender: Male
Modality: MRI

There is confluent T2 / FLAIR hyperintense signal abnormality affecting the corona radiata and the centrum semiovale of the cerebral hemispheres with involvement of the corpus callosum, the right frontal operculum, the hippocampi, to a lesser extent the thalami and the left cerebral peduncle. In the right frontal operculum there is involvement of grey and white matter, and the suggestion of gyral expansion.

Within the centrum semiovale and corpus callosum, there are a number of focal higher T2 / FLAIR hyperintensities with predominantly peripheral irregular enhancement. 

Conclusion: 

There are bilateral confluent T2 hyperintense abnormalities in the cerebral hemisphere with predominantly peripheral irregular areas of contrast enhancement as detailed. Appearance almost certainly represent a multifocal glioblastoma.

Case Discussion

The patient went on to have a biopsy.

Histology

MICROSCOPIC DESCRIPTION:

Paraffin sections show cores of a densely hypercellular astrocytic glioma. Tumour cells show marked nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There are foci of microvascular proliferation with multilayering of atypical cells around vessel lumena. There is also a small focus of necrosis.

IMMUNOHISTOCHEMISTRY:

  • GFAP positive
  • Nestin positive (high)
  • IDH-1 R132H negative (wildtype - not mutated)
  • ATRX positive (not mutated)
  • MGMT negative (likely methylated)
  • p53 positive
  • p16 focally positive
  • Topoisomerase labelling index: approximately 30%. 

FINAL DIAGNOSIS: Multifocal glioblastoma multiforme (WHO Grade IV).

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Case Information

rID: 38127
Case created: 7th Jul 2015
Last edited: 1st Mar 2017
Inclusion in quiz mode: Included

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