Multifocal glioblastoma - IDH wild-type

Case contributed by Dr Balint Botz

Presentation

Right sided progressive limb weakness and motor aphasia. Stat CECT acquired in referring center showed multiple enhancing left frontal massess. Metastases?

Patient Data

Age: 80 years
Gender: Female
  • Large area of vasogenic edema in the left frontal lobe, but also affecting the parafalcine right frontal cortex and the left basal ganglia. 
  • Embedded within the edema multiple partially cystic expansile lesions are visible, showing irregular rim enhancement with central necrotic core, and irregular calcifications and/or internal hemorrhagic foci. 
  • Midline shift to the right with compression of the frontal horns of the lateral ventricles. 
  • Small superficial, circumscribed, enhancing lesion adjacent to the left internal acoustic meatus. 
  • On the right side of the sphenoid sinus a circumscribed cytic lesion is visible showing low T2 and high intrinsic T1 signal on noncontrast acquisitions coupled with thin peripheral enhancement post contrast. 
  • A few scattered small SWI blooming foci indicative of prior microbleeds. 
  • Calcifications in the bilateral basal ganglia in line with Fahr syndrome. 

Case Discussion

The pattern of the tumors is characteristic for multifocal GBM as the lesions are embedded within a continous perifocal edema. 

The lesion close to the left CPA is possibly representing a leptomeningeal drop metastasis or atypical meningioma, though its small size prevents confident characterization. 

The sphenoid sinus lesion likely represents protein-rich mucocele.

Stereotactic biopsy and subsequent histopathology confirmed IDH wild-type glioblastoma. 

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Case information

rID: 84527
Published: 9th Jan 2021
Last edited: 10th Jan 2021
Inclusion in quiz mode: Included
Institution: University of Pécs

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