Multifocal glioblastoma - IDH wild-type

Case contributed by Bálint Botz


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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