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
From the case:
Multifocal glioblastoma - IDH wild-type
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- 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.