Presentation
Remote history of lymphoma and prostate cancer. Rapidly progressive left-sided weakness.
Patient Data
Noncontrast CT brain STAT: In the right parieto-occipital deep white matter a circumscribed, markedly hypodense lesion is noted with significant local mass effect and secondary vasogenic edema. Note hypodensity extending into the corpus callosum.
Postcontrast: Irregular, predominantly peripheral hyperenhancement of the mass. Features also considering the involvement of the splenium of the corpus callosum are in line with a high grade glial spectrum tumor.
The MRI essentially reiterates CT findings, better demonstrating vasogenic edema, callosal involvement and the partially cystic and hemorrhagic composition of the tumor.
Case Discussion
Stereotactic biopsy confirmed a high-grade IDH wild-type (grade IV.) glioblastoma.
Interestingly, the callosal involvement - which is highly unusual in secondary brain tumors - was well-demonstrated even on the initial noncontrast CT. This feature (if present) can significantly narrow down the list of differential diagnoses, and is strongly suggestive of a primary malignancy.