Presentation
Brain tumor surgery six months ago followed by thirty sessions of radiotherapy. Now complains of headache and vomiting.
Patient Data
Right temporoparietal craniotomy
Right parietotemporal heterogeneous intra-axial mass with thick irregular rim enhancement ( 50*70 mm) associated with vasogenic edema, mild mass-effect upon the occipital horn of the lateral ventricle, and midline shift measuring about 7 mm.
Right parietotemporal heterogeneous thick irregular rim enhancing intra-axial mass measuring about 60*80 mm associated with marked vasogenic edematous changes, mass effect upon the occipital horn of the lateral ventricle, and midline shift measuring about 13 mm.
Enlargement of right parietotemporal mentioned mass (60*80 mm) associated with stellate lesions, marked vasogenic edematous changes, the mass effect upon the occipital horn of the lateral ventricle, and midline shift measuring about 13 mm.
A few enhancing masses involving the corpus callosum and contralateral cingulate gyrus due to metastasis.
Case Discussion
The mass was resected six months ago and histopathology revealed:
Microscopic examination: Sections of the brain show a cellular neoplastic tissue composed of pleomorphic cells with nuclei ranging from irregular and hyperchromatic to oval and vesicular with prominent nucleoli and eosinophilic cytoplasm admixed with large cells with eccentrically placed, abundant glassy pink cytoplasm and scare large bizarre mononucleate tumor cells in a partly fibrillary background. Some mitotic figures are identified. Toci of necrosis and areas of hemorrhage are seen.
Diagnosis: Glioblastoma NOS, WHO grade IV.
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