Recurrent glioblastoma multiform

Case contributed by Dr Bahman Rasuli

Presentation

Brain tumor surgery six months ago followed by thirty sessions of radiotherapy. Now complains of headache and vomiting.

Patient Data

Age: 35 years
Gender: Male
MRI

First brain MRI six months after surgery

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.

MRI

The secound brain MRI a month later due to aggravating of clinical symtoms

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 multiform, WHO grade IV.

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Case information

rID: 84537
Published: 28th Nov 2020
Last edited: 28th Nov 2020
Inclusion in quiz mode: Included
Institution: Jame Jam Imaging Center

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