Patient went on to have surgery
Histology:
MICROSCOPIC DESCRIPTION: Paraffin sections show fragments of a densely hypercellular glial tumour. Tumour cells have fibrillary astrocytic morphological features with moderate nuclear pleomorphism. Scattered mitotic figures are identified. There are foci of microvascular proliferation with multilayering of atypical cells around vessel lumena. Additionally, an area of confluent necrosis is identified. This incorporates thin-walled necrotic blood vessels.
IMMUNOHISTOCHEMISTRY:
- GFAP positive.
- Nestin positive (high).
- IDH-1 R132H negative (not mutated).
- ATRX negative (mutated).
- MGMT negative (likely methylated).
- p53 positive.
- p16 CDKN2A negative.
- Topisomerase labelling index: Approximately 25%.
FINAL DIAGNOSIS: IDH-1 wild type, ATRX mutated glioblastoma (WHO Grade IV).