The patient went on to have a resection.
Histology
MICROSCOPIC DESCRIPTION: Sections show a hypercellular tumour composed of sheets of tumour cells with extensive areas of palisaded tumour necrosis. There is focal microvascular proliferation with multilayering of atypical cells around vessel lumena. Tumour cells contain abundant eosinophilic cytoplasm, oval angulated nuclei with coarsely granular chromatin and small nucleoli. Frequent mitoses are observed.
Immunohistochemistry:
- GFAP Positive
- Nestin Positive (high)
- IDH-1 R132H Negative (not mutated)
- ATRX Positive (not mutated)
- MGMT Negative (likely methylated)
- p53 Positive
- p16 CDKN2A Positive
- Topoisomerase labelling index: Approximately 20%.
The features are of glioblastoma, IDH wildtype (WHO CNS grade 4).
Management
An immediate post-op scan (not shown) demonstrated complete resection of the enhancing component. The patient went on to receive routine Stupp protocol (radiotherapy and temozolomide).
Follow-up scanning (not shown) showed a small amount of developing enhancement at ~10 weeks post-surgery.