Presentation
'Turn' while bike riding with left sided seizure. Now resolved.
Patient Data
Swelling of right frontal posterior cingulate gyrus with T2/FLAIR hyperintensity centered on cortical and subcortical region. A small focus of restricted diffusion. No definite enhancement.
Progress to typical GBM. Heterogeneous mainly marginal enhancement is noted with central necrotic region. Mild perifocal edema is noted at the right frontoparietal region. Indentation of the falx cerebri with focal bowing to the left side.
Case Discussion
Histology
Microscopy: Diffusely infiltrating malignant glioma with a small cell astrocytic phenotype. There are frequent mitoses, evidence of vascular proliferation and focal necrosis, including palisaded necrosis.
Immunohistochemistry:
- GFAP: positive
- IDH1-R132H mutation: negative
- P53: only focal abnormal nuclear staining
Summary: Glioblastoma (WHO grade IV)
On imaging, restricted diffusion and enhancement, indicating this is an aggressive tumor.
Note
In a 45-year-old, this tumor has not been fully classified thus remains a "Glioblastoma NOS" according to WHO classification. It requires IDH 1 and 2 sequencing to evaluate for non R132H and IDH2 mutations before being called an IDH-wt tumor.
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