Glioblastoma IDH wild-type (unusual)
The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION: Sections show fragments of a markedly hypercellular astrocytic glioma. Tumor cells show marked nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is prominent microvascular proliferation with multi-layering of atypical cells around vessel lumena. Extensive areas of palisaded tumor necrosis are also present.
Immunohistochemistry results show tumor cells stain:
- GFAP: Positive
- Nestin: Positive (high)
- NogoA: Negative
- IDH-1 R132H: Negative (non-mutated)
- ATRX: Positive (non-mutated)
- MGMT: Negative (likely methylated)
- p53: Positive
- p16 CDKN2A: Positive
- Topoisomerase labeling index: 20%.
- BRAF: No mutation detected.
Conclusion: Histologically the differential diagnoses include glioblastoma and anaplastic pleomorphic xanthoastrocytoma, however, the absence of a BRAF mutation strongly favors glioblastoma.
FINAL DIAGNOSIS: IDH-1 wild type Glioblastoma (WHO Grade IV).
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