The patient went on to have a biopsy.
Histology
MICROSCOPIC DESCRIPTION:
Sections show a hypercellular tumour composed of sheets and rosette-like structures. There is focal microvascular proliferation and pallisaded tumour cell necrosis. Tumour cells contain fibrillary eosinophilic cytoplasm, pleomorphic hyperchromatic nuclei with intranuclear cytoplasmic inclusions and inconspicuous nucleoli. Numerous large, multinucleated tumour cells with prominent intranuclear cytoplasmic inclusions are present. Frequent mitoses are observed (up to 12 per 10hpf).
Immunohistochemical results:
- GFAP Positive
- Nestin Positive (high)
- IDH-1 R132H Negative (not mutated)
- ATRX Positive (not mutated)
- MGMT Negative (likely methylated)
- p53 Positive (strong)
- p16 CDKN2A Positive
- Topoisomerase labelling index: Approximately 30%.
FINAL DIAGNOSIS: IDH-1 wild-type (negative) gigantocellular glioblastoma, WHO grade IV.
Treatment
The patient was commenced on Stupp protocol (chemotherapy and radiotherapy).