The patient went on to have emergency surgery without preoperative MRI.
Histology
MICROSCOPIC DESCRIPTION: The sections show features of a moderately cellular astrocytic tumour. Most of the tumour cells are astrocytic. They have elongated, angulated and pleomorphic nuclei. A second very minor population of neoplastic oligodendroglial cells is also present. These cells have round nuclei and perinuclear haloes. Scattered mitotic figures are identified. There are foci of microvascular proliferation. Areas of necrosis with focal palisading are present. There are perivascular lymphocytes.
The tumour cells are focally p53 positive. IDH-1 and MGMT immunostains are negative (likely methylated). There is no loss of staining for ATRX. The topoisomerase index is about 15%.
FINAL DIAGNOSIS: Glioblastoma with oligodendroglioma component (WHO Grade IV).
Following surgery, the patient had a post-op MRI and was commenced on Stupp protocol combined chemoradiotherapy.