Case 019

History/Physical

History/Physical:

49-year-old right-handed female.

Headache progressive over the past four months.

Progressive right hemianopsia.

There is a fairly well-defined lesion in the right frontal lobe (*).

There is a thick rim of enhancement which is slightly irregular (arrow). There is also patchy enhancement superiorly (arrowhead).

In addition to the right frontal mass (*), there is an unusual solid/cystic lesion in the medial left parietal and occipital lobe (arrowheads).

Diagnosis: Glioblastoma, IDH-wildtype

Hypercellular with foci of necrosis (*), adjacent pseudopalisades (arrowhead) and endothelial hyperplasia (arrow).

Marked pleomorphism and mitotic activity (arrow).

Nuclear over-expression of P53 (suggesting mutation).

High proliferative index (nuclear Ki67 expression).

Abundant GFAP expression.

Nuclear ATRX expression is retained (wild-type).

No evidence of IDH-1 (R132H) mutation (or other IDH1 or IDH2 mutations by molecular analysis).
TERT promoter mutation and +7/-10 chromosome copy-number alterations were identified.