Case 069

History/Physical

History/Physical:

74-year-old left-handed male.

Focal seizure right arm.

A heterogeneously-enhancing mass is present in the posterior left frontal lobe (*). Mass effect is mild.

At this level, the mass extends to the overlying dura, which is thickened (arrows). It is difficult to determine whether it is intra- or extra-axial.

Diagnosis: Glioblastoma (“gliosarcoma” phenotype)

Variegated lesion with chondroid areas (upper left) as well as other diffuse fibrillary patterns (lower right).

Increased mitotic activity.

Marked nuclear pleomorphism.

The tumour contains regions of restricted GFAP expression that emphasize glial vs. mesenchymal morphologies.

Widespread expression of vimentin is present, independent of regional mophology.
Nuclear expression of ATRX was retained and IDH-1(R132H) mutation was not present (not shown). Molecular studies confirmed IDH-wildtype status and a TERT promoter mutation.