PMC4392545_01
Epithelioid glioblastoma. (a) Noncontrast head CT shows a large parenchymal hemorrhage centered in the left temporal lobe and significant mass effect on surrounding brain, including left uncal herniation. Brain MRI with (b) T2 FSE, (c) T2 FLAIR, (d) GRE, (e) pre- and (f) post-contrast T1 FSE images demonstrates a lobulated enhancing hemorrhagic mass in the left anterior temporal lobe attached by a stalk to the left insula, moderate surrounding edema, and central vascular flow voids from the left middle cerebral artery. Acute hemorrhage with blood-fluid levels fills mostly a thin-walled cystic space posterior to the mass in the left temporal lobe as well as a smaller region in the left inferior frontal lobe. (g) DWI and (h) ADC map show a region of reduced diffusion medial to the mass within the left insula, probably infiltrative hypercellular tumor or acute ischemia from the mass
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F1
Subfalcine and uncal herniation were also present [Figure 1a]. Acute hemorrhage posterior to the mass was also seen with blood-fluid levels filling a thin-walled cystic space in the left temporal lobe and left inferior frontal lobe [Figure 1b-h].
Diffuse sheets of markedly atypical epithelioid cells with pleomorphic nuclei are noted in a hemorrhagic background. Prominent microvascular proliferation is seen (arrows)
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F2
Recent hemorrhage was seen in the background [Figure 2].
Glial fibrillary acidic protein immunohistochemical stain reveals cytoplasmic positivity in tumor cells
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F3
Immunohistochemically, the tumor cells were positive for glial fibrillary acidic protein (GFAP) [Figure 3] and S-100 protein.