PMC6882932_01
CT head pre- and post-corticosteroid therapy. (A,B) Initial CT head pre-corticosteroid therapy revealed a large hypodense lesion in the right parietal lobe with vasogenic edema. (C,D) Repeat CT head 4 weeks after post-corticosteroid therapy revealed a decrease in vasogenic edema and apparent size of the lesion.
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Computed tomography (CT) scan demonstrated a large hypodense lesion in the right parietal lobe suspicious for neoplasm (Figures 1A,B). Repeat CT compared to 4 weeks prior demonstrated a dramatic reduction in vasogenic edema and apparent size of the lesion (Figures 1C,D).
MRI of the brain pre- and post-corticosteroid therapy. (A) Initial T1-weighted imaging without evidence of subacute hemorrhage. (B-D) Initial MRI MP-RAGE sequences of the brain pre-corticosteroid therapy demonstrated a thick-walled peripherally enhancing lesion of the right parietal lobe with central necrosis and extensive surrounding vasogenic edema. (E) Initial gradient echo sequence without evidence of subacute hemorrhage. (F) Repeat T1-weighted imaging without evidence of subacute hemorrhage. (G-I) Repeat MRI MP-RAGE sequences of the brain 5 weeks after post-corticosteroid therapy demonstrated reduction in contrast enhancement, vasogenic edema, and apparent size of the lesion. (J) Repeat gradient echo sequence without evidence of subacute hemorrhage.
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Subsequently, MRI revealed a heterogeneous thick-walled peripherally enhancing lesion of the right parietal lobe with central necrosis and an extensive degree of surrounding vasogenic edema (Figures 2A-E). Repeat MRI compared to 5 weeks prior revealed a dramatic reduction in contrast enhancement, vasogenic edema, and apparent size of the lesion (Figures 2F-J).
Histopathology demonstrating pleomorphic glial cells, nuclear atypia, palisading necrosis, mitoses, and vascular proliferation consistent with a diagnosis of glioblastoma. (A,B) Palisading necrosis at 4x and 10x magnification, respectively. (C) Mitoses at 40x magnification. (D) Vascular proliferation at 10x magnification.
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Biopsy samples were sent as frozen sections to surgical pathology, which revealed pleomorphic glial cells, nuclear atypia, microvascular proliferation, and palisading necrosis consistent with a diagnosis of glioblastoma (Figure 3).
Post-operative imaging. (A,B) Post-operative CT Head demonstrated expected post-operative changes without evidence of acute pathology.
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Post-operative imaging was unrevealing for acute intracranial pathology (Figure 4).