PMC10070268_01
Skull magnetic resonance imaging (MRI). December 04, 2022. Preoperative. (a-c) Coronal axis T1 MRI, (d-f) coronal axis T2 MRI, and (g and h) coronal axis diffusion sequence.
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F1
On arrival at our institution, magnetic resonance imaging image studies were performed [Figure 1], revealing an intra-axial mass with poorly defined, heterogeneous borders and thick borders with perilesional edema in the left parietal lobe, as well as a rounded hypodense image with well-defined walls in the right internal capsule.
Histopathological findings of the resected tumor. A left frontoparietal lesion with a grayish-brown, hemorrhagic appearance is observed. (a and b) Hematoxylin and eosin staining reveal giant cells (* - ) with an infiltrative growth pattern, nuclear atypia, mitotic activity, and microvascular proliferation. (c and d) Immunohistochemical staining is positive for isocitrate dehydrogenase wild type and negative for ATRX. Original magnifications: (a and c) x200; (b and d) x1000.
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F2
Samples from the resected tumor were sent to the pathology department, which confirmed the diagnosis of wild-type glioblastoma [Figure 2].
Skull magnetic resonance imaging (MRI). December 15, 2022. Postoperative. (a and b) Coronal axis T2 MRI sequence. Post-surgical changes are observed in the left frontotemporal region, with a well-defined post-surgical space present in 90% of resections. In addition, the right thalamic lesion is larger in size and is compressing the lateral ventricle of the same hemisphere.
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F3
Postoperative imaging studies were conducted [Figures 3 and 4], however, due to the patient's deteriorating alertness and persistent headaches that did not respond to medication, a second surgery was scheduled.
Skull magnetic resonance imaging (MRI), January 09, 2023, postoperative. Axial axis T2 MRI sequence (a-d) and sagittal axis T2 MRI sequence (e-g) show a right thalamic lesion beginning to invade the pons from the midbrain and extending to the corpus callosum, with perilesional edema covering much of the frontal lobe. In addition, a larger area of hyperintensity is observed in the right parietal cortical lesion. The left frontoparietal post-surgical space is well-demarcated.
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F4
Postoperative imaging studies were conducted [Figures 3 and 4], however, due to the patient's deteriorating alertness and persistent headaches that did not respond to medication, a second surgery was scheduled.