PMC8720425_01
(a and b) Preoperative axial and sagittal T1 post contrast showing ring enhancing necrotic lesion in the right posterior temporal lobe. (c) Coronal FLAIR post-contrast showing central necrotic material. (d and e) T1 post-contrast axial and sagittal images showing gross total resection. (f) Coronal FLAIR post contrast image.
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F1
Due to her symptoms and the suspicion this lesion was neoplastic, she underwent a right temporal lobectomy and gross total resection of the lesion [Figure 1].
Histopathology from first surgery showing, (a) highly anaplastic glial cells with nuclear atypia and pleomorphism, microvascular proliferation and necrosis (b) GFAP positive, (c) IDH negative (d) ATRX retention (e) p53 positivity and (f) high Ki-67.
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F2
The histopathology report indicated the lesion was a glioblastoma (WHO Grade IV) and p53 positive [Figure 2].
(a-c) Postoperative MRI Brain at 6 months post-surgery showing no evidence of disease recurrence. The patient had received CCRT prior. (d-f) MRI Brain with contrast after symptom development. (d and e) T1 post-contrast axial and sagittal images demonstrating an extra-axial CPA lesion (red arrow) with extension into the internal acoustic meatus. (f) FLAIR coronal post contrast imaging demonstrating extent to the foramen magnum.
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F3
She had surveillance MRI scans which showed no disease progression at the primary site [Figure 3a-c]. MRI of the brain with contrast in this admission showed an extra-axial, abnormal signal intensity lesion in the left CPA [Figure 3d-f].
Photomicrograph from second surgery demonstrating highly anaplastic glial cells with nuclear atypia and microvascular proliferation and areas of necrosis.
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F4
Final histopathology report showed a high-grade glial neoplasm with features favoring glioblastoma (WHO Grade IV) [Figure 4].