PMC9891834_01
Axial plain CT (a) and contrast-enhanced MRI (b) at the level of the petrous ridges. (a) CT visualizes the osseous destruction of the right petrous ridge (arrow). (b) Contrast-enhanced T1-weighted MRI discloses infiltration of the GBM into the mastoid cells of the right temporal bone (arrow).
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The cranial computed tomography (CCT) on admission disclosed a right temporal mass lesion with perifocal edema and lytic changes of the adjacent petrous bone (Figure 1(a)), indicative of tumorous infiltration. Corresponding to the lytic bone changes seen on CCT, there was an extension of contrast-enhancing tumor components into the mastoid cells on contrast-enhanced magnetic resonance imaging (MRI; Figure 1(b)).
Axial, contrast-enhanced MR images at the middle cranial fossa level. (a) FLAIR and (b) T1-weighted images demonstrate an irregular enhancing mass lesion with central areas of necrosis within the right temporal lobe.
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MRI otherwise revealed an enhancing, cystic necrotic tumor, showing marked perifocal edema within the right temporal lobe (Figures 2(a) and 2(b)).
(a) HE staining showing a malignant glial tumor with histomorphological features of a glioblastoma, IDH wild-type (CNS WHO Grade 4). Black arrow: palisading necrosis. White arrows: microvascular proliferation. (b) The tumor shows areas with close association to fragments of the dura (black arrow) and bone (white arrow) (HE staining). (c) GFAP immunohistochemistry confirms the glial tumor cells. (d) No IDH1 mutation (R132H); inset in (d) on slide positive control. (e) Ki67 immunostaining highlights increased proliferation activity.
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