PMC3870073_01
Preoperative MR imaging. (a) Axial T1-weighted image with contrast at the level of the cerebellum showing an enhancing mass in the right cerebellar hemisphere measuring 2.9 cm x 2.4 cm. (b) Axial T1-weighted image with contrast at the level of the lateral ventricles demonstrating an enhancing lesion in the right posterior periventricular region measuring 1.0 cm x 1.4 cm.
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Subsequent magnetic resonance (MR) imaging of the brain with and without contrast revealed enhancing masses in the right cerebellum measuring 2.9 cm x 2.4 cm and in the right posterior periventricular region measuring 1.0 cm x 1.4 cm as well as subtle areas of abnormal enhancement adjacent to the temporal horn of the right lateral ventricle (Figure 1).
Photomicrographs displaying pathognomonic histopathological features of glioblastoma. (a) Microvascular proliferation with endothelial layer hyperplasia. (b) Areas of geographic necrosis are present. (c) Microscopic examination reveals a hypercellular neoplasm with large, hyperchromatic, pleomorphic cells with cerebellar granular layer cells on the left. (d) Mitotic figures are readily identified in a background of pleomorphic, hyperchromatic neoplastic cells. H&E; original magnification x10 (a), x10 (b), x10 (c), and x40 (d).
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Final histopathology was consistent with glioblastoma (Figure 2).
Photomicrograph demonstrating results of GFAP immunohistochemical staining. The neoplastic cells are strongly positive for GFAP immunostain. Original magnification x40.
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Glial fibrillary acidic protein (GFAP) was strongly positive in the tumor cells (Figure 3).
Postoperative MR imaging. (a) Axial T1-weighted image with contrast at the level of the cerebellum displaying subtotal resection of the tumor within the right cerebellar hemisphere. (b) Axial T1-weighted image with contrast at the level of the Sylvian fissures showing leptomeningeal enhancement. (c) Axial FLAIR image above the tentorium revealing diffuse FLAIR signal abnormality within bilateral cerebral hemispheres.
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Postoperative MR imaging showed leptomeningeal enhancement within the Sylvian fissures and diffuse FLAIR signal abnormality within bilateral cerebral hemispheres (Figure 4).
Gross autopsy image. A coronal section of the brain showing two grossly distinct, hemorrhagic lesions adjacent to the occipital horn of the right lateral ventricle associated with ventricular compression.
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In particular, two grossly separate lesions were present within the right hemisphere of the cerebrum, adjacent to the occipital horn of the right lateral ventricle, which were microscopically connected by infiltrating tumor cells and were consistent with GBM (Figure 5).