Extensive intraventricular glioblastoma mimicking intracranial lymphoma

Excerpt

A 20-year-old right-handed male patient experienced a modified state of consciousness, nausea, headaches, and vomiting for 2 weeks. On examination, he had bilateral papilloedema without any other neurological deficits. Lumbar puncture yielded cerebrospinal fluid (CSF) with an opening pressure of 320 mmH₂O, 21 mononuclear cells/mm³, a protein level of 58,180 mg/L, and a glucose level of 0.8 mmol/L. Cytology for malignancy and multiple cultures was negative. Magnetic resonance imaging (MRI) showed extensive thickening and marked enhancement of the walls of the ventricles and meninges (Fig. 1a–d). An endoscopic ventriculostomy and an endoscopic cancer biopsy were carried out for the primary treatment to determine the histological diagnosis. Occasional mitosis of 4/10 high power fields was evident (Fig. 1e). Immunohistochemistry demonstrated that the cancer was negative for IDH1 (R132H), and that ATRX was not expressed. p53 was not nuclear positive, and H3K27M was negative. GFAP immunohistochemistry revealed a strong positive result (Fig. 1f). Immunohistochemistry revealed a high level of Ki-67, with 50 to 80% nuclear staining (Fig. 1g). On the histopathological portion, a serpentine sequence of necrosis and neighboring hypercellularity was available, as well as the typical pseudo-palisading sequence seen in glioblastoma (GBM) (Fig. 1h). GBM, IDH1 (R132H) negative, WHO Grade 4 were diagnosed. During the first 2 days after surgery, he was in status epilepticus and died about a month later as a result of the development of his illness.

…