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21 November 2013 - Case of the Week #292
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Thanks to Dr. Mohammed Sami Saeed, University of Mosul (Iraq) for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
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Case of the Week #292
A 17 year old boy presented with a solid and cystic frontal brain mass, which was biopsied.
What is your diagnosis?
Glioblastoma, giant cell type
The microscopic images show an infiltrative cellular astrocytic tumor with prominent pleomorphic, hyperchromatic, multinucleated malignant giant and bizarre cells associated with frequent mitoses, many of which are atypical, in a fibrillary background. Microvascular endothelial proliferation and large foci of palisading tumor necrosis are easily identified. The tumor cells are immunoreactive for GFAP.
Giant cell glioblastoma is an relatively uncommon subtype of glioblastoma multiforme (5% of cases), that typically affects somewhat younger patients than the classic type (mean 51 years versus 62 years), and has a better prognosis. Grossly, there is a circumscribed, firm, often subcortical mass. Microscopically, as in this case, there are abundant, bizarre-appearing tumor giant cells, many multinucleated. There are also smaller fusiform cells, extensive necrosis, brisk mitotic activity and occasional perivascular lymphocyte cuffing. p53 mutations are identified in 75-90% and EGFR amplification is rare (Cancer Genet Cytogenet 2007;175:26).
The differential diagnosis includes pleomorphic astrocytoma, which also has pleomorphic cells and perivascular lymphocytic cuffing. However, typically there is no necrosis and no mitotic activity, except in tumors with components of anaplastic features.
Recommended treatment is complete resection with possible adjuvant radiotherapy (Neuro Oncol 2009;11:833).
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com