Freiburg Neuropathology Case Conference: Widespread Mass Lesions After Resection of a Glioblastoma Multiforme

Excerpt

An 80-year-old male patient presented with intermittent aphasia, focal seizures with speech arrest and gait disturbance. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the left temporal lobe (Fig. 1). A left temporal craniotomy was performed and a complete microsurgical resection of the lesion was achieved as demonstrated by early postoperative MRI (not shown). Neuropathological analysis revealed a glioblastoma multiforme WHO grade IV. The neurological symptoms resolved completely. The patient was treated with external beam radiation therapy (60 Gy). Four months after surgery, he presented with fatigue and reduced general condition. MRI revealed a contrast-enhancing rim around the resection cavity and a subdural hygroma with compression of the sulci of the left hemisphere (Fig. 2). He was treated with a subdural drainage for 3 days. Although the symptoms improved, computed tomography (CT) showed no resolution of the subdural effusion. The patient received four cycles of standard temozolomide chemotherapy (200 mg/m², 5/28 pattern). Eight months after the surgery, the follow-up MRI revealed multiple intra- and extraaxial contrast-enhancing mass lesions located supra- and infratentorially (Fig. 3). Meanwhile, the patient had developed a right-sided facial paresis and hearing loss, dysmetria and severe ataxia. Open biopsy was performed and an intradural, extracerebral lesion in the right parietal area was excised. The patient was transferred into palliative care. …