Transcript Slide 1

Student Case Presentation
Nick Paphitis, SMD-06
University of Virginia Health
System
55yo male
• 11/06 – CC: several weeks of intermittent HA
(worse in AM), worsening dysequilibrium and
visual changes (1yr h/o clumsiness and falls,
dx’d as migraines)
– Denied vertigo, weakness, weight loss, some N/V
– PMHx – HTN, lipids
– FHX – sister w/ migraines, father w/ prostate CA,
mom w/ breast CA
– SHx – no tobacco, 1-2 drinks/night
– Meds – HCTZ, Lipitor
Hospital Course and Outcome
• Admitted to Neuro, NSGY performed craniotomy w/
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gross total resection of tumor
Path - hypercellular glial neoplasm composed of
hyperchromatic, pleomorphic astrocytes. Areas of
palisading necrosis are identified, as are regions of
geographic necrosis. Endothelial proliferation is abundant
and mitotic figures are easily seen, favor astrocytoma,
WHO Grade IV (GBM)
Post-Op uncomplicated with good improvement of
neurologic symptoms
Rad Onc – 1/3 to 2/15 along w/ temozolomide, did well,
weaned from steroids completely
F/U MRI @ Duke sched. 3/1/06
Radiographic Features and DDx
• Malignant astrocytomas are usually hypointense on T1-
weighted images. These tumors typically enhance
heterogeneously and serpiginously following contrast
infusion. There may be areas of solid contrast
enhancement within a more diffusely serpiginous
pattern, or the lesion may show a totally solid pattern of
enhancement.
• The enhancing tumor can be distinguished from the
surrounding hypointense signal of edema on T1weighted sequences. On T2-weighted sequences, the
edema is hyperintense and cannot be distinguished from
tumor.
• Midline shift, necrosis, hemorrhage w/in mass
• DDx – malignant astrocytoma, metastatic dz, PCNSL,
MS, low-grade glioma/astrocytoma, abscess
Reference: Up to Date
Recurrence? (12/19/05)