Glioblastoma Multiforme

Unknown Brain Case 2

Presentation

50 y/o man with recent onset of seizures.

• Spin-density axial image
• T2-weighted axial image
• T1-weighted axial image
• T1-weighted axial image with Gad
• T1-weighted coronal image with Gad

Image Findings

One large, and a second small, primarily peripheral enhancing masses are noted with considerable surrounding edema in the left cerebral hemisphere.

Differential Diagnosis

• Brain abcess
• Metastasis
• Other primary brain tumor

Discussion

Forty to fifty percent of primary brain tumors are gliomas of which 50% are glioblastomas. Glioblastomas occur most commonly in the fifth through seventh decades. They usually develop in the cerebral hemispheres, most often the frontal lobes. Glioblastomas grow as an irregular mass in the white matter and is frequently seen to cross the corpus callosum to the opposite side yielding a "butterfly" appearance.
MRI is useful in evaluating tumor extension and the presence of hemorrhage. Gadolinium enhancement is almost always present and usually appears ring-like around the tumor with thick, irregular walls. Enhanced MRI may also help distinguish tumor from surrounding edema. The prognosis is poor. Mean survival length after diagnosis is 8-10 months with less than 10% survival after 2 years.