Multimodal MR imaging findings of a congenital glioblastoma multiforme
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LETTER TO THE EDITOR
Multimodal MR imaging findings of a congenital glioblastoma multiforme Fuldem Yildirim Donmez & Hulya Aslan & Gokcen Coban & Ozlem Ozen & Muhtesem Agildere
Received: 13 August 2012 / Accepted: 27 August 2012 / Published online: 8 September 2012 # Springer-Verlag 2012
Dear Editor: We wish to report a case of congenital glioblastoma multiforme which is a rare high-grade glial tumor, with diffusionweighted magnetic resonance images and MR spectroscopy. Published reports are mostly based on clinical, genetical, and pathological behavior of the tumor; reports of radiological appearance are relatively uncommon. The imaging in those reports most commonly involved antenatal diagnoses by ultrasound; we did not recognize any report of MRI with diffusion and spectroscopy so far. An 8-month-old female infant from North Iraq presenting with an enlarging head was admitted to our hospital. The parents stated that they were told that the head circumference was larger than normal limits at birth. No further investigation was made at that time. On her routine follow-up on the second month, a head CT was performed because of the enlarged head which revealed a supratentorial mass. The parents did not seek any treatment at that time. Six months later, the baby was seen at our hospital, with the complaint of increasing enlargement of the head circumference. On physical examination, the patient was fine, with normal reflexes and normal responses to the stimuli, except for the macrocephaly. An MRI of the brain revealed a huge mass in the right frontal and parietal lobes which contained multiple small and large cystic areas and solid components that were isointense to gray matter on both T1-weighted- (Fig. 1a) and T2-weighted images. The
F. Y. Donmez (*) : H. Aslan : G. Coban : M. Agildere Department of Radiology, Baskent University, Ankara, Turkey e-mail: [email protected] O. Ozen Department of Pathology, Baskent University, Ankara, Turkey
mass had a partially extraparenchymal appearance, especially on coronal slices (Fig. 1b). On diffusion-weighted images, the solid portions of the mass showed restricted diffusion, probably due to high cellularity (Fig. 1c). A multivoxel MR spectroscopy performed at TE 30, 135, and 270 ms depicted very high choline/creatine ratios and a significant decrease in N-acetylaspartate (NAA) (Fig. 1d). Based on the cystic and partially extraparenchymal appearance, desmoplastic infantile ganglioglioma and also astrocytoma and primitive neuroectodermal tumor (PNET) were in the differential diagnosis. The patient was operated the next day by subtotal resection of the tumor. On pathological examination, the mass contained cystic necrotic components grossly. Microscopically, a vascular solid lesion, which showed microvascular proliferation and increased mitotic activity, also included palisades and necrosis (Fig. 1e). Extensive GFAP, EMA, and p53 expression and small synaptophysin-positive areas were seen, which were all compatible with a congenital glioblastoma multiforme (WHO grade IV
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