Glioblastoma - recurrent
Intractable seizure and history of craniotomy one year ago.
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There is a heterogeneous avidly enhancing mass lesion with areas of restriction on DWI images and adjacent vasogenic edematous changes involving the right parieto-occipital lobes.
Invasion of the mass to the body and splenium of corpus callosum with midline crossing, trigone, occipital horn and choroid plexus of the right lateral ventricle also are seen.
In SVS-144 on the lesion involving the splenium of the corpus callosum, NAA, and Cr peaks is markedly decreased and Cho peak is markedly elevated with the Cho/NAA and Cho/Cr ratios of 5.90 and 4.52 respectively.
The patient underwent brain tumor surgery one year ago.
Sections show a neoplasm with dense cellularity, moderate pleomorphism, zones of coagulative necrosis lined by palisading tumor cells. Prominent vascular endothelial proliferation is noted.
Final diagnosis: Glioblastoma WHO grade IV.
The patient was referred with a flare-up of symptoms such as intractable seizure and headache.
Based above imaging findings, recurrence of the known brain tumor is considered most likely.