0:00

So, this is a very typical scenario

0:03

we see in clinical practice

0:05

where you have a patient,

0:08

74-year-old male, presenting with

0:12

cognitive decline going on for the last 2 months

0:15

and memory loss,

0:17

as well as some speech difficulties.

0:20

In MRI brain, as you can see,

0:23

we have different sequences,

0:25

FLAIR T2 post-contrast,

0:27

showing you a very ugly necrotic enhancing mass

0:33

with a lot of swelling and edema

0:37

in the right cerebral hemisphere

0:39

and also has some areas of

0:42

respective diffusion in the solid part.

0:45

And if I have to show you the perfusion maps,

0:48

it's very vascular.

0:49

You can see the blood volume is

0:52

markedly increased

0:53

in the solid enhancing part of the tumor,

0:57

even over here.

0:59

One of the things I struggle with is

1:01

trying to exactly localize where this

1:03

enhancing necrotic mass is,

1:05

just based on the axial images,

1:08

and that's where I would suggest

1:11

that everybody should look at the sagittal

1:13

reconstructed images,

1:16

and that's...

1:16

those are very helpful to decide.

1:18

For example,

1:20

based on this information I got from the sagittal images,

1:23

you can see that this tumor

1:25

is actually in the temporal lobe only.

1:28

It's not involving the frontal lobe,

1:31

probably going a little bit into the insula over here,

1:35

but definitely not involving the frontal lobe.

1:38

All the edema and swelling is in the temporal lobe.

1:41

And this is what we typically see with

1:44

primary de novo GBMs.

1:47

The reason I would like to call this a primary de novo GBM

1:51

IDH wild-type is because of the age,

1:54

more than 40 years.

1:56

This patient is 75

1:57

and presenting with subsequent neurological deficit.

2:01

Now, we also know that these tumors

2:04

are really bad tumors to have

2:06

and this is what happens.

2:08

This is a scan done a year and a half.

2:11

I'm not showing you all the follow-ups.

2:14

This patient did

2:15

undergo all the therapy regimens available,

2:18

including surgery, initial debulking

2:21

followed by a standard Stupp regimen,

2:24

and even a vast and therapy for the recurrent tumor.

2:28

But you can see

2:29

you know

2:30

the tumor is clearly increasing in size.

2:34

It is progressive

2:36

and this unfortunate patient ended up dying

2:39

after 20 months of the initial diagnosis.

Case: Primary IDH-Wildtype Glioma

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0:00

So, this is a very typical scenario

0:03

we see in clinical practice

0:05

where you have a patient,

0:08

74-year-old male, presenting with

0:12

cognitive decline going on for the last 2 months

0:15

and memory loss,

0:17

as well as some speech difficulties.

0:20

In MRI brain, as you can see,

0:23

we have different sequences,

0:25

FLAIR T2 post-contrast,

0:27

showing you a very ugly necrotic enhancing mass

0:33

with a lot of swelling and edema

0:37

in the right cerebral hemisphere

0:39

and also has some areas of

0:42

respective diffusion in the solid part.

0:45

And if I have to show you the perfusion maps,

0:48

it's very vascular.

0:49

You can see the blood volume is

0:52

markedly increased

0:53

in the solid enhancing part of the tumor,

0:57

even over here.

0:59

One of the things I struggle with is

1:01

trying to exactly localize where this

1:03

enhancing necrotic mass is,

1:05

just based on the axial images,

1:08

and that's where I would suggest

1:11

that everybody should look at the sagittal

1:13

reconstructed images,

1:16

and that's...

1:16

those are very helpful to decide.

1:18

For example,

1:20

based on this information I got from the sagittal images,

1:23

you can see that this tumor

1:25

is actually in the temporal lobe only.

1:28

It's not involving the frontal lobe,

1:31

probably going a little bit into the insula over here,

1:35

but definitely not involving the frontal lobe.

1:38

All the edema and swelling is in the temporal lobe.

1:41

And this is what we typically see with

1:44

primary de novo GBMs.

1:47

The reason I would like to call this a primary de novo GBM

1:51

IDH wild-type is because of the age,

1:54

more than 40 years.

1:56

This patient is 75

1:57

and presenting with subsequent neurological deficit.

2:01

Now, we also know that these tumors

2:04

are really bad tumors to have

2:06

and this is what happens.

2:08

This is a scan done a year and a half.

2:11

I'm not showing you all the follow-ups.

2:14

This patient did

2:15

undergo all the therapy regimens available,

2:18

including surgery, initial debulking

2:21

followed by a standard Stupp regimen,

2:24

and even a vast and therapy for the recurrent tumor.

2:28

But you can see

2:29

you know

2:30

the tumor is clearly increasing in size.

2:34

It is progressive

2:36

and this unfortunate patient ended up dying

2:39

after 20 months of the initial diagnosis.

Report

Faculty

Rajan Jain, MD

Professor of Radiology and Neurosurgery

New York University Grossman School of Medicine

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Case: Primary IDH-Wildtype Glioma