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Clinical history
64-year-old with new-onset seizures and a right temporal ring-enhancing lesion.
Specimen
Craniotomy resection · Stain: H&E and IHC
Microscopic description
Densely cellular astrocytic tumour with marked nuclear atypia, brisk mitotic activity, microvascular proliferation and palisading necrosis.
Diagnostic question
Which molecular markers are required for integrated diagnosis?
Reveal differential diagnosis
Anaplastic astrocytoma
Metastatic carcinoma
CNS lymphoma
Reveal final diagnosis
Glioblastoma, IDH-wildtype, CNS WHO grade 4
Learning points
IDH1/2 status is essential
TERT promoter, EGFR amplification and chromosome 7/10 changes support the diagnosis
MGMT promoter methylation informs treatment
Self-assessment
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All whole-slide images in this library are anonymised and used under appropriate licence. Cases are provided for education only and must not be used for clinical diagnosis.