The radiological imaging features of easily misdiagnosed epithelioid glioblastoma in seven patients.

The radiological imaging features of easily misdiagnosed epithelioid glioblastoma in seven patients.

World Neurosurg. 2019 Jan 03;:

Authors: Huang QL, Cao X, Chai X, Wang X, Xiao C, Wang J

Abstract
BACKGROUND: Epithelioid glioblastoma(eGBM) as a newly revised subtype of glioblastoma which is much less frequently found in other types of glioblastomas, and mainly focused on case reports and childrens.We collect seven cases confirmed by molecular disgnosis.In the study,we review the radiological imaging features of seven adult patients with epithelioid glioblastoma(eGBM) and histopathological findings.
CASE DESCRIPTION: Patients with a diagnosis of eGBM on brain tissue specimen were retrospectively confirmed by pathology. The tumor MRI characteristics of locations, number, necrosis, edema, enhancement, diffusion weighted image(DWI),values of apparent diffusion coefficient (ADC), magnetic resonance spectroscopy(MRS), dynamic susceptibility contrast-perfusion weighted imaging(DSC-PWI),and histopathological findings were documented.Seven patients are all adults.The tumors with iso-hyperintensive signal on T2 weighted image(T2WI)，and iso-hypointensive signal on T1 weighted image(T1WI). DWI displayed iso-hypointensive signal，two cases restricted significantly（2/7）.Peritumoral edema in all cases was mild.Four cases with tumor capsule(4/7),two cases with multifocus(2/7),one case with bleeding(1/7).Five cases located in cortical lobe(5/7),one in ventricle,one in thalamus and cerebral cortex.Four cases with matter collapse sign(4/7). These tumors with obvious enhancement after contrast injection,two cases with dura mater tail sign(2/7).Mean value of ADC is 1.09×10-3mm2/s. Mean value of rCBV in three cases is 2.84×10-3mm2/s on DSC-PWI. Mean value of CHo/NAA ratio in four cases is 6.47×10-3mm2/s on MRS. All cases expressed a BRAF V600E mutation by molecular characteristics.
CONCLUSION: EGBM predominantly located in cortex，encapsular and mild peritumoral edema are easily misdiagnosed as cortex-involved intracranial brain tumor such as meningiomas，multifocal tumors easily misdiagnosed as metastatic tumor and lymphoma. Multimodal images were helpful for the differential diagnosis.

PMID: 30611946 [PubMed - as supplied by publisher]

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