Answer of February 2011

Clinical History:

A 60-year-old lady presented with headache. CT brain showed acute haematoma within the R frontal horn. Patient also had hydrocephalus, a ventriculoperitoneal shunt was inserted. MRI was performed.

                               Flair                                                            Hemo

                              T1                                                                  T2

                              T1+C

Diagnosis:

Glioblastoma multiforme

Discussion:

MRI images show an intraventricular lesion in the right frontal-horn, which is hyperintense on T1WI and T2WI, compatible with a subacute haematoma. Haemosiderin rim demonstrated blooming on hemo/gradient echo sequence. There is an enhancing irregular mass lesion in the adjacent frontal white matter which crosses the midline to involve the genu of the corpus callosum. The differential diagnosis of midline mass lesions involving the corpus callosum include glioblastoma multiforme, lymphoma and metastasis. Other pathologies that can also involve the corpus callosum include vascular malformation, multiple sclerosis and progressive multifocal leukoencephalopathy. The definite diagnosis of this patient was glioblastoma multiforme.

Glioblastoma multiforme is an aggressive tumor, it is the most common primary brain tumor in adults, accounting for 25% of all cases. It is also the most common tumor to involve the corpus callosum. Bihemispheric involvement by glioblastoma can result in a classical butterfly pattern. On MR imaging, these tumors typically show intense contrast enhancement.

The MRI images also showed diffuse leptomeningeal metastasis with hyperintensity on FLAIR and enhancement on T1+C images.