Intraventricular glioblastoma multiforme with previous history of intracerebral hemorrhage : a case report

Abstract

GBM is the most common primary brain tumor, but intraventricular GBM is rare and only few cases have been reported in the literature. The authors report a case of 64-year-old man who had a remote history of previous periventricular intracerebral hemorrhage. Brain computed tomography (CT) and magnetic resonance (MR) imaging showed an intraventricular lesion with inhomogeneous enhancement, infiltrative borders and necrotic cyst, and obstructive hydrocephalus. The patient underwent surgical removal through transcortical route via the bottom of previous hemorrhage site and the final pathologic diagnosis was GBM. We present a rare case of an intraventricular GBM with detailed clinical course, radiological findings, and pathological findings, and the possible origin of this lesion is discussed.

Keywords: Glioblastoma multiforme; Intracerebral hemorrhage; Intraventricular tumor; Obstructive hydrocephalus.

Fig. 1

Brain magnetic resonance (MR) images of previous intracerebral hemorrhage on the first admission (3 years before tumor operation). T1 weighted axial (A), T2-weighted axial (B) and T1-weighted sagittal(C) MR images show early subacute stage of intracranial hemorrhage (7 days after initial hemorrhage). Note there is neither a mass lesion nor a signal change except for minimal C edema caused by hemorrhage.

Fig. 2

Initial brain computed tomography scan on the second admission demonstrates a large ventricle and an intraventricular lesion with periventricular edema.

Fig. 3

Preoperative (A, B, C) and postoperative (D) magnetic resonance (MR) images on the second admission. T1-weighed Gd-enhanced MR image reveals an enhancing huge intraventricular mass. Axial (A) and coronal (B) images show that the heterogenously rim-enhancing mass is located from the medial occipital periventricular area to septum pellucidum. Note the relationship between previous hemorrhage site and tumor on sagittal image (C). The mass was near-totally removed on postoperative Gd-enhanced sagittal image (D).

Fig. 4

Microscopic findings confirming glioblastoma multiforme. Necrosis with the pseudopalisading pattern of malignant nuclei and endothelial cell proliferation (A:×100). A strong positive glioblastoma multiforme (GFAP) stain is noted (B:GFAP,×400).