Difficult diagnosis of brainstem glioblastoma multiforme in a woman: a case report and review of the literature

Abstract

Introduction: Brainstem gliomas are rare in adults. They most commonly occur in the pons and are most likely to be high-grade lesions. The diagnosis of a high-grade brainstem glioma is usually reached due to the presentation of rapidly progressing brainstem, cranial nerve and cerebellar symptoms. These symptoms do, however, overlap with a variety of other central nervous system disorders. Magnetic resonance imaging is the radiographic modality of choice, but can still be misleading.

Case presentation: A 48-year-old Caucasian woman presented with headache and vomiting followed by cerebellar signs and confusion. Magnetic resonance imaging findings were suggestive of a demyelinating process, but the patient failed to respond to therapy. Her condition rapidly progressed and she died. At autopsy, a high-grade invasive pontine tumor was identified. Histological evaluation revealed glioblastoma multiforme.

Conclusion: While pontine gliomas are rare in adults, those that do occur tend to be high-grade and rapidly progressive. Progression of symptoms from non-specific findings of headache and vomiting to rapid neurological deterioration, as occurred in our patient, is common in glioblastoma multiforme. While radiographic findings are often suggestive of the underlying pathology, this case represents the possibility of glioblastoma multiforme presenting as a deceptively benign appearing lesion.

Figure 1

Pons lesion, low power. The tumor completely effaced the normal pontine architecture. Tumor cells invaded into the cerebellum and cervical spinal cord (not shown).

Figure 2

Pons lesion, high power. The tumor is composed of pleomorphic, poorly differentiated glial cells. Immunohistochemical staining for Ki-67 was diffusely positive (not shown), consistent with the rapid progression seen clinically.