Rapid progression of glioblastoma multiforme: A case report

Abstract

Glioblastoma multiforme (GBM) tumors are intracranial lesions with varying shapes that grow rapidly. GBM tumors most commonly present as solitary lesions and multiple lesions are rare. The aim of the present case report was to investigate the imaging features of glioblastoma multiforme (GBM). In this study, the case of a 60-year-old patient who was hospitalized due to seizures is presented. Magnetic resonance imaging (MRI) revealed multiple lesions, heterogeneous in size, with peritumoral edema and ring-shaped enhancement. The lesions grew rapidly within 10 days of hospitalization and were initially misdiagnosed as either infections or intracranial metastatic tumors as a result of imaging examinations. The patient was subsequently administered mannitol, diazepam, Tegretol and ceftriaxone. After treatment, the patient recovered and regained full consciousness. However, MRI examination 23 days after hospitalization revealed that the multiple lesions in the left temporal and left occipital lobes had increased in size. Therefore, resection of the tumor in the left temporal occipital lobe was performed. Histopathological examination identified GBM (grade IV) in the left temporal and parietal lobes. The patient succumbed to the disease 7 months after surgery due to GBM recurrence. The findings of the present case indicate that GBM may progress rapidly with a doubling time of 10 days and multiple cystic alterations. Furthermore, if diagnosis of GBM is unclear, early biopsy is recommended.

Keywords: glioblastoma multiforme; magnetic resonance imaging; proliferation time.

Figure 1.

Magnetic resonance imaging performed following initial hospitalization. (A) Sagittal and (B) axial T2-weighted images revealed multiple round, long signals in the left temporal, parietal and occipital lobes. A cyst-solid lesion, ~7 mm in diameter, with clear edges was identified. Furthermore, the inferior horn of the lateral ventricles was evidently compressed. (C) Axial diffusion-weighted images revealed homogenous signals. (D) Enhanced axial T1-weighted images demonstrated marked enhancement of the cystic wall and the solid nodule.

Figure 2.

Magnetic resonance imaging performed 12 days after hospitalization. (A) Sagittal and (B) axial T2-weighted images revealed that lesion size had increased and the diameter of the maximal cyst-solid lesion increased to 13 mm, with enlargement of the lesion cavity. The inner wall of the tumor was smooth.

Figure 3.

Magnetic resonance imaging performed 23 days after hospitalization. (A) Sagittal and (B) axial T2-weighted images revealed a larger lesion, 17 mm in diameter. The tumor exhibited clear edges and homogenous signals in the cavity in addition to peritumoral edema. (C) Axial diffusion-weighted images revealed homogenous signals. (D) Enhanced axial T1-weighted images revealed weak enhancement of the cystic wall in contrast to marked enhancement of the solid nodule.

Figure 4.

Histopathological findings. (A) Proliferating tumor cells and heterocysts were observed with abundant small vessels. Necrosis was observed on the left side (magnification, ×10). (B) Proliferating tumor cells and heterocysts were observed with abundant small vessels (magnification, ×40).

Figure 5.

Computed tomography imaging performed 7 months after surgery revealing a multiloculated cystic lesion located at the left temporoparietal junction (multiple views). The position effect was evident, indicating tumor recurrence.