J Korean Soc Radiol.  2016 Aug;75(2):121-125. 10.3348/jksr.2016.75.2.121.

Primary Pontine Glioblastoma Multiforme: A Case Report and Review of the Literature

• Baik J
• Baek HJ
• Moon JI
• Cho SB
• Choi BH
• Bae K
• Jeon KN
• Choi DS
• Shin HS

• KMID: 2344801
• DOI: http://doi.org/10.3348/jksr.2016.75.2.121

Abstract

Glioblastoma multiforme (GBM) most commonly occurs in the pons while it is rare in the brainstem. However, diagnosis of brainstem GBM can be difficult due to its rarity and nonspecific clinical manifestations. Herein, we presented a case of a 47-year-old female patient confirmed as primary pontine GBM by histopathological examination. This case highlights that GBM should be considered in the differential diagnosis of patients with a space-occupying lesion in the brainstem as well as the importance of a meticulous radiological review with clinical suspicion.

MeSH Terms

Brain Stem
Diagnosis
Diagnosis, Differential
Female
Glioblastoma*
Humans
Magnetic Resonance Imaging
Middle Aged
Pons

Figure

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  Fig. 1 Representative MRI of primary pontine glioblastoma multiforme in a 47-year-old female patient. A. Axial T2-weighted MR image demonstrates a heterogenously hyperintense tumor with partially defined margin. B. Axial pre-contrast T1-weighted MR image reveals a homogeneously hypointense tumor. C. Axial post-contrast fluid attenuated inversion recovery image shows a heterogeneously enhancing tumor with partial obstruction of the fourth ventricle and peritumoral vasogenic edema.

• 

  Fig. 2 Representative MRI of primary pontine glioblastoma multiforme in a 47-year-old female patient. A. Axial T2-weighted MR image demonstrates a heterogenously hyperintense tumor with partially defined margin. B. Axial pre-contrast T1-weighted MR image reveals a homogeneously hypointense tumor. C. Axial post-contrast fluid attenuated inversion recovery image shows a heterogeneously enhancing tumor with partial obstruction of the fourth ventricle and peritumoral vasogenic edema. D-F. Axial (D), sagittal (E), and coronal (F) enhanced T1-weighted MR images show a heterogeneously enhancing tumor with intratumoral necrosis involving pons and left Meckel's cave.

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  Fig. 3 Pathologic findings of primary pontine glioblastoma multiforme in a 47-year-old female patient. A. Photomicrograph (original magnification, × 100; hematoxylin and eosin stain) shows dense cellularity, nuclear pleomorphism and a variable nuclear:cytoplasmic ratio. B. GFAP staining (immunohistochemistry, × 200) shows diffusely positive immunoreactivity, presenting brownish staining. This result indicates astrocytic nature of tumor. C. Approximately 40% of cells have Ki-67 reactivity, which demonstrates increased cell proliferation (original magnification, × 200; Ki-67 stain). GFAP = glial fibrillary acidic protein

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