Disclosures: Marc C. Ramos Emos, MD: No financial relationships or conflicts of interest

Case Diagnosis: 40-year-old Haitian male with Glioblastoma Multiforme

Case Description or Program Description: Patient presented to the hospital with progressive right sided hypersensitivity, right leg weakness, and intermittent left sided headaches. Brain MRI showed numerous bilateral intraparenchymal cystic ring enhancing lesions. Laboratory workup showed positive quantiferon and negative HIV. Workup for occult primary malignancy was negative. CSF studies showed atypical cells. Patient was empirically treated with corticosteroids, antibacterials, and antiparasitics for suspected neurocysticercosis versus latent tuberculosis. However, further testing revealed negative neurocysticercosis antibody and CSF cryptococcal antigen. Cystic lesions on imaging and presenting symptoms were unchanged despite treatment, prompting stereotactic biopsy and drainage of cysts. Patient subsequently admitted to acute inpatient rehabilitation.

Setting: Tertiary Care Academic Hospital

Assessment/Results: Biopsy results showed high-grade, non-lymphoid neoplasm. Molecular sequencing revealed mutations in PTEN confirming the diagnosis of GBM. Patient was then planned for standard of treatment with Temozolomide with concurrent radiation.

Discussion (relevance): Glioblastoma Multiforme is a malignancy of astrocytes in the CNS. It is one of the most malignant CNS tumors with median survival of 15 months. It accounts for 50% of gliomas among all age groups. Peak incidence is between 55 to 60 years. Depending on the location of lesions, symptoms can include focal neurological deficits, seizures, headaches, or vomiting. Imaging studies commonly show areas of central necrosis, surrounded by white matter edema. Tumors are usually unifocal or less commonly multifocal. The majority of GBM tumors are solid; cystic tumors account for about 10% of cases. To our knowledge, few cases of bilateral multi-cystic GBM have been reported but the prevalence is currently unknown.

Conclusions: We present an atypical case of bilateral multi-cystic GBM. Given its prevalence and highly malignant nature, physicians should maintain high clinical suspicion for GBM in the absence of classic radiographic features.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/glioblastoma-multiforme-presenting-as-multiple-cystic-intracranial-masses-a-case-report/