1. B. Rychlý Cytopathos, Bratislava
SDIAP Case 481
B. Rychlý Cytopathos, Bratislava

2. Clinical information 43-year-old man
4-month history of headache, double vision, dizziness, unsteady gait
MRI solid-cystic brain TU
F, on both sides, perifocal edema
shift of the midline structures
preoperative dg.: glioblastoma susp.
radical operation

3. MRI

13. ?

14. AE1/3

15. CK8/18

16. CK5/6
M903

17. GFAP

18. GFAP
other markers negative: CHA, SY, NeuN (also in small cells), SMA, Dezmin, HHF35
retained INI1

19. ?

20. after exclusion of carcinoma to glioma MTS
Our dg.
True epithelial differentiation in the sarcomatoid / small cell glioblastoma
after exclusion of carcinoma to glioma MTS

21. Clinical work-up chest, abdomen skiagraphy sonography
CT: chest, abdomen, pelvis
whole body PET scan
... all negative
patient died 4 month after operation from tumor progression
microdissection and CGH from both components? (but we extracted only 300bp DNA fragments from paraffin material...)

22. Glioblastoma most malignant brain tumor treatment median OS 12 month
surgery
Stupp regiment (concomitant RT and CHT + adjuvant CHT
temozolomide (MGMT promoter methylation)
median OS 12 month

23. Special types of glioblastoma
gliosarcoma
giant cell
small cell
epitheloid
epithelial
with oligo component
MG-PNET
prognostic relevance?

24. Epithelial glioblastoma
very rare
true epithelial differentiation (morphology, IHC, EM)
features of glioblastoma along with epithelial differentiation showing the formation of squamous nests and/or glands staining for EMA, cytokeratin CAM 5.2, E-cadherin, cytokeratin AE1/AE3, cytokeratin 7, pCEA, cytokeratin 5/6 and cytokeratin 20

25. Epithelial glioblastoma
molecular alterations: P53, p21, EGFR, chromosome loss: 10q22-26, 17p13
mean OS: 7 months
glial and epithelial components are clonal (microdissection)

26. Carcinoma to glioma MTS?
in very advanced cancer
glioblastoma with epithelial differentiation?
florid / atypical reactive gliosis around MTS?

27. Summary
glioblastomas with true epithelial differentiation are very rare
mostly diagnosed as MTS carcinoma
clinicopathologic correlation
Thank you for your attention.