1. Student Case Presentation Nick Paphitis, SMD-06 University of Virginia Health System

2. 55yo male 11/06 – CC: several weeks of intermittent HA (worse in AM), worsening dysequilibrium and visual changes (1yr h/o clumsiness and falls, dx’d as migraines) 11/06 – CC: several weeks of intermittent HA (worse in AM), worsening dysequilibrium and visual changes (1yr h/o clumsiness and falls, dx’d as migraines) –Denied vertigo, weakness, weight loss, some N/V –PMHx – HTN, lipids –FHX – sister w/ migraines, father w/ prostate CA, mom w/ breast CA –SHx – no tobacco, 1-2 drinks/night –Meds – HCTZ, Lipitor

6. Hospital Course and Outcome Admitted to Neuro, NSGY performed craniotomy w/ gross total resection of tumor Admitted to Neuro, NSGY performed craniotomy w/ gross total resection of tumor Path - hypercellular glial neoplasm composed of hyperchromatic, pleomorphic astrocytes. Areas of palisading necrosis are identified, as are regions of geographic necrosis. Endothelial proliferation is abundant and mitotic figures are easily seen, favor astrocytoma, WHO Grade IV (GBM) Path - hypercellular glial neoplasm composed of hyperchromatic, pleomorphic astrocytes. Areas of palisading necrosis are identified, as are regions of geographic necrosis. Endothelial proliferation is abundant and mitotic figures are easily seen, favor astrocytoma, WHO Grade IV (GBM) Post-Op uncomplicated with good improvement of neurologic symptoms Post-Op uncomplicated with good improvement of neurologic symptoms Rad Onc – 1/3 to 2/15 along w/ temozolomide, did well, weaned from steroids completely Rad Onc – 1/3 to 2/15 along w/ temozolomide, did well, weaned from steroids completely F/U MRI @ Duke sched. 3/1/06 F/U MRI @ Duke sched. 3/1/06

7. Radiographic Features and DDx Malignant astrocytomas are usually hypointense on T1- weighted images. These tumors typically enhance heterogeneously and serpiginously following contrast infusion. There may be areas of solid contrast enhancement within a more diffusely serpiginous pattern, or the lesion may show a totally solid pattern of enhancement. Malignant astrocytomas are usually hypointense on T1- weighted images. These tumors typically enhance heterogeneously and serpiginously following contrast infusion. There may be areas of solid contrast enhancement within a more diffusely serpiginous pattern, or the lesion may show a totally solid pattern of enhancement. The enhancing tumor can be distinguished from the surrounding hypointense signal of edema on T1- weighted sequences. On T2-weighted sequences, the edema is hyperintense and cannot be distinguished from tumor. The enhancing tumor can be distinguished from the surrounding hypointense signal of edema on T1- weighted sequences. On T2-weighted sequences, the edema is hyperintense and cannot be distinguished from tumor. Midline shift, necrosis, hemorrhage w/in mass Midline shift, necrosis, hemorrhage w/in mass DDx – malignant astrocytoma, metastatic dz, PCNSL, MS, low-grade glioma/astrocytoma, abscess DDx – malignant astrocytoma, metastatic dz, PCNSL, MS, low-grade glioma/astrocytoma, abscess Reference: Up to Date

8. Recurrence? (12/19/05)