Right frontal brain biopsy was performed to obtain tissue from the right frontal mass. Histopathologic examination revealed hypercellular brain parenchyma infiltrated by a proliferation of atypical cells that had hyperchromatic, angular nuclei. Vascular proliferation and large areas of necrosis were noted. The pathology was felt to be consistent with glioblastoma multiforme (WHO grade 4). The chiasmal lesion was presumed to represent the same malignant process and a diagnosis of multicentric glioblastoma multiforme was made. Diffusely infiltrating high-grade astrocytoma with multiple foci of progression to glioblastoma multiforme could not be excluded, however. Palliative radiation and chemotherapy were offered, but the patient and his family declined further treatment. The patient died one month later. An autopsy was not performed.
History
A 78 year-old man presented with a one-month history of progressive painless binocular vision loss. He had sustained head trauma without loss of consciousness three days prior to the onset of vision loss. On the morning of his presentation to us, he had awoken with complete binocular vision loss and had been started on oral prednisone (70 mg daily) by his local eye care provider. He denied symptoms of giant cell arteritis. His past medical history was remarkable for hypertension, diabetes, and a distant history of prostate cancer that was thought to be in remission. Neurologic review of systems was unremarkable. Examination revealed no light perception OU. The pupils were dilated and minimally reactive to light. There was no RAPD. Intraocular pressures were within normal limits OU. Extraocular movements were full OU. Anterior segment examination revealed pseudophakia OU. Dilated funduscopic examination revealed diffuse optic atrophy OU. Neurologic examination was unremarkable.
Disease/Diagnosis
Multicentric glioblastoma multiforme involving the optic chiasm
Date
2015-02
References
1. Pallini R et al. Glioblastoma of the optic chiasm. J Neurosurg 1996; 84: 898-899. 2. Synowitz M et al. Multicentric glioma with involvement of the optic chiasm. Clin Neurol Neurosurg 2002; 105: 66-68. 3. Dinh TT et al. Glioblastoma of the optic chiasm. J Clin Neurosci 2007; 14: 502-505. 4. Abou-Zeid A et al. Blindness from multiple cerebral gliomas mimicking metastatic brain disease. Br J Neurosurg 2008; 22: 772-773. 5. Goh JJ et al. Vanishing glioblastoma after corticosteroid therapy. J Clin Neurosci 2009; 16: 1226-1228. 6. Matloob S et al. Multifocal malignant optic glioma of adulthood presenting as acute anterior optic neuropathy. J Clin Neurosci 2011; 18: 974-977. 7. Kang JJ et al. De novo malignant optic chiasm glioma with initial clinical response to steroids. Neuroophthalmology 2012; 36: 59-63. 8. Thomas RP et al. The incidence and significance of multiple lesions in glioblastoma. J Neurooncol 2013; 112: 91-97
