34 years, Male, Reason: 34 yo male w/ GBM; s/p 3 resections, RT (59.4 Gy and 33 fractions), BCNU, and TMZ+RT; recently relapsed. Again seen is a left frontal tumor resection cavity with multiple adjacent foci of susceptibility compatible with chronic blood products. Since the prior exam from 7/12/2016, there has been marked increase in nodular and heterogeneous enhancement surrounding the left frontal resection cavity along its lateral, medial, and inferior aspects. Interval increase in enhancement extends across the corpus callosal genu into the right frontal lobe, left basal ganglia inferiorly, posteriorly into the left parietal lobe, as well as across the splenium into the right parietal lobe. Inferior tumor extension is noted now filling the suprasellar cistern with associated mass effect including posterior displacement of the midbrain. Elevated cerebral blood volume is noted with the increased areas of enhancement.There is also increase in T2/FLAIR hyperintensity in the left frontal, left parietal, right frontal, and right parietal lobes. There is worsened mass effect including increased effacement of the left lateral ventricle. There is subfalcine herniation and rightward midline shift measuring approximately 8 mm at the level of the foramen of Monro. The right temporal horn is enlarged indicative of entrapment. The third ventricle is posteriorly displaced and dilated which appears to be related to obstruction at the cerebral aqueduct. There is increase in edema in the midbrain. There is effacement of the bilateral ambient cisterns related to downward herniation.There is restricted diffusion associated with the tumor. No evidence of infarct or new large hemorrhage. Major flow-voids are grossly preserved. Right transparietal shunt catheter is in place with its tip in the lateral ventricle abutting the septum pellucidum, similar to prior.
1. Compared to 7/12/2016, there is marked progression of known glioblastoma with increased extension in the left frontal and left parietal lobes, increased extension across the corpus callosum, inferior extension into the basal ganglia as well as inferior extension into the suprasellar cistern. 2. Worsened mass effect includes midline shift, dorsal displacement of the midbrain, and downward herniation. There is also increase in dilatation of the lateral and third ventricles which is suspected to be related to obstruction at the level of the cerebral aqueduct.Dr. Ali discussed findings with Dr. Lukas at 1600 hrs on 8/12/2016.