Clinical question: Glioblastoma status post 2 cycles of PDL1 therapy. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination really demonstrate a large hemorrhagic enhancing residual GBM of the left posterior temporal parietal and occipital region. Tumor also extends extensively into the splenium of corpus callosum. There is complete encasement of the occipital horn and trigone of right lateral ventricle by the tumor. Very extensive surrounding vasogenic edema is again noted.There is interval increased size of tumor and more dense pattern of enhancement. The largest transverse diameter of tumor and including the corpus callosum component measures at 62 mm in transverse diameter compared to prior study measurement of 44. There is interval increase in tumor into the sparing splenule of the corpus callosum which extends on current exam further across the midline to the left with resultant extension to the ependymal lining of the trigone of left lateral ventricle. There is also interval decreased size of resected surgical cavity since prior study which could at least partially be secondary to interval increased size of tumor.There is also mild interval increase in vasogenic edema surrounding the tumor. There is trace deviation of midline to the left which is a new finding since prior exam.
1.Examination demonstrate interval increased size of a large hemorrhagic enhancing right hemispheric GBM. Further extension of tumor across the splenium of corpus callosum to the left and involvement of the ependymal lining of trigone of the left lateral ventricle.2.Slight interval increased surrounding edema, decreased surgical cavity size and traced the radiation of midline to the left.