Female 74 years old with history of GBM s/p craniotomy.Additional clinical history from electronic medical records:Underwent craniotomy with complete radiographic resection (7/22/14, Dr. Lesniak). She lacked EGFRv3 mutation. She received RT/TMZ and then TMZ. This was for a total of 6 cycles of TMZ. When there was progression of disease she enrolled in RTOG1205 for which she received re-RT, as well as additional bevacizumab. She had then been continuing bevacizumab off study under the care of Dr. Nicolau in Florida. More recently, she returned to Chicago and received a dose of bevacizumab on 05/18/2016 with Dr. Narula. She underwent right temporal craniotomy and viral vector injection on 6/27/2016. Interval reresection of suspected tumor recurrence along the anterior aspect of the right temporal resection cavity. There are expected post-surgical findings with fluid and air noted within an enlarged resection cavity. The previously seen faintly rim-enhancing and diffusion restricting lesion appears to be completely or near completely excised. An additional nodular area along the superior margin of the original resection cavity with diffusion restriction and faint peripheral enhancement appears stable to minimally increased in size from prior exam and measures approximately 16 x 12 mm (series 17 image 175). There is a nonspecific thin rim of enhancement along the anterior and posterior margins of the resection cavity which is likely postsurgical. There is confluent T2/FLAIR white matter hyperintensity surrounding the resection cavity, not significantly changed from prior exam. Additional non-specific patchy periventricular and subcortical T2 hyperintensity is also noted. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Findings of prior bilateral cataracts surgeries noted. There is an unchanged subcentimeter enhancing lesion in the left parietal bone, which is non-specific. The paranasal sinuses are grossly unremarkable.
1. Complete or near complete resection of recurrent tumor along the anterior aspect of the original resection cavity. 2. Redemonstration of nodular thickening superior to the original resection cavity is also suspected to represent tumor and appears stable to minimally increased in size. 