Glioblastoma. Patient is receiving reradiation and on temozolomide and Avastin. Last tumor resection was on April 28, 2015 at UIC. Path at that time redemonstrated WHO grade IV, IDH wt, 1p19q codeletion absent, MGMT promoter unmethylated. He had notable clinical improvement following resection and then enrolled in a trial of reRT/TMZ/bevacizumab (8 week cycles). While the right frontoparietal surgical cavity and the contiguous abnormality along the resection margin remain unchanged, multiple relatively well-defined and homogeneously T2-hyperintense lesions have developed in the deep gray nuclei, the right midbrain, and the adjacent right superior cerebellar peduncle, as well as in the corpus callosum and left frontal parietal white-matter. These new lesions demonstrate heterogeneous contrast enhancement and small foci of susceptibility effect. The largest of these involves the body of the corpus callosum and measures up to 3.1 cm. The second largest lesions, which measures up to 2.4 cm, involves the right thalamus and is likely partly cystic or necrotic. These lesions are associated with increased cerebral blood volume ratio, up to 8 times when compared to the least abnormal-appearing left parietal white-matter. The lesions are associated with mass-effect, but no herniation. Besides the focal mass-effect on the lateral and third ventricles, the ventricular system is overall less dilated than on the previous examination. The focal contrast enhancement in the left internal auditory canal is unchanged. The orbits and the paranasal sinuses remain unchanged. Thinning and flattening at the site of the large right pterional craniotomy flap is unchanged.
Since February 2016, multiple new significantly hyperperfused, mildly hemorrhagic lesions have developed in the bilateral cerebral hemispheres and brainstem, most compatible with disease progression.