Case ReportRadiologic Dilemma in an Extra-Axial Petroclival Lesion: Low Grade versus High Grade
Introduction
Reliable preoperative identification of the nature of a lesion has implications for management. It helps the surgeon in deciding on the aggressiveness of excision depending on the tumor extent and location and the patient's performance status. Occasionally, there is significant overlap between the radiologic features of low-grade and high-grade tumors. We report a case in which a petroclival lesion that was seemingly extra-axial with calcification was shown to be a rare variant of glioblastoma.
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Case Report
Informed consent was obtained from the patient for this case report. A 27-year-old woman presented with a 4-month history of left facial paresis, numbness, and difficulty in walking. She developed headache and episodes of vomiting 3 weeks previously. Examination revealed papilledema as well as partial cranial nerve III, IV, V (motor and sensory), VII, IX, and X and bilateral cerebellar involvement. Computed tomography demonstrated a possible extra-axial lesion in the left petroclival location
Discussion
The occurrence of posterior fossa glioblastoma multiforme (GBM) in adults is unusual.1 Cerebellar GBM (1% of all GBM) and exophytic brainstem GBM have been rarely reported.1, 2 Giant cell variant arising from cerebellum is even rarer.1 The clinical presentation and radiology of GCGBM are similar to conventional GBM. The median age at diagnosis is younger than patients with conventional GBM (51 years vs. 62 years), and the median survival reported was 1 year, possibly a bit better than
Conclusions
An atypical radiologic appearance confounding a high-grade lesion needs to be borne in mind. Magnetic resonance spectroscopy and relevant additional sequences may clue to aid precise diagnosis in patients with ambiguous imaging. This case also extends the spectrum of location of GCGBM to rarer sites.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.