A 62-year-old man is brought to the emergency department after a new-onset, generalized tonic-clonic seizure. His wife reports that for the past several weeks he has been having episodic headaches, nausea, and progressive weakness. The headaches are particularly worse at night and occasionally awaken him from sleep. His other medical problems include well-controlled hypertension and osteoarthritis. On physical examination, the patient is postictal but follows simple commands. He is admitted to the hospital for further evaluation but dies several days later due to aspiration pneumonia and septic shock. A brain section obtained during postmortem examination is shown in the image below. This patient most likely had which of the following conditions?

Question

A 62-year-old man is brought to the emergency department after a new-onset, generalized tonic-clonic seizure.  His wife reports that for the past several weeks he has been having episodic headaches, nausea, and progressive weakness.  The headaches are particularly worse at night and occasionally awaken him from sleep.  His other medical problems include well-controlled hypertension and osteoarthritis.  On physical examination, the patient is postictal but follows simple commands.  He is admitted to the hospital for further evaluation but dies several days later due to aspiration pneumonia and septic shock.  A brain section obtained during postmortem examination is shown in the image below.  This patient most likely had which of the following conditions?

Quizplus · Accepted Answer

11ec160b_39ac_f49f_9249_5be585fab898_MD0001_00 The solitary lesion designated by the dashed circle in the image above likely represents glioblastoma, the most common primary cerebral neoplasm in adults. Glioblastoma arises from astrocytes and is typically located within the cerebral hemispheres. Tumors can become significantly large, causing mass effect with midline shift (red arrow), and may occasionally cross the corpus callosum ("butterfly glioma"). On gross examination, glioblastomas are soft and poorly defined with areas of necrosis and hemorrhage. These tumors are highly malignant with a very poor prognosis as most patients die less than a year after diagnosis. (Choice A) Most adult brain tumors represent metastases from other cancers, especially those of the lung, breast, kidney, and skin (eg, melanoma). However, on gross examination, brain metastases typically appear as multiple, well-circumscribed masses at the junction of gray and white matter. (Choice C) Meningiomas are benign, well-circumscribed neoplasms of adults that arise from arachnoid cells (external to the brain parenchyma). They are typically located on the brain surface at sites of dural reflection (eg, falx cerebri, tentorium cerebelli). (Choice D) Oligodendrogliomas are slow growing tumors of adults that typically involve the white matter of the cerebral hemispheres. On gross examination, they usually appear as well-circumscribed gray masses with calcification. (Choice E) Primary central nervous system lymphoma is most often seen in the immunocompromised (eg, patients with AIDS, transplant recipients) and appears as multiple brain lesions involving the deep gray matter, white matter, and cortex. (Choice F) Schwannomas are mostly benign tumors that commonly arise from the vestibular branch of cranial nerve VIII at the cerebellopontine angle (vestibular schwannoma). Patients typically present with sensorineural hearing loss and tinnitus. Educational objective: Glioblastoma is the most common primary cerebral neoplasm of adults that is typically located within the cerebral hemispheres and may cross the midline ("butterfly glioma"). These tumors are highly malignant and grossly contain areas of necrosis and hemorrhage. __________ References: Primary brain tumors in adults. (http://www.ncbi.nlm.nih.gov/pubmed/18533376)

A 62-Year-Old Man Is Brought to the Emergency Department After