Mast cellular-type stage-III glioblastoma: a case report

Abstract

A 48-year old male patient was admitted to our hospital on December 5, 2006, because of a distending head pain over a period of 13 months. CT and MRI examinations showed that there was a space-occupying lesion in the right frontal lobe. During the operation a tumor was found at the juncture between the grey and white matter of the right frontal lobe, with a limpid border and without an envelop. The frontal tumor was totally excised. Macroscopic examination indicated that the size of the tumor was 4.5×3.5×1.5 cm3, with a dark-red color and a rough surface. A cross section presented a hemi-substantial and hemi-cystic, or semihard and moderate quality, hemorrhage in the middle part, necrosis and cystic degeneration. A microscopic examination indicated that the tumor was mainly formed by fusiform and mast cells, where the proportion of the two types was respectively 60% and 40% of the tumor. There were multiple areas of microvascular hyperplasia and laminating necroses. The mast cells were big, rich in cytoplasm, and acidophilic, with a round and orbicular-ovate nucleus and nuclear dissymmetry. Many mitoses were obvious, with a lamellar distribution, as shown in Fig.1. Immunohistochemical analysis showed that the glial fibrillary acidic protein (GFAP) was positive for both cell types present, but negative for both creatine kinase (CK) and epithelial membrane antigen (EMA). It was confirmed by pathological diagnosis that this was a mast-cell type right frontal lobe glioblastoma at StageIII.