Glioblastoma multiforme ("Butterfly glioma")

Findings

CT shows a large ill-defined area of hypodensity and mass effect in the right frontal lobe which extends across midline. MRI confirms a large heterogeneously enhancing bilobed mass crossing the rostrum of the corpus callosum. There is associated vasogenic edema and sulcal effacement. Mass effect is seen on the lateral ventricles. Mild midline shift. There is restricted diffusion within the right frontal lobe mass.

Differential Diagnosis:
- Glioblastoma multiforme (GBM)
- Primary CNS lymphoma
- Metastasis
- Demyelinating disease
- Infection


Diagnosis: Glioblastoma multiforme ("Butterfly glioma" distribution)


Key points

Most common primary malignant intracranial neoplasm (50-60% of astrocytomas).
Most commonly in cerebral hemispheres, but can be seen in brainstem and cerebellum (which is more common in children).
May invade meninges and cause dural enhancement.
Often demonstrates a marked mass effect, marked surrounding edema and a necrotic core.
Demonstrates irregular rim enhancement on CECT and MR + C.
"Butterfly Glioma" (such as this case) involves both hemispheres and the corpus callosum.
May be sporadic or associated with a tumor syndrome including NF1, p53 mutation, Turcot syndrome, Ollier Disease, and Maffucci syndrome.
20% are multifocal.