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Washington University Experience | NEOPLASMS (GLIAL) | Diffuse midline glioma, H3 K27-altered | 3B3 DMG (Case 3) N6 H&E 20X
There are large areas of geographic and pseudopalisading necrosis. The tumor also invades into the lateral ventricles, entraps the cranial nerves, involves the choroid plexus, and displays prominent subarachnoid spread. Tumor infiltration along the Virchow-Robin spaces is evident in several foci. The ventricular lining multifocally shows granular ependymitis. (H&E) ---- Not shown: The collective findings were thought consistent with a histologic diagnosis of glioblastoma using criteria of the time. However, given its location i.e. thalamus, an immunostain for mutant H3 K27M was performed which reveals strong nuclear positivity in the vast majority of tumor cells. The final diagnosis was: Diffuse midline glioma, H3 K27M-mutant, WHO grade IV, of the thalamus with widespread leptomeningeal dissemination s/p biopsy and chemoradiation therapy
