Glioblastoma with the appearance of arteriovenous malformation: Pitfalls in diagnosis

Objectives

Very few cases of arteriovenous malformations (AVMs) associated with gliomas were reported so far in the literature.

Methods

Here, we report a rare case of a glioblastoma with an AVM-like lesion and review the existing literature.

Results

We report an unusual case of a 72-year old woman, who presented with a progressive history of aphasia, memory deficit, and headache. Initial MRI imaging was suggestive of a high-grade glioma for which a pterional craniotomy was performed. Intraoperatively, the lesion resembled a vascular malformation. Total extirpation of the lesion was verified by intraoperative MR imaging. Initial histopathological analysis revealed an AVM. Due to the discrepancy between the radiologic and histopathologic findings, the patient was monitored at close intervals. Two month later, multiple lesions were visible on MRI imaging, thus, supporting the diagnosis of malignant glioma. Therefore, after reinvestigating the histopathological sections and cutting the paraffin block in additional serial sections, in only 5% of the section a glioblastoma was discerned which was surrounded by an AVM-like lesion.

Conclusion

Gliomas are rarely found in association with AVMs and require accurate diagnostic evaluation and interpretation for adequate therapeutic interventions.