The T2-FLAIR mismatch sign in glioblastoma, isocitrate dehydrogenase wild-type A case report

Author:

Nishimura Shunsuke1,Yamashita Koji1ORCID,Togao Osamu2,Kikuchi Kazufumi2ORCID,Kuga Daisuke3,Yamamoto Hidetaka45,Yoshimoto Koji3,Ishigami Kousei1

Affiliation:

1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

2. Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

3. Department of Neurosurgery, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Fukuoka, Japan

4. Department of Anatomic Pathology, Pathologic Sciences, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Fukuoka, Japan

5. Department of Pathology, Dentistry and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Okayama, Japan

Abstract

We present a case of the T2-FLAIR mismatch sign in glioblastoma, isocitrate dehydrogenase (IDH)-wild type. The T2-FLAIR mismatch sign is known as a highly specific imaging finding of astrocytoma, IDH-mutant. Meanwhile, IDH-wildtype diffuse astrocytic gliomas with telomerase reverse transcriptase ( TERT) promoter mutation in adults are defined as glioblastoma in the 2021 World Health Organization Classification of Tumors of the Central Nervous System, fifth edition (2021 WHO classification), which underscores the importance of molecular information in central nervous system tumors. This indicates even glioblastoma, IDH-wild type may be masquerading as lower-grade glioma in histology. The reasons for the discrepancy between tumors with less aggressive histology and poor prognosis caused by telomerase reverse transcriptase promoter mutation of IDH-wildtype diffuse glioma remain unclear. However, glioblastoma, IDH-wildtype should be considered as a potential differential diagnosis even in patients with the T2-FLAIR mismatch sign in diffuse gliomas.

Funder

Japan Society for the Promotion of Science

Publisher

SAGE Publications

Subject

General Earth and Planetary Sciences,General Environmental Science

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