title: Early presentation of primary glioblastoma.
abstract: BACKGROUND
  Clinical and neuroimaging findings of glioblastomas (GBM) at an early stage have rarely been described and those tumors are most probably under-diagnosed. Furthermore, their genetic alterations, to our knowledge, have never been previously reported.
  
  
  METHODS
  We report the clinical as well as neuroimaging findings of four early cases of patients with GBM.
  
  
  RESULTS
  In our series, early stage GBM occurred at a mean age of 57 years. All patients had seizures as their first symptom. In all early stages, MRI showed a hyperintense signal on T2-weighted sequences and an enhancement on GdE-T1WI sequences. A hyperintense signal on diffusion sequences with a low ADC value was also found. These early observed occurrences of GBM developed rapidly and presented the MRI characteristics of classic GBM within a few weeks. The GBM size was multiplied by 32 in one month. Immunohistochemical analysis indicated the de novo nature of these tumors, i.e. absence of mutant IDH1 R132H protein expression, which is a diagnostic marker of low-grade diffuse glioma and secondary GBM.
  
  
  CONCLUSIONS
  A better knowledge of early GBM presentation would allow a more suitable management of the patients and may improve their prognosis.
authors.affiliation: Department of neurosurgery, university hospital, 4, rue Larrey, 49933 Angers cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Faguer
authors.affiliation: Department of radiology, university hospital, 4, rue Larrey, 49933 Angers cedex 9, France.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Tanguy
authors.affiliation: Department of pathology, university hospital, 4, rue Larrey, 49933 Angers cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Rousseau
authors.affiliation: Department of neurosurgery, university hospital, 4, rue Larrey, 49933 Angers cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Clavreul
authors.affiliation: Department of neurosurgery, university hospital, 4, rue Larrey, 49933 Angers cedex 9, France. Electronic address: phmenei@chu-angers.fr.
authors.forename: P
authors.initials: P
authors.lastname: Menei
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D059906:Neuroimaging / Q000379:methods*; D012640:Seizures / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
keywords: Biologie moléculaire; Diagnostic précoce; Early diagnosis; Glioblastoma; Glioblastome; Immunohistochemistry; Immunohistochimie; Molecular biology; Occult tumor; Tumeurs occultes