title: Hypervascular glioblastoma multiforme or arteriovenous malformation associated Glioma? A diagnostic and therapeutic challenge: A case report.
abstract: BACKGROUND
  Simultaneous presentation of arteriovenous malformation (AVM) and glioblastoma multiforme (GBM) is rarely reported in the literature and needs to be differentiated from "angioglioma", a highly vascular glioma and other differential diagnosis such as hypervascular glioblastoma. Incorporating critical features of both, malignant glioma and AVM, such lesions lack a standard algorithm for diagnosis and therapy due to their rare incidence as well as their complex radiological and highly individualized clinical presentation.
  
  
  METHODS
  We present a case of a 71-year-old female with newly developing motor deficits and radiographic findings of a heterogeneously contrast enhancing right-sided thalamic lesion with highly prominent vasculature. While computed tomography angiogram and cerebral digital subtraction angiography supported the diagnosis of AVM, contrast-enhancing magnetic resonance imaging (MRI) and MR-spectroscopy was suggestive of malignant glioma. A stereotactic biopsy revealed the diagnosis of a GBM (WHO IV) and the patient was treated accordingly.
  
  
  CONCLUSIONS
  The coincidental presentation of vascular lesions such as AVM and malignant glioma is rare and presents a major challenge when establishing a diagnosis. The respective treatment decision is complicated by the fact that available treatment modalities (e.g. radiosurgery and/or open resection) carry disease specific complications for each entity. Finding a suitable solution for such cases requires standardization of early diagnostic and therapeutic management.
authors.affiliation: Department of Neurosurgery with Pediatric Neurosurgery, Charité-University Medicine, Campus Virchow, Berlin, Germany.
authors.forename: Laura-Nanna
authors.initials: LN
authors.lastname: Lohkamp
authors.affiliation: Department of Neurosurgery, Brigham and Woman's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Strong
authors.affiliation: Department of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rojas
authors.affiliation: Department of Pathology and Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Anderson
authors.affiliation: Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Laviv
authors.affiliation: Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ekkehard M
authors.initials: EM
authors.lastname: Kasper
keywords: Angioglioma; angiogenesis; arteriovenous malformation; case report; hypervascular glioblastoma multiforme