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Tectal plate glioblastoma multiforme

Michael D Nemer1Cathy Blight2Jacky T Yeung1Karim M Fram3Aftab S Karim1
1 Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI, USA
2 Department of Pathology, Hurley Medical Center, Flint, MI, USA
3 Department of Neurology, Lapeer Regional Medical Center, Lapeer, MI, USA

Background: Tectal plate tumors have traditionally been considered low-grade, indolent lesions. We report a patient who presented with a tectal region glioblastoma multiforme (GBM), a rare pathology in this anatomic location.
Case Description: This is a case report of a 45-year-old female that presented with worsening confusion, memory loss, and loss of bladder control for 3 days. There was no family history of brain malignancy. The patient presented with Parinaud’s phenomenon. Pronator drift was not present. The patient had dysarthric speech. An elevated white blood cell count was also noted. Non-contrast CT scan of the head showed the presence of a tectal region mass and hydrocephalus. A follow-up MRI with and without contrast confirmed the presence of a 4.2 × 3.3 × 4.6 cm 3 mass. Magnetic Resonance Spectroscopy (MRS) demonstrated an elevated choline/N-acetylaspartate ratio and an increase in lactate suggesting an aggressive neoplasm. A ventriculoperitoneal shunt was initially placed to relieve the hydrocephalus. The patient subsequently underwent a suboccipital craniotomy for debulking of tumor and for tissue diagnosis. Pathology of the lesion was consistent with GBM. The patient declined postoperative treatment with chemotherapy and radiation.
Conclusion: Although tectal region masses are predominantly low-grade lesions, high-grade lesions can present in this anatomical location. Furthermore, MRS can help to differentiate benign lesions from more aggressive lesions in the tectal plate. Biopsy of tectal plate lesions should be considered in select cases to establish diagnosis and prognosis in order to optimize treatment.

Keywords: Glioblastoma multiforme, hydrocephalus, magnetic resonance spectroscopy, tectal plate

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