A 55-year-old man has experienced headaches for the first time in his life beginning 2 months ago. He comes to the
emergency department following a generalized tonic-clonic seizure. MR imaging of his brain shows an ill-defined 2 cm
mass in the right posterior parietal cortex. A stereotaxic biopsy of the mass microscopically shows pleomorphic cells
positive for glial fibrillary acidic protein (GFAP). Molecular analysis shows abnormalities of p53 and platelet-derived growth
factor-alpha (PDGF-α). He receives treatment for this lesion. Which of the following neoplasms is he most likely to develop
in the future?
A. Diffuse large B cell lymphoma B. Glioblastoma C. Hemangioblastoma D. Medulloblastoma E. Pilocytic astrocytoma
Glioblastoma-(b) he initially had an infiltrating astrocytoma that is the most common primary brain neoplasm in adults, typically
arising in a cerebral hemisphere. lower grade astrocytomas in adults may have a more indolent course. some of these
patients go on to develop a high-grade glioma known as secondary glioblastoma. most glioblastomas arise de novo
(primary glioblastoma) and have mdm2 mutations. regardless of origin, glioblastomas are aggressive and have a poor
prognosis. diffuse large b cell lymphoma is the most common type of primary cns lymphoma (without evidence for
disease elsewhere); some arise in immunocompromised patients. hemangioblastomas are uncommon neoplasms arising
in the cerebellum, often with von hippel-lindau disease, and associated with polycythemia. medulloblastomas and
pilocytic astrocytomas are usually childhood brain tumors arising in the posterior fossa.
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