Incidentalomas to glioblastoma multiforme

In April 1999, a 25-year-old male underwent magnetic resonance imaging (MRI) as a control subject for a multiple sclerosis study. The scan serendipitously revealed two lesions (‘incidentalomas’) in the right frontal lobe. Initially, he was asymptomatic and was monitored with interval MRI scans. After years of monitoring, contact was accidentally lost. He later presented following a witnessed generalized seizure. He was commenced on phenytoin, which was changed to carbamazepine due to side effects. MRI revealed three gliomas and an open brain biopsy confirmed a diagnosis of low-grade astrocytoma. The location and multifocal nature of the gliomas ruled out complete neurosurgical debulking. However, his seizures increased in frequency and in February 2007, the biopsy confirmed malignant transformation to multifocal glioblastoma multiforme. He successfully underwent partial debulking, radiotherapy and adjuvant temozolomide chemotherapy. Currently, he is 6 years post-treatment and asymptomatic.