2-Year-old girl with right leg weakness

A previously healthy two year girl presented with new neurological deficits including a limp and right leg weakness. Her deficits increased with a worsening gait and holding the right arm flexed. Radiological imaging revealed a large, heterogeneous supratentorial mass within the frontoparietal region. Despite medical management, her condition rapidly deteriorated due to rapid tumor progression with subsequent herniation. A brain-only autopsy showed a markedly edematous brain with sulcal and gyral flattening and uncal herniation. Serial sectioning revealed a soft, hemorrhagic gelatinous tumor involved both hemispheres which crossed the corpus callosum and effaced both ventricles. Microscopic examination revealed a glioblastoma multiforme. Glioblastomas in children present with a wide spectrum of symptoms based on the location of the lesion. The genetics of pediatric glioblastoma differ from adult tumors with p53 inactivation and no significant epidermal growth factor amplification. The Ki-67 has been shown to be a strong predictor of outcomes, and unfortunately this case had an aggressive course as predicted with at least 50% tumor staining. Similar to adults, glioblastoma in children follows an aggressive course despite surgery, radiation and/or chemotherapy.