A case of glioblastoma multiforme with long term survival: can we predict the outcome?

Glioblastoma Multiforme (GBM) presents a major challenge for a neurosurgeon as the most common primary malignant tumour of the central nervous system. The median life span after the diagnosis still remains between 6 months to 1 year even after gross total excision of the tumour. However, few patients survive long and develop recurrence after a substantial time interval. The exact reason behind the long term survival in GBM cases remains obscure. However, few predictors have been identified of late. Young age, p53 positivity, O6-methylguanine methyltransferase (MGMT) methylation, aggressive surgical resection and a good pre-operative Karnofsky Performance Score (KPS) have been identified with good survival rates in these select cases. Immunohistochemistry forms an integral part of a glioblastoma work up and it must be done in each and every case as it may provide crucial insights regarding prognosis. We report a rare case of glioblastoma multiforme with a long term survival of 20 years. This patient developed a frontal cystic tumour bilaterally in these 20 years and is still leading an active life. The clinical summary, imaging, histopathology, immunohistochemistry along with relevant literature have been discussed.