Overall: a glioma with vascular features suggestive of glioblastoma, but few mitotic figures, many apoptotic cells, and the necrosis (4283 and 4284) is caseous rather than typical for glioblastoma. However, the rim is vaguely epithelioid. But the clinical diagnosis was tuberculoma. Thanks !

I don't believe in a tuberculoma or a combined lesion. Except for the large nonspecific necrosis all other pictures demonstrate a cellular glioma with protoplasmic astrocytes and a small cell component. The glomeruloid microvessel proliferations justify a high grade glioma and the necrosis is another argument in favor of a glioblastoma.

I agree: the glomeruloid microvascular proliferations in conjunction with necrosis are strongly suggestive of a glioblastoma. What is a bit unusual in this present case, are the obviously rather frequent granular mitotic figures resembling the Creutzfeldt cells encountered in Multiple Sclerosis and related conditions; however, occasionally, high-grade gliomas may exhibit this feature as well. I assume that the submitted biopsy material does not contain any fragments showing infiltration of adjacent brain tissue, nor fragments exhibiting pseudopalisading necrosis, both of which would additionally strengthen the Dx of an GBM.