The patient came to the clinic 18-June-2014 complaining of speech problems for 3 weeks and headache left fronto-temporal for 10 days. The patient was operated previously for discectomy and underwent treatment for Ca prostate for 2 years. MRI brain done 14-June-2014 showing rounded lesion left temporal lobe with ring enhancement resembling MTS with massive perifocal edema.

On examination; The patient is neurologically free, except for the headache and difficult to notice speech perception.

The patient was sent for cardio evaluation  and CXR was free.

Spectroscopy was done the day before surgery, supporting data for MTS (Figure1-6).

Osteoplastic craniotomy in the left temporal area above the left ear with reflection of the bone flap to the left ear. Cross-shape incision of the dura. The tumor was seen directly with a massive cluster of arterialized veins. Resection of the tumor and part of it was sent for histologic verification. There was no proper cleavage to follow, instead the net of arterialized veins, which were coagulated. The wound was closed temporarily and intraoperative MRI was done. It seems that the tumor was resected, but some questionable remnant was noted in the postero-superior of the resected tumor cavity. The wound was inspected at that area and the lesion had a look of normal brain, but it was included in the resection. This part was very near to Wernicke's area. The brain is lax and strict hemostasis was achieved and water-tight closure of the dura and routine closure of the wound.

Smooth postoperative recovery. The comprehension became more difficult after surgery, but the patient has no other neurologic deficit. The patient was sent to the ward.

The next postoperative day, the patient is talking, walking, but understanding the verbal command with difficulty.

The final histologic result was high grade glioma consistent with glioblastoma multiforme with sections showing cellular tumor composing of pleomorphic cells with high grade nuclear atypia, giant tumor cells and brisk mitosis. Gemistocytic cells were noted. Vascular endothelial proliferation presented with thrombosis. Necrosis is focal and minimal. Fragments of brain tissue with gliosis was seen. The neoplastic cells are GEAP +, PSA -, CK -. ( Dr. Fayez Hajjiri).

The patient was discharged 26-June-2014 with speech comprehension difficulties.

The glioblastoma multiforme, can mimic any tumor morphologically, as appreciated by its name. This case a demonstration, that it can mimic even chemically other tumors including metastasis. This spectroscopic picture was typical for MTS, but the tumor turned to be glioblastoma multiforme.

The patient under treatment for adenocarcinoma of the prostate for 2 years. The lesion is solitary and the chest is free.

Usually the MTS has good cleavage, but this case had no cleavage. The pathologic arterialized veins were seen all over the tumor clusters where as cluster of rich leaves around this tumorous vascular tree.

In retrospective analysis, intraoperative MRI must be performed with best protocol done before surgery, where the tumor was best shown.

Concerning intraoperative functional MRI, a new protocol of anaesthesia must be done, to achieve the location of the functionally important areas such in this case the area of Wernicke for speech comprehension.