Clinical information of 37-year-old female patient. A, Brain enhanced CT scan demonstrated an irregularly enhanced tumor node with cyst in right temporal lobe. B showed 1st recurrence tumor relapsed and invaded posteriorly, superiorly to parietal lobe. C showed 2nd recurrence tumor was solid lesion with obvious enhancement. D, primary tumor (HE staining, magnification 400×): neoplastic neurons, neoplastic astrocytes and binucleate neurons (↑) can be seen. Pathological diagnosis was ganglioglioma (WHO grade II). E, 1st recurrent tumor (HE staining, magnification 400×): Neop1astic neurons disappeared, while neoplastic glial cells increased with high density. Nuclei heteromorphism can be seen and chromatin increased obviously. Pathological diagnosis was anaplastic astrocytoma (WHO grade III). F, 2nd recurrent tumor (HE staining, magnification 100×): Microscopic field was crowded with neoplastic astrocytes. And pseudopalisade formation and multinucleated giant cells were found. Pathological diagnosis was glioblastoma multiform (WHO grade IV).