PMC6365988_01
Contrast-enhanced CT of the brain: right cerebellar mass (left) and left posterior temporal mass (right) showing a good contrast uptake.
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During current admission, a contrast-enhanced computed tomography (CT) of the brain revealed two lesions - one right cerebellum (4 x 4 cm2) and another left temporal lobe (2 x 2 cm2) with avid contrast uptake (Figure 1).
Post-gadolinium contrasted MRI images showing a distinct right cerebellar lesion with central necrosis (black arrow). The left temporal lesion is entirely solid, and the vein of Labbe is seen traversing along the tumour (white arrow).
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T1-weighted sequence and avid enhancement post gadolinium administration (Figure 2). T2-weighted sequence demonstrated blooming artefact in the right cerebellar lesion suggestive of intratumoural haemorrhage and necrosis.
(a) Tumour cells clustering around a blood vessel: haematoxylin and eosin (original magnification: 10x objective), (b) spindle and epithelioid tumour cells with increased mitotic activity (red arrow): haematoxylin and eosin (original magnification: 20x objective).
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Histopathological sections of the specimens showed sheets, clusters and haphazardly dispersed spindled and epithelioid tumour cells (Figure 3(a)). In certain areas, the tumour cells were seen closely aggregated around blood vessels (Figure 3(b)).
(a) Tumour cells showing positivity for HMB45 (original magnification: 10x objective), (b) smooth muscle actin; SMA (original magnification: 20x objective) and (c) high Ki67 proliferative index (original magnification: 10x objective).
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Immunohistochemistry revealed focal positivity for HMB45 (Figure 4(a)) and showed weak smooth muscle actin positivity (Figure 4(b)). Ki67 proliferative marker was more than 30% (Figure 4(c)).