PMC4960923_01
Magnetic resonance imaging of the head without contrast (a) and with contrast was performed (b), which showed a posterior fossa mass that enhanced inhomogenously, as well as noncommunicating hydrocephalus
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F1
T1-weighted images, an inhomogenously enhanced appearance in T1-weighted contrast images, and iso-hyperintensity in T2-weighted images. The MRI also revealed that the temporal horns were more than 2 mm with frontal horns-internal diameter ratio (FH/ID) of 50% and the Evan ratio of 0.3. [Figure 1a and b] Preoperative investigation suggested that the patient had an infratentorial mass at the fourth ventricle, suspected ependymoma, which caused a noncommunicating hydrocephalus.
The tumor had been treated with prone position (a), skin incision line (b), surgical view (c) and gross-total surgical excision (d) Craniotomy Tumor Removal Transvermian
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F2
We performed ventriculoperitoneal shunt procedure to overcome the hydrocephalus and transvermian craniotomy tumor removal to eradicate the tumor [Figure 2a-d].
Histological examination, magnification 100x (a) and 200x (b) shows carrot-shaped cell with polimorfic hyperchromatic nuclei and Homer Wright Rossetes appearance as patognomonic sign for medulloblastoma
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F3
A histopathology sample from the mass was obtained and the examination revealed a "carrot-shaped cell" with polymorphic hyperchromatic nuclei and "Homer Wright Rosettes" appearance, which suggested that the mass was medulloblastoma [Figure 3a and b].
Immunohistochemistry analysis was conducted and the result showed that the tumor is positive for glial fibrillary acidic protein, synaptophysin, and smooth muscle actin (a-c), whereas negative for cytokeratin, desmin, and epithelial membrane antigen (d, from upper, middle, and lower figures, respectively)
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F4
In addition, immunohistochemical analysis was also conducted and the result showed that the tumor was positive for glial fibrillary acidic protein (GFAP), synaptophysin, and smooth muscle actin [Figure 4a-c], whereas it was negative for cytokeratin, desmin, and epithelial membrane antigen (EMA) [Figure 4d].