PMC3144597_01
Preoperative noncontrast (a) and contrast (b) T1-weighted sagittal MRI images suggestive of a midline tectal mass with central necrosis
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F1
A follow-up MRI with and without contrast confirmed the presence of a 4.2 x 3.3 x 4.6 cm3 mass in the tectal region compressing the cerebellum and obliterating the fourth ventricle [Figure 1a and b].
Pre- and postoperative sagittal and axial, noncontrast, CT scans. (a) Preoperative sagittal CT scan illustrating an ill-defined tectal mass. (b) Postoperative sagittal CT scan illustrating partial resection of the lesion, decreased size of the mass, and improvement of hydrocephalus. (c) Preoperative axial CT scan demonstrating marked hydrocephalus and the presence of a midline mass. (d) Postoperative axial CT scan demonstrating improved hydrocephalus and decrease in the mass size after ventriculoperitoneal shunt and debulking of tumor
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F2
However, it was difficult to discern the boundaries of the mass [Figure 2a and c]. Her postoperative CT scan showed improvement of hydrocephalus and a decrease in tumor size [Figure 2b and d].
Magnetic Resonance Spectroscopy with voxel in tectal lesion demonstrating elevated choline and lactate with decreased levels of creatine and N-acetylaspartate compatible with a high-grade glioma
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F3
MRS demonstrated an elevated choline/N-acetylaspartate ratio and an increase in lactate suggesting an aggressive neoplasm as opposed to an abscess [Figure 3].
Histological sections (Hematoxylin and eosin stain): Panels a-d show the histological appearance of a high grade glioma, characterized by areas of necrosis (Panel a, dark arrows), increased mitotic activity (Panel b, white arrow), neovascularization (Panel c, asterisk), nuclear pleomorphism and dense cellularity (Panels d, thin black arrows)
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F4
Biopsy of the lesion was consistent with GBM [Figure 4a-d].