PMC6103236_01
Preoperative computed tomography and MR images of the tumour. A-B) Pre-contrast and post-contrast computed tomography. Yellow arrow shows posterior clival and prepontine cistern invasion. C-H) MRI using T1-weighted imaging (T1WI) was hyperintense with heterogeneous isointensity to grey matter showing an expansile lesion with intracranial and extracranial components, its epicenter being in the sphenoid sinus and right cavernous sinus (red asterisk). The mass measured 6.5 x 4.2 x 3.7 cm with erosion of the optic canal (blue arrow), middle cranial fossa, clivus, and petro-occipital fissure and with protrusion to the sphenoid sinus and nasopharynx (white arrow). Both the pituitary gland and the chiasm were displaced superiorly. The mass also caused effacement of the prepontine cistern with encroachment on the right internal carotid artery (ICA) and Dorello's canal, while T2WI showed a high hyperintensity along with partial isointensity to the grey matter, which suggested the presence of haemorrhage
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T1-weighted imaging demonstrated a lobulated, hyperintense with heterogeneous isointensity to grey matter mass with its epicentre in the sphenoid sinus and right cavernous sinus. The tumour was adjacent to the right temporal lobe (Figs. 1B, 1E, 1F, 1H). Both the pituitary gland and the chiasm were displaced superiorly (Figs. 1C, 1D). T2-weighted images showed a high hyperintensity along with partial isointensity to the grey matter, which suggested the presence of haemorrhage (Fig. 1).
Histopathological findings. A-B) Immunohistochemical staining showing positivity of the spindle to epithelioid tumour cells embedded in myxofibro-hyaline stroma (400x and 200x, respectively), demonstrating intracytoplasmic lumina (yellow arrow) with erythrocytes (black arrow). C, D, E, and F) Tumour cells were positive for CD34, CD31, Factor VIII, and CD99, respectively (400x). G) Ki67 proliferation index was 10% (400x). H) The immunohistochemical stains revealed negativity for cytokeratin (400x)
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Ki-67 proliferation index was 10% (Fig. 2).
Postoperative MRI showing minimal residual tumour (white arrow)
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Until now, the therapeutic approach has been satisfactory, and our patient is both symptom and recurrence free (Fig. 3) two years after resection of the tumour.