PMC9719745_01
T2-weighted image (A), T1-weighted image (B), FLAIR image (C), diffusion-weighted image (D), and Gd-enhanced T1-weighted images (E, F). MR images show left temporal ring-enhanced mass with perifocal edema (A-E). Left vestibular schwannoma is also observed (F). H.E. staining (G) and GFAP immunostaining (H) of the left temporal glioblastoma, IDH-wildtype.
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Imaging studies revealed a ring-enhanced mass at the left temporal lobe with perifocal brain edema (Fig. 1A-E) and the left vestibular schwannoma (Fig. 1F). Hematoxylin & eosin (H.E.) staining showed a diffuse proliferating tumor and moderately pleomorphic nuclei hyperchromatism and atypical mitosis with endothelial proliferation and palisading necrosis (Fig. 1G). Immunohistochemically, these tumor cells were markedly reactive to GFAP (Fig. 1H), OLIG2, and negative for IDH1R132H and Synaptophysin.
T2-weighted image (A), T1-weighted image (B), FLAIR image (C), diffusion-weighted image (D), and Gd-enhanced T1-weighted images (E, F). MR images show right parietal homogeneously enhanced mass with perifocal edema (A-E). Tumor shows low intensity on T2-weighted images (A). No local recurrence is observed in the surgical cavity of the left temporal glioblastoma (F).
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He developed a right parietal intra-axial tumor 6 months after local irradiation with concurrent temozolomide (Fig. 2A-E) without local recurrence (Fig. 2F).
T2-weighted image (A), T1-weighted image (B), FLAIR image (C), diffusion-weighted image (D), and Gd-enhanced T1-weighted images (E, F). MR images show right temporal homogeneously enhanced mass with perifocal edema (A-E), and the characteristics of MR images are the same as the previous right parietal tumor. Right parietal tumor disappears after temozolomide treatment (F). H.E. staining (G), CD20 immunostaining (H), and EBER-ISH (I) of the right temporal diffuse large B-cell lymphoma.
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However, at the eighth cycle of temozolomide, he developed a right temporal lobe tumor (Fig. 3A-E) without recurrence of both the left temporal and right parietal tumor (Fig. 3F). The H.E. staining showed diffuse proliferation of large atypical lymphocytes with hyperchromatic nuclei and scant cytoplasm (Fig. 3G). Immunohistochemically, these lymphoma cells were positive for leukocyte common antigen (LCA), CD20 (Fig. 3H), CD79a, bcl-6, multiple myeloma oncogene-1 (MUM-1), bcl-2 (partly), and negative for CD3, CD5, CD10, c-Myc. The EBV-encoded small RNA in situ hybridization (EBER-ISH) confirmed the negativity of EBV infection (Fig. 3I).