PMC5026690_01
(A) MRI Brain T1 weighted showing hypointense nodular thickening in the left temporal lobe and para sylvian fissure. (B) T2 weighted image showing hyperintense lesion in the left temporal lobe. (C) T1 contrast image showing patchy enhancement in the left temporal lobe.
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It appeared as a multicystic lesion with peripheral enhancement and marked perilesional oedema (Fig. 1).
MR spectroscopy showing high Choline/Creatine and high Choline/NAA ratios in the enhancing areas and persistent lactate peak in all enhancing areas favoring neoplastic lesion.
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MR Spectroscopy showed high choline/creatine and high choline/NAA ratios in the enhancing areas (Fig. 2).
MRI Brain showing significant overall increase in the size of tumor involving the left frontal, temporal and parietal lobes with perilesional edema and post surgical changes in T1, T1 post contrast and T2 weighted images respectively.
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Repeat scan showed a significant overall increase in tumor size with both multifocal cystic and solid components involving left frontal, temporal and parietal lobes measuring approximately 9.6 x 5.1 x 5 cm clearly elicited disease progression (Fig. 3).
A. PXA tumor exhibiting numerous eosinophilic hyaline globule. B. Tumor showing sheets of astrocytic cells having pleomorphic nuclei with some cells having xanthomatous cytoplasm. Presence of frequent mitoses (arrows showing two mitotic figure) 40x. C. Tumor showing sheets of spindly to large polygonal astrocytic cells having pleomorphic nuclei with nuclear inclusions 40x. D. PXA exhibiting necrosis.
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CD34 immune staining was negative excluding epitheliod cell glioblastoma (Fig. 4, Fig. 5).