PMC6763678_01
Re-evaluation (2017) of available samples from needle biopsy performed in 2008 (2 samples of <4 mm). (a) Hematoxylin and Eosin glial biopsy with a mild increase in astrocytes. (b) Inflammatory process dominated by foamy macrophages (confirmed by immunohistochemistry). (c+d) CD68 immunohistochemistry: presence of a large number of macrophages.
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F1
The ensuing needle biopsy on the left frontal lobe lesion showed solely inflammatory signs of demyelination, suggesting an evolving tumefactive MS-plaque [Figures 1 and 2].
T1-weighted magnetic resonance imaging, axial (top), and coronal (bottom) cross sections before biopsy (2008).
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F2
The ensuing needle biopsy on the left frontal lobe lesion showed solely inflammatory signs of demyelination, suggesting an evolving tumefactive MS-plaque [Figures 1 and 2]. A histopathologic revaluation of the previously collected samples pre-GKRS demonstrated the presence of an anaplastic astrocytoma (AA) [Figure 2, Tables 2 and 3].
First microsurgery (August 2010): T1-weighted magnetic resonance imaging, axial (top), and coronal (bottom) cross sections. Left column: preoperative images. Right column: postoperative images.
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F3
The patient underwent microsurgery twice followed by prophylactic radiation therapy to the surgical cavity shortly after [Figures 3 and 4]; the corresponding histopathologic evaluation suggested the presence of an oligodendroglioma, WHO Grade 2-3. A histopathologic revaluation of the previously collected samples pre-GKRS demonstrated the presence of an anaplastic astrocytoma (AA) [Figure 2, Tables 2 and 3].
T1-weighted magnetic resonance imaging (October 2010) before second resection (November 2010). Axial (left), coronal (center), sagittal (right) cross sections: tumor regrowth.
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F4
The patient underwent microsurgery twice followed by prophylactic radiation therapy to the surgical cavity shortly after [Figures 3 and 4]; the corresponding histopathologic evaluation suggested the presence of an oligodendroglioma, WHO Grade 2-3.
Gamma knife treatment plan on stereotactic T1-weighted magnetic resonance imaging: Axial (left), coronal (Top, right), and sagittal cross sections (Bottom, right). Yellow line: prescription isodose at the margin (18Gy-50%). Green line: 10Gy-isodose.
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F5
The contrast enhancing part of the recurrence was treated in October 2017 using gamma knife radiosurgery (GKRS), applying 18Gy at the 50% isodose line [Figure 5].