PMC9975338_01
Post-contrast T1-weighted images showed a right frontal mass with a rugged marginal enhancement and possible extensive interior necrotic change; this was also suggested by the presence of a lactic acid peak on MR spectroscopy.
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F1
Subsequent magnetic resonance imaging (MRI) further delineated a large mass of 53 mm in the right middle frontal lobe with an avid marginal enhancement and central necrosis (Figure 1).
Diffusion-weighted images showed a right frontal mass without water restriction that differed from the abscess (white arrowhead), and a large area of water restriction in the right frontotemporal lobe, suggesting a massive arterial infarction in the MCA vascular region (black arrowhead).
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F2
Another small lesion of 18 mm in the right caudate head with similar enhancement plus hemorrhaging and diffuse swelling of the right frontal and temporal-occipital lobes was also detected (Figure 2).
Susceptibility-weighted images showed a mildly increased vascularity in the right frontal mass and a curvilinear dark signal in the right sylvian fissure cistern near the thrombosis of the middle cerebral artery (white arrowhead).
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F3
Right MCA infarction was also apparent on the MRI images (Figure 3).
Gross appearance of the resected infectious tumor; microscopic section with PAS; and GMS stain showing hyphal formation.
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F4
The patient underwent an emergency craniotomy with en-bloc excision of an elastic solid mass (Figure 4). The pathology report later identified a Cryptococcus infection (Figure 4).