PMC3479943_01
T1 axial MRI brain depicting left frontal tumor with rim enhancement associated with midline shift, (a) and after resection MRI brain demonstrates no residual tumor and a resolved mass effect (b). Photograph of the patient skin cafe-au-lait spots (c). (d) Histopathology shows high mitotic index and multinucleated giant cells representing GBM features. Hematoxylin and eosin stain 5 400.
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On his skin there were multiple cafe-au-lait spots and areas of hypopigmentation (Figure 1). IV) (Figure 1). Immunohistochemistry of the tumor showed positive p53 and Ki-67 >90%.
Colon fiberscopy demonstrates ulcerative adenoma (arrow; (a), (b)). Histopathology slides reveal the adenoma, hematoxylin and eosin stain 5 100. (c) and carcinoma invasion of the colon muscular layer, hematoxylin and eosin stain 5 200 (d).
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Upper GI endoscopy was normal; however, colonoscopy showed multiple colonic polyps of various sizes with ulceration and active bleeding (Figure 2). Punch biopsy of the polyps revealed grade 2 adenocarcinoma (Figure 2).
MRI brain shows the dissemination of the GBM in the left hemisphere ((a) (b)). (c) MRI pelvis (sagittal) demonstrates extensive colorectal adenocarcinoma recurrence.
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CT and MRI of the brain showed a left temporal ring-enhancing lesion about 4 x 5 cm in size with uncal herniation (Figure 3). At the same time, he had a massive progression of colonic carcinoma (Figure 3).