PMC7771479_01
Preoperative MRI dated 1 month before surgery. (a) Axial T1WI MRI showing extensive amorphic heterogeneous mass invading both lateral ventricles with a commitment of midline. (b) Axial T1WI Gd MRI demonstrates the same lesion with ring and internal enhancement. (c) Coronal T1WI Gd MRI showing better the internal enhancement and commitment of both lateral ventricles. (d) Axial T2WI MRI exhibiting heterogeneous intratumoral signal and irregular-margin enhancement. Note hypointense signal surrounding the lesion suggesting extensive vasogenic edema. (e) Axial DWI shows nonimpaired diffusion. (f) ADC Map demonstrating high signal.
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F1
Immediate postoperative Control MRI. (a-c) T1WI Gd MRI exhibiting residual mass on the left ventricle atrium. (d-f) T2WI MRI demonstrating residual mass on the left ventricle atrium. The inclusion criteria in our first systematic review were case series studies with at least ten patients containing GS with molecular profile study (IDH1/2, ATRX, tp53, TERT, 1p19q, or Ki-67). Cases series without any molecular profile were excluded from the study.
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F2
The immediate postoperative MRI revealed a residual tumor volume of 14.03 cc (estimated mean diameter of 30.58 mm) in the left ventricular trigone [Figure 2a-f].
(a) Sarcomatous component, with marked pleomorphic spindle cells and mitotic activity (H and E, x10). (b) Glial component, presenting hypercellularity, pleomorphism, mitotic figures, and nuclear atypia (H and E, x20). (c) Glial component. Featuring hypercellularity, a high degree of anaplasia, presence of bizarre multinucleated cells, nuclear atypia, and evident mitotic figures (H and E, x40). (d) Sarcomatous component, presenting mitotic figures, and nuclear atypia (H and E, x20).
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F3
The histopathological study [Figure 3a-d] showed a GS - Grade IV tumor and the immunohistochemistry [Figure 4a-i] confirmed the diagnosis of GS (WHO - 2016).
Immunohistochemical stains. (a) Focal positivity for GFAP, only in glial component (x10). (b) IDH was positive in the glial component (x10). (c) SMA (Smooth Muscle Actin) was positive in the sarcomatous component (x10). (d) Partial loss of ATRX expression (intact) in tumor cells (x10). (e) S100 was positive in the glial component (x10). (f) Vimentin was positive in the sarcomatous component (x20). (g) Diffuse positivity for p53 stain - approximately 80% of neoplastic cells (x10). (h) Ki-67 stain showed more than 60% proliferative activity in the tumor nuclei - 35% of neoplastic cells (x10). (i) Gomori silver stain highlights reticulin, negative in the glial component, and positive in the sarcomatous component.
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The histopathological study [Figure 3a-d] showed a GS - Grade IV tumor and the immunohistochemistry [Figure 4a-i] confirmed the diagnosis of GS (WHO - 2016).
Postoperative MRI one month after surgery. (a-c) Axial T1WI Gd MRI showing notorious residual lesion growth.
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F5
However, one month after the tumor resection, a new MRI revealed important residual lesion growing on the trigone of the left ventricle with a tumor volume of 41.6 cc (estimated mean diameter of 43.65 mm) and an impressive growth rate estimated in 176.68 mm/year [Figure 5a-c].