PMC5379808_01
Contrast computed tomographic scan of head showing an ill-defined heterogeneously enhancing left CPA mass with mild perifocal edema (a). Second day postoperative image demonstrates the craniectomy site, adequate decompression of left CPA region with no hemorrhage on the tumor bed (b)
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F1
Computed tomographic (CT) scan of the head showed an ill-defined, heterogeneously enhancing left CPA mass with mild perifocal edema [Figure 1a]. CT scan head done on second postoperative day showed adequate decompression of the left CPA region [Figure 1b].
Magnetic resonance (MR) image revealing T1 hypointense (a), T2 hyperintense (b) intra-axial fairly marginated inhomogenously enhancing (c) mass of size 24 x 21 x 24 mm in left CPA region with mild perilesional edema and mass effect, compressing the fourth ventricle causing mild outflow obstruction. No evidence of restricted diffusion was seen in diffusion-weighted image (d)
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F2
Magnetic resonance imaging (MRI) revealed T1 hypointense, T2 hyperintense intra-axial fairly marginated inhomogenously enhancing mass lesion of size 24 x 21 x 24 mm in left CPA region with mild perilesional edema and mass effect, compressing the fourth ventricle causing mild outflow obstruction [Figure 2].
MR spectroscopy (MRS) shows decrease in N-acetyl aspartate with raised choline peak, along with increased choline-NAA ratio
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F3
Single-voxel magnetic resonance spectroscopy (MRS) of the lesion demonstrated decrease in N-acetyl aspartate (NAA) and creatine with raised choline peak, along with increased choline-NAA ratio [Figure 3].
Photomicrograph of the excised specimen showing a cellular tumor composed of elongated, spindle-shaped cells with irregular, moderately pleomorphic nuclei, as well as proliferative blood vessels and necrosis (a: Original magnification x200). The tumor cells showing cytoplasmic positivity for glial fibrillary acidic protein (b: Original magnification x200)
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F4
Histological examination of the removed tumor specimens showed a cellular tumor composed of elongated, spindle-shaped cells with irregular, moderately pleomorphic nuclei, as well as proliferative blood vessels and necrosis [Figure 4a]. The presence of glial fibrillary acidic protein (GFAP) in immunohistochemistry staining confirmed the glial origin of the neoplasm [Figure 4b].