PMC4295440_01
T1-weighted (a, b) and T2-weighted (c) magnetic resonance imaging (MRI) revealing the tumor in the vermis with homogeneous enhancement by gadolinium. Note that the tumor compressing medulla resulting in obstructive hydrocephalus (b).
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Magnetic resonance imaging (MRI) showed a round, 4-cm tumor appearing isointense on T1- and T2-weighted imaging with homogeneous enhancement (Figures 1(a)-1(c)) causing obstructive hydrocephalus.
Intraoperative findings. The tumor in the vermis was totally removed. The mass appears yellowish, elastic, and hard with a clear boundary from normal structures.
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The tumor was totally removed (Figure 2).
Microscopic photograph showing spindle-shaped cells with moderate cellularity crowded into bundles (hematoxylin and eosin stain, x20) (a). Immunohistochemical studies reveal that tumor cells are positive for c-kit (b), CD34 (c), and alpha-smooth muscle actin (d) (x20).
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Spindle-shaped cells with moderate cellularity were crowded into bunches with mitotic figures (Figure 3(a)). Based on immunohistochemical studies revealing positivity for c-kit, CD34, and alpha-smooth muscle actin (Figures 3(b)-3(d)), the patient was diagnosed with GIST.
Postoperative MRI shows medulla decompressed without the residual tumor in the vermis (a). Positron emission tomography (PET) reveals abnormal accumulations in the cardiac apex, subclavial region, and peritoneal cavity (b).
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Postoperatively, the patient showed an improved level of consciousness and postoperative MRI showed no residual tumors (Figure 4(a)). Positron emission tomography (PET) revealed multiple accumulations in the cardiac apex, subclavial region, and peritoneal cavity (Figure 4(b)).
Following surgical operation and radiation therapy, computed tomography (CT) showed a large recurrent tumor with perifocal edema in the right frontal lobe (a) (b).
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CT showed multiple recurrent tumors in the right frontal lobe with expanding perifocal edema (Figure 5).