PMC4040044_01
Noncontrast computed tomography of head reveals bilateral iso- to hyperdense thalamic masses with hydrocephalus and periventricular ooze
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Noncontrast computed tomography (CT) of the head revealed a bilateral thalamic iso- to hyperdense lesion with moderate hydrocephalus [Figure 1].
T2-weighted magnetic resonance imaging reveals bilateral hyperintense thalamic masses with focal hypointensities
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T2 and fluid-attenuated inversion recovery (FLAIR) sequences [Figure 2]. The contrast images showed mild peripheral enhancement [Figure 3]. There was evidence of moderate hydrocephalus with periventricular ooze.
T1-weighted axial post-contrast image reveals mild peripheral enhancement
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T2 and fluid-attenuated inversion recovery (FLAIR) sequences [Figure 2]. The contrast images showed mild peripheral enhancement [Figure 3]. There was evidence of moderate hydrocephalus with periventricular ooze.
Photomicrographs showing (a) a highly cellular tumor with foci of palisading necrosis (hematoxylin and eosin (H and E), original magnification x400) and (b) microvascular proliferation (H and E, original magnification x400). (b) The tumor cells display marked nuclear pleomorphism and frequent mitotic figures (H and E, original magnification x400). (c) Immunohistochemistry for p53 showed nuclear positivity (immunohistochemistry (IHC), original magnification x400). (d) MIB-I labeling index is 60% (IHC, original magnification x400)
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Histopathological examination of the biopsy specimen revealed a highly cellular tumor with foci of palisading necrosis [Figure 4a] and microvascular proliferation [Figure 4b]. The tumor cells showed marked nuclear pleomorphism and frequent mitotic figures [Figure 4b], including atypical forms. On immunohistochemistry, the tumor cells were immunopositive for p53 [Figure 4c] and were negative for epidermal growth factor receptor (EGFR). MIB-I labeling index was approximately 60% in the highest proliferating areas [Figure 4d].