PMC3804146_01
Preoperative axial flair MRI (a) and axial/coronal T1 MRI ((b),(c)) showing a large hemorrhagic infiltrative mass at the right fronto-parietal region. Postoperative axial flair MRI (d) and axial/coronal T1 MRI ((e),(f)) showing a 1 cm persistent tumor within the surgical cavity.
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MRI with contrast revealed a hematoma measuring 4.1 cm AP x 3.5 cm transverse x 4.1 cm craniocaudal with an associated mass effect resulting in approximately 5 mm leftward midline shift (Figure 1). MRI demonstrated a persistent 1 cm enhancing lesion in the right frontal lobe within the surgical cavity (Figure 1).
Hematoxylin and eosin (H&E) stained sections of the initial resection shows fascicular (a) to a less organized (b) arrangements of enlarged hyperchromatic nuclei with atypical mitotic figures. Cells are entrapped by a reticular network (c), containing collagen IV (d). Some of the cells are positive for smooth muscle marker desmin (e). Original magnifications: 50x (a), 200x ((b)-(e)).
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Microscopic sections disclosed highly pleomorphic cells with hyperchromatic nuclei and numerous mitotic figures (Figure 2).
Resection of tumor recurrence showing frank sarcoma composed of intersecting fascicles spindle cells (a), often in a loose arrangements (b), or showing epithelioid changes (c). Granular cytoplasmic changes were evidence (b). Tumor cells are enmeshed by reticulin (d) and collagen IV-containing basal laminas (e). Original magnifications: 100x (a), 200x ((b)-(e)).
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The second pathologic interpretation was therefore of a high-grade malignant spindle cell neoplasm, similar to the previous lesion (Figure 3).
((a),(b)) Preoperative axial flair MRI and T1 coronal MRI showing a recurrent new 7 mm nodular area of enhancement at the superior aspect of the surgical cavity associated with the dura. ((c),(d)) Postoperative axial flair MRI and T1 coronal MRI showing resection of the lesion.
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At 3.7 years after the initial surgery, there was evidence of a new 7 mm nodular area of enhancement at the superior aspect of the surgical cavity associated with the dura in the right frontal lobe with flare changes (Figure 4).