PMC5838827_01
Preoperative magnetic resonance imaging (MRI). T2 (a), T1 native (b), and T1 after gadolinium administration (c): left cerebellar lesion (arrowhead) slightly hypointense on T1-weighted images and hyperintense on T2-weighted images, with peritumoral edema (black star) and strong ill-defined contrast enhancement. (d) MR perfusion with cerebral blood volume (CBV) cartography: slight peripheral hyperperfusion (white arrow); rCBV = 1.9 x normal contralateral cerebellum white matter. (e) Proton MR spectroscopy: elevated doublet of lactate at 1.33 ppm which is inverted on the spectrum with long echo-time (green arrow). NAA/Creatine ratio is reduced (f) Postoperative CT scan: resection cavity (white arrow)
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F1
MR spectroscopy was obtained and showed a high choline/creatine ratio with increased myoinositol level, suggesting anaplastic behavior of the lesion [Figure 1].
(A): (Hematoxylin eosin x20): tumor showing biphasic pattern of ganglion cells and neoplastic glial cells. (b): (Hematoxylin eosin x20): malignant glial component characterized by hypercellularity, nuclear atypia and increased mitotic activity. (B) Immunohistochemistry x400. (c) GFAP: the neoplastic glial cells are immunoreactive for GFAP. (d) Ki67: Ki67 proliferation index was 20%. (e) Synaptophysin: the neoplastic ganglion cells are immunoreactive for synaptophysin
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F2
The malignant glial component characterized by hypercellularity, nuclear atypia, and increased mitotic activity; however, no microvascular proliferation or necrosis was present [Figure 2a]. The neoplastic glial cells were immunoreactive for glial fibrillary acidic protein (GFAP), immunoreactive for synaptophysin, and the Ki67 proliferation index was 20% [Figure 2b]. Follow-up of the patient with a computed tomography (CT) scan for 6 months after the surgery did not show any evidence of tumor recurrence [Figure 2f].