PMC7751792_01
Head MRI. (A) Cross-sectional T1WI showed large areas of iso- to slightly hypointense signals in the right frontal and parietal lobes (indicated by the arrow). (B) Cross-sectional T2WI showed mixed hyperintense signals in the right frontal and parietal lobes (indicated by the arrow). (C) Coronal FLAIR images showed hyperintense signals on in the right frontal and parietal lobes (indicated by the arrow). (D) Cross-sectional T1W enhanced image showed scattered strips of mild enhancements and strong round enhancements (diameter, 0.5 cm) in the limbic gyrus (indicated by the arrow).
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No abnormal signal intensity was found in the pericranial soft tissues (Figure 1).
HE staining under light microscope at 400x magnification. (A) Tumor cells are pleomorphic and consist of monocytes, multinucleated giant cells, and cells with atypical nuclei, with prominent atypia. (B) Some areas of tumor cells are vacuous with acidophilic bodies. (C) Cells with atypical nuclei and proliferation of reticular fibers around vacuolated cells. (D) The tumor is located in the superficial cortex.
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There was no necrosis or vascular endothelial hyperplasia in the tumor tissue (Figure 2). (3) Immunohistochemical staining:
Immunohistochemical staining (SP two-step method) under light microscope at 400x magnification. (A) There was no loss of ATRX in tumor cells. (B) Some tumor cells expressed GFAP. (C) Some tumor cells expressed OLIG-2. (D) Some tumor cells expressed Vim. (E) A few tumor cells expressed NeuN. (F) Ki-67 antigen marking of the tumor cells showed areas with higher cell proliferation indices. (G) BRAF V600E antigen marking of the tumor cells showed no expression in tumor cells. (H) The BRAF locus was amplified by polymerase chain reaction (PCR) and showed that the tumor had a BRAF V600E mutation.
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The expression patterns of ATRX protein (Figure 3A), glial fibrillary acidic protein (GFAP, Figure 3B), oligodendrocyte transcription factor-2 (OLIG-2, Figure 3C), vimentin (Vim, Figure 3D), neuronal nuclear antigen (NeuN, Figure 3E), and P53 protein were positive. The expression patterns of synaptophysin (Syn), CD34 protein, BRAF V600E (Figure 3G), IDH1 R132H, and S-100 protein were negative. The Ki-67 antigen labeling index was about 15% (Figure 3F). (4) Genetic testing: The BRAF locus was amplified by polymerase chain reaction (PCR). The results showed that the tumor had a BRAF V600E mutation (Figure 3H). The final pathological diagnosis identified (space-occupying lesion in the right frontal lobe)