PMC8492419_01
Initial brain MRI showing a cystic mass in the left frontal region, presented on axial plain, T1-weighted image (a-c).
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F1
Initial magnetic resonance imaging (MRI) revealed cystic mass in the left frontal region; due to pregnancy intravenous contrast was not applied [Figure 1].
Microphotography of a pathohistological section showing histological and immunohistochemical features of a tumorous tissue stained with (a) hematoxylin and eosin, original magnification of x100, (b) GFAP, original magnification of x100, (c) CD34, original magnification of x100, (d) proliferation index Ki67, original magnification of x100. Tumor consisted out of large polymorphic bizarre cells with large nuclei and atypical mitotic figures, cells with empty vacuoles and small astrocytic like neoplastic cells in an epithelioid pattern. A few pre-necrotic areas were described. Proliferation index was positive in 3-5% of the small cells, while in large, bizarre cells was around 30%. According to the WHO classification tumor tissue corresponded to a pleomorphic xanthoastrocytoma.
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F2
According to the WHO classification tumor tissue corresponded to an anaplastic PXA Grade III [Figure 2].
Control brain MRI, after initial biopsy and conformation on diagnosis; supratentorial recurrent tumor mass in the left frontal region with the cystic part in the superior frontal gyrus was revealed, presented on T2-weighted image on coronal (a) and axial plain (b).
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F3
New MRI was performed [Figure 3].
Control brain MRI, 6 months after initial diagnosis, after childbirth revealed a supratentorial recurrent tumor mass in the left frontal region with the cystic part in the superior frontal gyrus, presented on T1-weighted image with contrast enhancement on coronal (a) and axial plain (b).
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F4
After the administration of intravenous contrast, the mass showed heterogeneous enhancement [Figure 4].
Microphotography of a pathohistological section showing histological and immunohistochemical features of a tumorous tissue stained with (a) hematoxylin and eosin, original magnification of x100, (b) synuclein, original magnification of x100, (c) proliferation index Ki67, original magnification of x200. Tumor consisted out of atypical astroglial cells and high mitotic activity. Extensive microvascular proliferation of individual blood vessels was described, as well as focal points of tumor necrosis. Ki67 proliferation index higher was than 50%. According to the WHO classification, it corresponded glioblastoma multiforme, WHO Grade IV.
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F5
According to the WHO classification tumor tissue corresponded to a glioblastoma WHO Grade IV [Figure 5].
(a-f) Control MRI 2 years after initial diagnosis revealed expansive neoplastic masses in the right frontal region, left frontal region with rectal and orbital gyri and pericallosal area affected and in left temporal region, along with necrotic zones.
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F6
MRI revealed expansive neoplastic masses in the right frontal region, left frontal region with rectal and orbital gyri and pericallosal area affected and in the left temporal region, along with necrotic zones [Figure 6].