PMC9428339_01
At the first illness, on T1-weighted and T2-weighted images, the tumor revealed long signal abnormal signals (A,B). In FLAIR, it was an iso-low signal (C). DWI showed a low-signal tumor (D). Contrast-enhanced MRI images showed a markedly enhanced mass (E-G).
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F1
On T1-weighted and T2-weighted images, the tumor revealed long signal abnormal signals (Figures 1A,B), an iso-low signal in FLAIR (Figure 1C), a flocculent slightly high signal in the inner part, and a slightly low signal and thin signal in the edge. Contrast-enhanced MRI images showed lamellar enhancement in the early stage after enhancement, and lamellar enhancement was visible in the capsule after delay, and the meninges were also significantly strengthened (Figures 1E-G). The lesions were hypointense on DWI, and were slightly isointense in patches (Figure 1D).
After the first surgery, hematoxylin and eosin staining of aggressive angiomyxoma (AAM): short spindle cells are seen on a mucous background, showing invasive growth (A:10x, B: 40x); in immunohistochemistry, S-100 was positive (C).
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F2
The tumor was completely removed and a pathological examination revealed short spindle cells on a mucous background with mild cell morphology and aggressive growth (Figures 2A,B). CD34 (-) (Figure 2C). Combined with the results of immunohistochemistry, two professors of pathology participated in the diagnosis, and finally the tumor was considered to be aggressive angiomyxoma.
One year after the first operation, the CT scan showed multiple cystic bone destructions around the original cranial repair site (A-C). Around the repaired skull, the tumor revealed long signal abnormal signals on T1-weighted and T2-weighted images (D,E). In FLAIR, it was an iso-low signal (F). Contrast-enhanced MRI images also showed a markedly enhanced mass (E-G).
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F3
MRI data also revealed that there was aberrant space occupied near the cranioplasty with abnormal signals of long T1 and long T2, an iso-low signal in FLAIR, a flocculent slightly high signal in the inner part, and a slightly low signal and thin signal in the edge. Meanwhile, a slightly hypointense thin capsular shadow can be seen at the edge (Figure 3).
After the second operation, Hematoxylin-eosin (HE) staining and immunohistochemistry of the tumor. Thin-walled blood vessels surrounded by several spindle cells can be seen in the images (A: 10x, B: 40x); In immunohistochemistry, vimentin was positive (C).
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F4
The tumor contains small thin-walled blood vessels, and proliferating spindle cells can be seen around the vessels (Figures 4A,B). With combined immunohistochemical analysis [EMA (-), vimentin (+), desmin (-), S100 (+-), CD34 (-), cytokeratin pan (-), ER (-), PR (-)] and medical history-taking, we considered a recurrence of aggressive angiomyxoma (Figure 4C).