PMC5767479_01
(a) Head CT scan shows a hyperdense lesion in the right parietal area. CT scan with bone window shows remarkable bone destruction of the right parietal skull. (b) Gd-enhanced MRI shows a heterogeneously enhanced lesion, adjacent to the mastoid air cell.
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F1
A non-contrast computed tomography (CT) scan of the brain demonstrated a 5-cm mass involving the meninges with invasion of the parietal bone (Fig. 1a). A magnetic resonance imaging (MRI) scan with gadolinium showed a heterogeneously enhanced mass in the right parietal region (Fig. 1b).
(a) Light microscopy shows high-grade sarcoma with poorly differentiated and highly proliferative atypical spindle shaped cells. (b) Immunochemistry revealed staining for vimentin, alpha-smooth muscle actin, and desmin.
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F2
Histology showed a malignant spindle cell neoplasm (Fig. 2a) with positive immunostaining for alpha-smooth muscle actin, vimentin, and desmin (Fig. 2b).
(a) Follow-up head MRI at 31 months showed local recurrence in the right mastoid air cell. (b) Follow-up head MRI at 45 months showed cystic degeneration of the recurrent lesion.
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F3
Although postoperative recovery was uneventful, follow-up MRI at 31 months showed local recurrence mainly in the mastoid air cell (Fig. 3a), which was probably caused by cancer cell dissemination through cerebrospinal fluid leakage. Follow-up MRI at 45 months showed cystic degeneration of the local recurrent lesion (Fig. 3b), and she is doing well in spite of hearing loss of the right ear.