PMC3994687_01
T2-weighted (a) and T1-weighted (b) MRI showing synchronous tumour in the left frontal and temporal regions with solid and necrotic-cystic areas with significant perilesionaledema. (c) T1-weighted image post-gadolinium contrast showed heterogenous enhancement
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F1
Magnetic resonance imaging (MRI) brain scan was performed which revealed two intra-axial lesions with similar imaging characteristics [Figure 1].
(a) The glioblastoma component of the left temporal lobe tumour showing neoplastic astrocytes with pleomorphic nuclei and fibrillary cytoplasm. There was frequent mitotic activity and microvascular proliferation (right of field) (H and E, x200). (b) The CNS PNET component of the left temporal lobe tumour showing densely packed cells with hyperchromatic oval to elongated nuclei, high nuclear cytoplasmic ratios and brisk mitotic activity (H and E, x400). (c) GFAP staining in the glioblastoma cells (GFAP, x200). (d) Synaptophysin was positive in the PNET-like component (Synaptophysin x400)
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F2
In some areas, the tumour resembled a glioblastoma (WHO grade IV) [Figure 2a]. In other areas, the tumour resembled a central nervous system primitive neuroectodermal tumour (CNS PNET, WHO grade IV) [Figure 2b]. Immunoperoxidase staining for glial fibrillary acid protein (GFAP) was positive in the glioblastoma component [Figure 2c] and negative in the CNS PNET areas, while synaptophysin was positive in the CNS PNET areas [Figure 2d] and negative in the glioblastoma cells.
(a) The glioblastoma component of the left frontal lobe tumour showing neoplastic astrocytes with pleomorphic nuclei and fibrillary cytoplasm. There was frequent mitotic activity, microvascular proliferation (right of field) and pseudopalisading necrosis (left of field) (H and E, x200). (b) The oligodendroglial component of the left frontal lobe tumour (H and E, x400)
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F3
There was brisk mitotic activity, microvascular proliferation and pseudopalisading necrosis [Figure 3a]. The oligodendroglial population was associated with a branching capillary network [Figure 3b].