PMC6744787_01
(a) Initial magnetic resonance imaging sequences confirmed a right predominant mass with biventricular expression clearly attached to the septum pellucidum and invasion of the fornix commissure, as shown in axial, coronal, and sagittal T1WI C+ sequences, with gadolinium enhancement of the lesion in a ring-like fashion. (b) The lesion, as seen through the endoscope, was polylobulated, avascular, shiny, and of fibrous consistency. (c) Intraoperative examination showed a nonencapsulated, partially necrotic lesion surrounded by a dense cellular component that included "atypical" multinucleated cells with hyperchromatic nuclei (Hematoxylin-Eosin, x2). (d) Numerous round yeasts with a characteristic thick capsule were found both in the cytoplasm of the histiocytes and giant cells (Gomori Methenamine silver stain, x20).
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F1
Furthermore, active hydrocephalus was present [Figure 1a]. She underwent removal of the lesion plus third ventriculostomy through endoscopy [Figure 1b]. Intraoperative histologic examination showed a partially necrotic lesion surrounded by a dense cellular component that included atypical multinucleated cells and reactive glial proliferation, favoring the diagnosis of primary glioma [Figure 1c].