PMC6180856_01
A well-demarcated mass is seen in the right temporal lobe with extensive vasogenic oedema on T
2 weighted MRI. The mass shows hyper- and hypo-intensity, indicating haemosiderin deposition (arrows; a). T
1 weighted image shows a hypointense mass (arrowheads) with hyperintense areas in the periphery, suggesting haemorrhagic foci (arrows; b). Contrast-enhanced T
1 weighted image of the brain shows significant contrast enhancement in the hypointense areas on the pre-enhanced T
1 weighted image (c).
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fig1
The patient underwent a contrast-enhanced brain MRI that revealed a well-demarcated mass in the right temporal lobe (Figure 1).
Right lateral common carotid angiogram of the brain shows contrast medium enhancement (arrow), supplied by the inferior branch of the right middle cerebral artery, in the arterial phase (a). The contrast medium pooling continues until the venous phase, suggesting the presence of a blood sinus-like structure in the mass (arrow; b).
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fig2
T 1 weighted image of the brain showed significant contrast enhancement in the hypointense area on the pre-enhanced T 1 weighted image. The mass was supplied by the inferior branch of the right middle cerebral artery, and conventional angiography showed spotty stains in the arterial phase and spreading and pooling of the contrast medium in the venous phase, which suggested the presence of blood sinus-like structure in the mass (Figure 2).
An MRI performed 1 year ago shows hyperintense areas in the bilateral temporal lobes, indicating radiation-induced change on a T
2 weighted image (arrows).
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fig3
T 2 weighted image 1 year before (Figure 3), the mass was considered to arise within the radiation field of the previous radiotherapy, which probably involved opposing portal irradiation. The preoperative diagnosis was radiation-induced lesions, including cavernous malformation and glioma.
Haematoxylin and eosin-stained section of the temporal lobe mass (original magnification, x400) reveals widespread haemorrhage and abnormal vessel proliferation in the tumour. Abnormal vessels contain organized blood clots, and have thick and hyalinized walls. The dilated intravascular lumens are covered by epithelial cells. These cells exhibit variable cytologic atypia and mitotic activity.
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fig4
These cells exhibited variable cytologic atypia and mitotic activity (1-2  per 10 high power field) (Figure 4).
Contrast-enhanced T
1 weighted image performed the day after the surgery reveals no residual tumour.
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fig5
Complete surgical resection was achieved and no residual tumour was evident on the postoperative MRI (Figure 5).