PMC4927557_01
Preoperative magnetic resonance imaging and digital subtraction angiography. Preoperative axial (a) and sagittal (b) views in gadolinium-enhanced T1-weighted MRI, showing a prominent enhanced mass lesion and enhanced vessel-like structures in surrounding parenchyma in the left cerebellar hemisphere. Anteroposterior (c) and lateral (d) views in angiography, showing strong tumor staining with a feeding artery from the left posterior inferior cerebellar artery, and a draining vein into the left inferior vermian vein, indicating arteriovenous shunt [anteroposterior view (e) and lateral view (f)]
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Fig1
Gadolinium-enhanced magnetic resonance imaging (MRI) showed a homogeneous strongly enhanced hypervascular lesion with surrounding enhanced vessels located in the left cerebellar hemisphere (Fig. 1a, b). Digital subtraction angiography showed a strongly stained lesion fed by the peripheral branch (tonsillohemispheric segment) of the left posterior inferior cerebellar artery (PICA) and draining into the inferior vermian vein, revealing arteriovenous shunting (Fig. 1c-f).
Photomicrographs showing histological and immunohistochemical findings in tumor tissue. a Intraoperative frozen section of the tumor tissue. Polygonal cells proliferated in nests and cords. Many blood vessels (arrows) were found between the nests and cords. Hematoxylin and eosin staining in the formalin-fixed paraffin-embedded tumor tissue showed numerous thin-walled microvessels (b) and proliferation of vacuolated atypical sheeted tumor cells with clear and eosinophilic cytoplasm (c). d A small part of the tumor had a thyroid follicle-like pattern including eosinophilic liquid. CD31 (e) and CD34 (f) staining were positive. g The tumor was diffusely positive for vimentin. h Thyroid transcription factor-1 (TTF-1)-positive cells were present in part of the tumor. a, b, e-h x200; c, d x600
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Fig2
An intraoperative pathological examination was performed, and the frozen section of the tumor tissue showed that polygonal cells proliferated in nests and cords with many blood vessels (Fig. 2a). Histological examination of the formalin-fixed paraffin-embedded tumor tissue revealed proliferation of vacuolated sheeted tumor cells with clear and eosinophilic cytoplasm and numerous thin-walled vessels (Fig. 2b, c). A thyroid follicle-like pattern including eosinophilic liquid was partially present (Fig. 2d). Tokyo, Japan), vimentin (dilution 1:50; Dako) and thyroid transcription factor-1 (TTF-1) (dilution 1:200; Dako) (Fig. 2e-h), and negative for GFAP (data not shown). The final diagnosis was PTC.
Postoperative magnetic resonance imaging. Postoperative axial (a) and sagittal (b) views of gadolinium-enhanced T1-weighted and c T2-weighted MRI, showing total resection of the tumor and no ischemic and contusional complications
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Fig3
Postoperative MRI showed total resection of the tumor bulk and no ischemic complications (Fig. 3).