PMC5655758_01
Noncontrast axial head CT of patient on initial presentation
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A noncontrast head computed tomography (CT) scan revealed a 4 cm right frontal hematoma with associated edema and sulcal effacement along with 3 mm of right-to-left midline shift [Figure 1].
T1 post-gadolinium axial MRI of patient on initial presentation
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Magnetic resonance imaging (MRI) of the brain with and without contrast done on the night of admission revealed stable acute hemorrhage in the right frontal lobe with underlying dural-based lesions in the right frontal lobe including a dominant hemorrhagic lesion measuring up to 2.4 cm [Figure 2].
T1 post-gadolinium axial MRI of patient obtained within 48 hours of first resection surgery
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Postoperative MRI brain with and without contrast demonstrated enhancement along the margins of the resection cavity, compatible with a resolving residual hematoma [Figure 3].
Histopathology demonstration of resected mass at initial presentation. (a) Much of the neoplasm consisted of uniform cells with pink cytoplasm and vesicular nuclei having single small nucleoli and many mitoses. H and E, x375. (b) In other areas, the tumor was infiltrated by an inflammatory cell reaction rich in eosinophils. H and E, x375. (c and d) Immunohistochemical marker studies were unrevealing except for CD35 and clusterin. Photography courtesy of Dr. M. Rosenblum, Memorial Sloan Kettering Cancer Center, New York, NY. X375
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On immunohistochemical staining, there was focal labeling for CD35 and more diffuse expression of clusterin [Figure 4].
Noncontrast axial head CT obtained on readmission 2 months after initial presentation and surgery
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CTH was performed in the ED, which demonstrated vasogenic edema in the right frontal lobe and 9 mm of the midline shift [Figure 5].
T1 post-gadolinium axial MRI obtained on readmission 2 months after initial presentation and surgery
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MRI brain with and without contrast on admission demonstrated increasing enhancement and edema in the region of the right frontal resection cavity, including a new 1.4 cm nodular focus of enhancement along the falx cerebri [Figure 6].
T1 post-gadolinium axial MRI obtained on third and final admission in December 2015
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