PMC9674501_01
Perimetry of the patient shows right-sided inferonasal quadrantanopia.
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Ophthalmological examination revealed a choked disc on both optic fundi and right-sided quadrantanopia (Fig. 1).
(A) Axial computed tomography scan shows an isodense mass in the right frontal convexity (asterisk) accompanied by extensive perifocal edema. Axial (B) and coronal (C) bone target computed tomography scans at the same level reveal smooth-contoured skull erosion adjacent to the tumor, involving the inner table and diploe (arrows). The outer table is intact and hyperostotic changes are not observed.
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The outer table was intact, and no hyperostotic changes were found (Fig. 2).
Axial T1- (A), T2- (B), and post-contrast axial (C) and coronal (D) T1-weighted magnetic resonance images reveal a dural-based mass in the right frontal lobe. It measures 33 x 35 x 37 mm in diameter, appearing with inhomogeneous intensity on T1- and T2-weighted sequences, and is intensely enhanced. A dural tail is inconspicuous (C, D). Intralesional cysts are identified peripherally (D).
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On cerebral magnetic resonance imaging (MRI), the tumor was dural-based, measured 33 x 35 x 37 mm, appeared inhomogeneous intensity on both T1- and T2-weighted sequences, and was intensely enhanced (Fig. 3). Moreover, intralesional cysts were found peripherally (Fig. 3D).
Magnetic resonance angiography, oblique view, shows an unusually ectatic middle meningeal (arrows) and superficial temporal (dashed arrows) arteries on the right side.
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Magnetic resonance angiography revealed unusually ectatic middle meningeal and superficial temporal arteries on the ipsilateral side of the tumor (Fig. 4).
Photomicrographs of the resected specimens show tumor tissue comprising cells with oval-shaped nuclei and intervening vasculature of varying sizes (A). Few mitotic figures are observed. Immunohistochemical examination shows positive staining for epithelial membrane antigen (B) and progesterone receptor (C) and negative staining for STAT6 (D). A: hematoxylin and eosin stain, x400; B: epithelial membrane antigen, x400; C: progesterone receptor, x400; D: STAT6, x400.
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Immunohistochemical examination showed positive staining for epithelial membrane antigen and progesterone receptor and negative staining for STAT6 (Fig. 5).
Pre- (A) and postoperative (B) post-contrast coronal T1-weighted magnetic resonance images reveal compression of the right superomedial surface of the optic chiasm (A, arrow), caused by the swollen frontal lobe, and its remarkable resolution after surgery (B, dashed arrow). OC, optic chiasm.
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Cerebral MRI performed on postoperative day 5 showed remarkable resolution of compression exerted on the optic chiasm that had been caused by the swollen right frontal lobe (Fig. 6).