PMC9703048_01
Contrast-enhanced computed tomography of the brain (A) in axial plane and neck (B) in coronal plane. An enhancing lesion in the left middle cerebellar peduncle is causing mass effect with mild effacement of the fourth ventricle (curved arrow). A right thyroid nodule is also seen synchronously (star).
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CT scan of the brain revealed an intra-axial lesion in the left cerebellum with an incidental finding of a right thyroid nodule ( Figure 1 ).
MRI* of the brain in axial T2W** (A, D), T1W*** post gadolinium (B, E), SWI**** (C), and rCBV***** colour map (F) at presentation (top row) and at 2 months (bottom row). The left middle cerebellar peduncle mass demonstrates a heterogeneous hyperintense signal on T2 with minimal peripheral enhancement on T1 post-contrast. The hypointensity on SWI*** indicates presence of hemosiderin (arrow). The lesion significantly increases in size on the follow-up MRI (C, D) causing significant mass effect; the enhancement is more heterogeneous with irregular rim enhancement and central necrosis. Increase in rCBV at the enhancing region of the rCBV colour map indicates a high-grade tumour (block arrow). *Magnetic resonance imaging, **T2-weighted, ***T2-weighted, ****susceptibility-weighted imaging, and *****relative cerebral blood volume.
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Magnetic resonance imaging (MRI) revealed a lobulated lesion in the left middle cerebellar peduncle extending into the pons ( Figures 2A-C ). A follow-up MRI 2 months later revealed enlarging left cerebellar/pons mass with central necrosis ( Figures 2D-F ).
Cytological features of papillary thyroid carcinoma. (A) Cellular smears with loose cohesive clusters of malignant cells (Pap*, x100). (B) The malignant cells display enlarged overlapping nuclei with irregular contours and fine powdery chromatin. Occasional intranuclear inclusions (arrow) and grooves are observed (Pap, x600). (c) Psammoma bodies are also noted (Pap, x600). *Papanicolaou stain.
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Ultrasound-guided, fine-needle aspiration cytology of the enlarged thyroid gland confirmed the presence of papillary thyroid carcinoma ( Figure 3 ).
Immediate post-op plain computed tomography of the brain in axial (A, B) and coronal (C). Hyperdense hematoma (star) at the left cerebellopontine angle is seen. The fourth ventricle is obliterated with resultant hydrocephalus.
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His immediate post-op CT showed a small haematoma at the left cerebellopontine angle with no mass effect and hydrocephalus ( Figure 4 ).
Histopathological and immunohistochemistry features of glioblastoma. (A) Unremarkable cerebellar tissue (asterisk) with adjacent tumour tissue (H&E*, x40). (B) Composed of diffuse sheets of malignant cells exhibiting pleomorphic hyperchromatic nuclei with inconspicuous nucleoli and moderate cytoplasm. Mitotic figures are frequently seen, including the atypical form (H&E, x400). (C) Microvascular proliferation and geographical necrosis (arrow) are also noted (H&E, x100). Immunohistochemically, the malignant cells showed (D) diffuse GFAP** positivity (GFAP, x400). (E) Ki 67 proliferative index is high (Ki67, x400), while (F) CK*** AE1/AE3 is negative (CK AE1/AE3, x 400). *Haematoxylin and eosin stain, **glial fibrillary acidic protein, and ***cytokeratin stain.
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Histopathological examination confirmed the presence of glioblastoma multiforme, World Health Organization grade IV ( Figure 5 ).