PMC9395982_01
(A-D) Head MRI images showed a space-occupying lesion in the left frontal lobe with heterogeneous enhancement of the mass, surrounding edema, right-lateral midline structure, compression narrowing of the lateral ventricle, and shallowing local sulci and cistern (these red arrows indicate ependymoblastoma).
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F1
Head MRI suggested that the lesion was in the left frontal lobe, about 4.8 x 4.3 cm in size, and T1WI showed uneven enhancement of the lesion (Figure 1). Immunohistochemistry showed EMA (+) (Figure 4C), Syn (weak +) (Figure 4D), CK-P(+), CD56(+), CgA(-), CD99(-), Ki-67(70% +), TTF-1(-), GFAP(-), and Oligo-2(-).
(A,B) High magnification view showed multiple rosettes of ependymoblastoma consisting of a concentric arrangement of small blue round cells around the cavity with nuclear pleomorphism and mitotic activity (HE, x200 and HE, x400). (C,D) Immunohistochemical staining was positive for EMA and Syn, respectively (x100) (these red arrows indicate multiple rosettes).
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F2
The patient was pathologically diagnosed with a PNET in our hospital, which was confirmed as left frontal ventricle ependymoblastoma by pathologic consultation in a superior hospital (Figures 2A,B), with a multi-layer rosette structure. The immunohistochemical staining was positive for EMA (Figure 2C) and Syn (Figure 2D) expressions.
(A) Chest CT scan (before treatment, after radiotherapy, after chemotherapy, and at a recent point), showed a large space-occupying lesion with bronchial occlusion in the left thoracic cavity with an unclear mediastinum boundary. (B) As treatment continued, the lesions gradually shrank, and left pleural effusion increased. (C,D) No significant change was observed in lung metastases between the end of chemotherapy and the last follow-up period, and they were similar in size (these red arrows indicate lung metastases).
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F3
In April 2021, chest CT showed a huge space-occupying lesion in the lung with bronchial occlusion, about 12.9 x 12.5 cm in size (Figure 3A), with an unclear boundary with the mediastinum and a small amount of effusion in the left pleural cavity. Chest CT reexamination in June 2021 (after radiotherapy) indicated that the lung metastasis was significantly smaller than before, about 2.6 x 4.2 cm in size (Figure 3B), with soft tissue shadow visible in the anterior mediastinum, accompanied by mediastinal gas and increased left pleural effusion. In October 2021 (after chemotherapy), chest CT reexamination showed that the lung metastatic lesions continued to shrink, about 2.2 x 0.9 cm in size (Figure 3C), and there was a large pleural effusion on the left side. The most recent chest CT reexamination (February 2022) showed stable lung metastases, about 2.2 x 0.9 cm in size (Figure 3D).
(A,B) High-power view of lung biopsy histopathology showed irregular multilayered rosettes composed of small round blue cells with atypia, respectively (HE, x200). (C,D) Immunohistochemical staining was positive for EMA and Syn, respectively (x100) (these red arrows indicate multiple rosettes).
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F4
Routine biopsy pathology of left lung mass showed fibrous tissue and a small number of round cell tumors with crush injury, containing multiple layers of irregular rosettes (Figures 4A,B). Immunohistochemistry showed EMA (+) (Figure 4C), Syn (weak +) (Figure 4D), CK-P(+), CD56(+), CgA(-), CD99(-), Ki-67(70% +), TTF-1(-), GFAP(-), and Oligo-2(-).