PMC10134051_01
Solid-cystic lesion with epicenter in the right occipital lobe (a, b) and heterogeneously enhancing solid component adjacent to the torcula (c, d), showing mild restricted diffusion (e, f), delineating a central area of necrosis. No associated hemorrhagic or calcified component (g) or increased perfusion (h). Sequences: axial FLAIR (a), sagittal T1 (b), axial and coronal T1 post-contrast (c, d), axial DWI and ADC map (e, f), axial SWI (g), and axial ASL (h). ASL, arterial spin labeling; FLAIR, fluid-attenuated inversion recovery.
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F1
Magnetic resonance imaging (MRI) (Fig. 1) showed an expansive solid-cystic mass lesion centered in the right occipital lobe, with a predominant lateral cystic component and an enhancing medial solid component adjacent to the torcula, which showed mild restricted diffusion.
a Pathological and immunohistochemical analysis: highly cellular tumor, resembling CNS embryonal tumors' morphology; hematoxylin and eosin (HE), magnification x40. b Spontaneous micronecrosis, HE magnification x100. c Atypia, mitosis, and microvascular proliferation; HE, magnification x200. d P53 mutated, magnification x100. e GFAP negative, magnification x100. f Loss of ATRX expression, magnification x100. g OLIG2 negative, magnification x100. h EGFR negative, magnification x100. i IDH-1 negative, magnification x100. j Ki67 80%, magnification, x200.
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F2
The Ki67 was 80% (Fig. 2).
a Immediate postoperative imaging shows no residual tumor. 2020: a new area of increased FLAIR signal (b) and restricted diffusion (c) in the white matter of the right corona radiata and centrum semiovale, with increased perfusion (d) as per DSC technique. 2021: new markedly restricted lesions in the body of the corpus callosum (e) and left corona radiata (f). 2022: new progression to both cerebral hemispheres (g) with heterogeneous contrast enhancement (h). FLAIR, fluid-attenuated inversion recovery; DSC, dynamic susceptibility contrast.
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F3
In February 2020, she presented with left hemiparesis, and the MRI demonstrated a new area of restricted diffusion and increased fluid-attenuated inversion recovery signal in the white matter of the right corona radiata and centrum semiovale, with no contrast enhancement (Fig. 3). We changed the systemic therapy for lomustine plus bevacizumab, performed from May 2020 to January 2021 when we evidenced a new progression in a nonirradiated area with lesions in the body of the corpus callosum and left corona radiata, with marked diffusion restriction (Fig. 3). MRI showed a new lesion extending to both cerebral hemispheres and heterogeneous enhancement, inferring disruption of the brain-blood barrier (Fig. 3).