PMC5569391_01
Top left: HE (Magnification x200); DNT simple form with oligodendroglial-like cells. Top right: GFAP (Magnification x400); immunostaining GFAP is negative in tumour cells. Bottom left: S100 (Magnification x400); immunostaining S100 is positive in tumour cells. Bottom right: Ki-67 (Magnification x600); immunostaining Ki-67 proliferative index is low <1%
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F1
The histopathological analysis revealed a DNT of complex form with specific glioneuronal elements and associated FCD [Figure 8 and Table 1].
(a-c) Axial, coronal and sagittal 3D T1 FFE MR images of the lesion for preoperative planning in 2002, showing the lesion's inferior extension in the white matter to within a few millimetres of the superolateral edge of the left lateral ventricle
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F2
The lesion was treated with a peripheral dose of 12 Gy at the 50% isodose [Figure 10a-c and Table 2].
(a-c) Postoperative axial, coronal and sagittal SET1 (above) and axial T2 (below) MR images in January 2003 demonstrate a small amount of residual DNT tissue (thin graphic circle) at the inferior resection margin in the white matter extending to the left lateral ventricle
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F3
Follow-up MRI in January 2003 [Figure 3a-c] showed nonenhancing residual tumor, without radiological signs of malignant transformation.
PMC5569391_02
Top left: HE (Magnification x200); DNT simple form with oligodendroglial-like cells. Top right: GFAP (Magnification x400); immunostaining GFAP is negative in tumour cells. Bottom left: S100 (Magnification x400); immunostaining S100 is positive in tumour cells. Bottom right: Ki-67 (Magnification x600); immunostaining Ki-67 proliferative index is low <1%
SNI-8-174-g001.jpg
PMC5569391_03_SNI-8-174-g001.jpg
F1
The histopathological analysis revealed a DNT of complex form with specific glioneuronal elements and associated FCD [Figure 8 and Table 1].
(a-c) Axial, coronal and sagittal 3D T1 FFE MR images of the lesion for preoperative planning in 2002, showing the lesion's inferior extension in the white matter to within a few millimetres of the superolateral edge of the left lateral ventricle
SNI-8-174-g003.jpg
PMC5569391_03_SNI-8-174-g003.jpg
F2
The lesion was treated with a peripheral dose of 12 Gy at the 50% isodose [Figure 10a-c and Table 2].
Top left: HE (Magnification x200); DNT complex form tumour pattern resembling low grade glioma with multicystic (pilocytic like) pattern. Top right: GFAP (Magnification x400); immunostaining GFAP is negative in tumour cells. Bottom left: S100 (Magnification x400); immunostaining S100 is positive in tumour cells. Bottom right: Ki-67 (Magnification x600); immunostaining Ki-67 proliferative index is low <1%
SNI-8-174-g006.jpg
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F4
Further re-examination based on immunohistochemistry and molecular analyses (MA) proved the lesion to be a complicated type of DNT, displaying mosaic-like patterns composed of complex structures together with nonspecific elements (low-grade glioma-like structures, see Figure 4 and Table 1).
(a-c) Stereotactic sagittal T1, sag CET1, axial T2 MR images for Gamma Knife treatment planning demonstrates partial, solid contrast enhancement in the T2 hyperintense, residual DNT in the left postcentral gyrus (2002)
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F5
(a and b) T1 + contrast (left), T2 (centre) and FLAIR (right) MR images. Top row (MRI 2008) demonstrates area of T2/FLAIR high signal with no contrast enhancement in the left post central gyrus. Subsequently unchanged over 5 years of follow-up, here compared to MR images from 2013 (bottom row)
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F6
There have been no signs of recurrence or radiation necrosis/edema on subsequent annual MRI from 2008 to 2013 [Figure 6a and b].
PMC5569391_03
Top left: HE (Magnification x200); DNT simple form with oligodendroglial-like cells. Top right: GFAP (Magnification x400); immunostaining GFAP is negative in tumour cells. Bottom left: S100 (Magnification x400); immunostaining S100 is positive in tumour cells. Bottom right: Ki-67 (Magnification x600); immunostaining Ki-67 proliferative index is low <1%
SNI-8-174-g001.jpg
PMC5569391_03_SNI-8-174-g001.jpg
F1
The histopathological analysis revealed a DNT of complex form with specific glioneuronal elements and associated FCD [Figure 8 and Table 1].
(a-c) Axial, coronal and sagittal 3D T1 FFE MR images of the lesion for preoperative planning in 2002, showing the lesion's inferior extension in the white matter to within a few millimetres of the superolateral edge of the left lateral ventricle
SNI-8-174-g003.jpg
PMC5569391_03_SNI-8-174-g003.jpg
F2
The lesion was treated with a peripheral dose of 12 Gy at the 50% isodose [Figure 10a-c and Table 2].
(a and b) Preoperative axial and coronal T2 weighted MR images demonstrate the well-delineated hyperintense mass in the right medial temporal lobe and hippocampus (1994)
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F7
MRI (without IV contrast) revealed a T1 hypointense/T2 hyperintense, well-delineated, possibly multilobular mass located in the inferomedial aspect of the right temporal lobe including hippocampus [Figure 7a and b].
Top left: HE (Magnification x100); DNT complex form with specific glioneuronal element. Top right: HE (Magnification x400); DNT complex form with specific glioneuronal element. Bottom left: GFAP (Magnification x200); immunostaining GFAP is negative in tumour cells. Bottom centre: S100 (Magnification x200); immunostaining S100 is positive in tumour cells. Bottom right: Ki-67 (Magnification x600); immunostaining Ki-67 proliferativ index is low <1%
SNI-8-174-g010.jpg
PMC5569391_03_SNI-8-174-g010.jpg
F8
The histopathological analysis revealed a DNT of complex form with specific glioneuronal elements and associated FCD [Figure 8 and Table 1].
(a-c) 2001 axial T2, axial and coronal CE T1 MR images post subtotal resection demonstrate residual contrast enhancing DNT
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F9
The patient remained stable until 2001, when a follow-up MRI demonstrated a suspect nodular contrast enhancement in the region of the residual tumor located in the right hippocampus and posterior aspect of the medial temporal lobe [Figure 9a-c].
(a-c) 2005 Stereotactic axial T2, axial and coronal CET1 MR images demonstrate the increase in DNT size and contrast enhancement just prior to Gamma Knife treatment
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F10
The lesion was treated with a peripheral dose of 12 Gy at the 50% isodose [Figure 10a-c and Table 2].
(a-d) MRI 2013: axial T2, axial and coronal T1 MR images show dramatic decrease in DNT size and contrast enhancement 8 years after GKRS
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F11
Serial MRI imaging between 2006 and 2013 showed a gradual decrease in tumor size, ultimately without any signs of ARE [Figure 11a-d].