PMC3764961_01
a MRI scan, T2 imaging and axial view: a deep left insular lesion in the temporal lobe is shown. b MRI scan, T2 imaging, and axial view: the lesion can be clearly seen as well as the partial resection of its anterior portion.
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F1
T1 hypointense and T2 hyperintense lesion in the left insular region, which did not enhance with gadolinum (fig. 1a). The lesion was exposed via a pterional approach and wide splitting of the Sylvian fissure and generously removed; however, it was intentionally not radically removed. This latter was well controlled with a low medication dosage until 2004, when, due to recrudescence of the seizures, he underwent a MRI that again documented an abnormal area in the deep left temporal region (fig. 1b).
a Histological sections of cerebral tissue with moderately increased cellularity constituted by astrocytes showing monotony in their appearance, elongated or round nuclei with occasional atypia, absence of mitosis, and somewhere gemistocytic aspect, featuring a diffuse astrocytoma. b, c Immunohistochemical examination reveals the positivity for glial fibrillary acid protein in the majority of cells (b) and CD68 in an area of pseudo-cystic degeneration (c). d Interstitial cells containing hemosiderin pigment are also present. e, f Examination of recurrent tumor biopsy at different magnification reveals marked hypercellularity with nuclear pleomorphism and mitotic figures (arrowhead), compatible with the diagnosis of anaplastic astrocytoma. a, d-f HE staining. b, c Diaminobenzidine as chromogen. a-c, e Original magnification, 100x. d, f Original magnification, 200x.
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F2
II according to the WHO classification). In addition, pseudo-cystic areas containing hemosiderin pigment and CD68-positive macrophages, interstitial hemosiderin-loaded macrophages and inflammatory cells were also detected (fig. 2c, d). Histological examination now revealed (fig. 2e, f) an anaplastic astrocytoma (grade III according to the WHO classification).
a MRI scan, T1 imaging, and axial view: a deep slightly hyperintense lesion localized to the cavity related to the previous resections can be seen. b MRI scan, T1 imaging, and axial view: the lesion enhancement following gadolinium is shown.
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F3
He was readmitted in December 2006 because an MRI follow-up study (fig. 3a, b), performed again because of worsening of the seizures, had demonstrated an area of contrast enhancement in the context of the previously abnormal area.