PMC7395537_01
Magnetic resonance imaging with diffusion sequence shows an important restriction of diffusion in the peripheral region.
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F1
Magnetic resonance imaging (MRI) showed an expansive intracranial lesion at the right frontoparietal level with abundant perilesional edema, areas that enhance paramagnetic contrast and a marked restriction of diffusion in the peripheral region [Figure 1].
Intraoperative image showing a tumor lesion in the subcortical region with a weak fluorescence of the tumor tissue after administration of 5-aminolevulinic acid.
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F2
Suspecting a high-grade primary brain tumor, a fluorescence-guided total resection with 5-ALA was performed, showing a tumor tissue of solid consistency, pale appearance, and with poor uptake of fluorescent marker [Figure 2].
Hematoxylin-eosin stain showing both tumor components and transition area (x2).
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F3
The definitive histological study revealed a GB/PNC with a high cellular proliferation index (Ki-67 95%) [Figures 3 and 4].
(a) Hematoxylin-eosin stain showing a tumor with dense cellularity and glomeruloid vessels GB-compatible (x10). (b) Hematoxylin- eosin stain showing atypical cellularity with marked nuclear pleomorphism and abundant mitosis (x20). (c) Gliofibrillar acid protein (GFAP) staining showing glial line hypercellularity (x10). (d) Synaptophysin staining showing negative immunoreactivity (x10). (e) MIB-1 staining showing the proliferation index of glioblastoma (x10). (f) Anti-isocitrate dehydrogenase (IDH)-1 R132H immunohistochemistry showing absence of IDH-1 mutation (IDH wild-type GB) (x10). (g) Hematoxylin-eosin stain showing solid-looking primitive nodules presenting neuronal differentiation separated by a desmoplasic stroma (x10). (h) Hematoxylin-eosin stain showing high nuclear-cytoplasmic ratio, karyorrhexis, and occasional cell wrapping (x20). (i) GFAP staining showing low GFAP expression within the foci of the primitive neuronal component in contrast to the glioma component (x10). (j) Synaptophysin staining showing positive immunoreactivity in primitive cells (x10). (k) MIB-1 staining showing a high Ki-67 labeling index with nuclear positivity for more than 90% of tumor cells PNC-compatible (x10). (l) Anti-IDH-1 R132H immunohistochemistry showing a negative study for primitive neuronal component (x10).
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F4
The definitive histological study revealed a GB/PNC with a high cellular proliferation index (Ki-67 95%) [Figures 3 and 4].
Average percentage of MGMT methylation.
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F5
The average methylation percentage of O6-methylguanine- DNA methyltransferase (MGMT) was 66.2% [Figure 5].