PMC4061578_01
T1 with contrast, FLAIR, and DWI MRI shortly after presentation
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F1
MRI performed shortly after presentation [Figure 1] demonstrates a 2 x 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe.
Magnetic Resonance Spectroscopy
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F2
There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain [Figure 2].
T2 FLAIR MRI one month after presentation
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F3
Repeat MRI at one month demonstrated worsening edema consistent with worsening of the pathologic process [Figure 3].
T1 with contrast MRI on postoperative day one
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F4
The MRI performed on postoperative day one showed some residual enhancement along the splenium of the corpus callosum [Figure 4].
T2 FLAIR MRI one year postoperative
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F5
At last follow-up 1 year postoperation, cerebritis had resolved on MRI [Figure 5] and her neurologic status was normal.
Hematoxylin and eosin stain at x200 magnification
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F6
Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7].
Silver stain at x400 magnification
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F7
Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7].