PMC5329863_01
Pre- and post-operative brain MRI. (A) Axial T2 - weighted image. (B) Axial FLAIR T2 - weighted image. (C) Axial T1 - weighted image. (D) Coronal T2 - weighted image. (E) Coronal T1 - weighted image. (F) Enhanced sagittal T1-weighted image. (G) Enhanced coronal T1 - weighted image. (H) Post-operative enhanced sagittal T1-weighted image. (I) Post-operative enhanced coronal T1 - weighted image.
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A high intensity zone was observed in the grey matter of the lesion (Fig. 1A-E) and non-homogeneous contrast enhancement images were discovered (Fig. 1F-G). The patient's post-operation MRI confirmed that the mass had been completely removed and no evidence of tumor remnants was revealed (Fig. 1H&I).
Photomicrographs of the surgical specimens from this case. Haematoxylin-Eosin (H & E) stained frozen section (A) and paraffin section (C) show the tumor consisted primarily of cholesterol cleft granulomas and hemosiderosis. Haematoxylin-Eosin (H & E) stained frozen section (B) and paraffin section (D) show xanthoma cells and lymphoplasma cells. (E) Prussian Blue Staining shows that the ferric ion (+3) present in the tissue combines with the ferrocyanide. (F), (G) Ziehl-Neelsen method for demonstrating lipofuscin shows lipofuscin. (H) Immunohistochemistry revealed the expression of cytokeratin in the tissue. Anti-cytokeratin stain. (I) Immunohistochemistry revealed no expression of prolactin in the tissue. Anti-Prolactin stain. A-F, H, I x 100, Bar = 200 1/4m; G, x400, Bar = 50 1/4m.
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Intraoperative frozen sections showed that the tumor was composed of small epithelial cells with foamy macrophage and lymphoid infiltration, a portion was undergoing necrosis; hemosiderin deposits and cholesterol clefts were also observed (Fig. 2A&B). Histologic examination of the mass revealed distinct granulomatous inflammation consisting of macrophages and hemosiderin-laden macrophages with a few lymphocytes and plasma cells admixed with large regions of cholesterol cleft deposition and fibrin (Fig. 2C-G). Immunohistochemical analysis of the lesion tissue was performed; the results revealed that there were a few small and low cuboidal epithelium, showed positive immunoreactivity on staining for cytokeratin (Fig. 2H) and negative expressions of prolactin (Fig. 2I).