PMC4429840_01
MR images on admission demonstrating two different types of lesions in each cerebellar hemisphere. The right lesion shows ring enhancement with gadolinium and hyper-intensity on DWI, whereas, the left lesion does not. Left: T1-weightedimages, center: T1-weighted images with gadolinium, right: diffusion-weighted images.
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Computed tomography (CT) and magnetic resonance (MR) imaging revealed two cystic lesions, one in each of the cerebellar hemispheres (Fig. 1). Initially, we considered these lesions to be metastases, but the right lesion showed high intensity on diffusion-weighted images (DWI) (Fig. 1), raising the possibility of a brain abscess.
Upper: MR image showing slightly elevated amino acids (0.9 ppm) and a relatively low choline peak. Lower: pathological examinations of the exudate showing a collection of inflammatory cells (left: Papanicolaou stain x 10; right: Papanicolaou stain x 200).
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MR spectroscopy revealed elevated lactate, slightly elevated amino acids (0.9 ppm), and a relatively low choline peak, which also suggested an abscess (Fig. 2). Pathological examination of the exudate indicated large numbers of inflammatory cells but no malignant cells were detected after Papanicolaou staining, and the exudate was thus, confirmed to indicate an abscess (Fig. 2).
Right lesion showing progression over two months; pathological examinations after the second surgery confirmed well-differentiated adenocarcinoma. Left: T1-weighted images with gadolinium three weeks after surgery (upper: axial images, lower: sagittal images). Center: T1-weighted images with gadolinium eight weeks after surgery (upper: axial images, lower: sagittal images). Right: pathological examinations after the second surgery (upper: hematoxylin-eosin stain x 10, lower: hematoxylin-eosin stain x 200).
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The lesion was relatively hard with numerous fine feeding arteries, and the histopathology indicated a well-differentiated adenocarcinoma (Fig. 3).