PMC4665129_01
PMC4665129_02
Preoperative axial images. T1-weighted image after gadolinium administration (a), demonstrating multiloculated ring-enhancement. Diffusion- weighted image demonstrates a very small amount of increased signal (b), but a decreased apparent diffusion coefficient value is not obvious (c). Findings are consistent with malignant neoplasm, either primary or metastatic, but also with abscess
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F1
While closely associated with the convexity dura and the tentorium, the masses appeared to be intra-axial, and were interpreted as most consistent with malignant glioma or metastatic lesion [Figure 1].
Postoperative axial T1-weighted image after gadolinium administration, demonstrating resection of the lesions with postoperative changes and no evidence of residual enhancement
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F2
The abscess was resected [Figure 2] and the patient was started on intravenous lipid complex amphotericin B and flucytosine, which he received for approximately 3 weeks.
Numerous giant cells are present in the granulomatous inflammation (a), many of which contain intracytoplasmic fungal organisms (b). A CD163 stain shows abundant macrophages (c)
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F3
A CD163 stain demonstrated abundant macrophages, and also highlighted the larger, multinucleated histiocytic giant cells [Figure 3].
The fungal organisms are positive with both periodic acid-Schiff (a) and Gomori's methenamine silver stains (b)
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F4
The fungal organisms were positive for both periodic acid-Schiff and Gomori's methenamine silver [Figure 4] stains.
There is an abundance of both CD4 helper T cells (a) and CD8 cytotoxic T cells (b)
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F5
There was an abundance of T cells, with a slight predominance of the CD4 helper/inducer subset as compared to the CD8 cytotoxic/suppressor subset [Figure 5].
The CD56 (a) and CD57 (b) stains show that rare natural killer cells are present
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F6
Natural killer cells were rarely present [Figure 6].
Axial T1-weighted image after gadolinium administration showing complete resolution of lesions with chronic encephalomalacia at 1 year postsurgery and after completing antifungal treatment
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F7
His MRI at this time showed small lobulated areas of enhancement that were interpreted as postsurgical change and not a recurrence of the abscess [Figure 7].