PMC4508741_01
Postcontrast CT showing uniformly enhanced masses in the lateral left orbit (a) and right parietal bone (b); both were accompanied by bone destruction. Contrast-enhanced T1-weighted MRI of the lesions (c). The lateral lesion of the left orbit partially invaded bone, muscle, and the dura mater. CT: computed tomography, MRI: magnetic resonance imaging.
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F1
CT showed uniformly enhanced masses in the lateral left orbit and right parietal bone; both accompanied bone destruction (Fig. 1a, b). T1- and T2-weighted images, respectively, for both lesions (Fig. 1c). The tumor partially invaded the bone, muscle, and dura mater.
Methionine-PET showing high uptake by the lateral left orbit (a) and right parietal bone (b). FDG-PET (c, d) also shows high uptake by the same lesions, which was less obvious than that shown by methionine-PET. FDG-PET: 18F-fluorodeoxyglucose positron emission tomography.
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F2
Methionine positron emission tomography (PET) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed high uptake by the skull tumors (Fig. 2) but no uptake by other lesions. Because the parietal tumor showed high uptake on PET (Fig. 2b), it was diagnosed as the same metastatic tumor without biopsy.
Histopathological examination of the lateral lesion of the left orbit (a, x400) revealed a large vesicular nucleus and abundant eosinophils to clear the cytoplasm. Immunohistochemical staining was positive for CD7 (b, x400) and CD19 (c, x400) in tumor cells, which indicated a metastasis of intrahepatic cholangiocarcinoma (ICC). These findings were similar to those of the ICC pathological specimen obtained by hepatotomy 2 years previously (d, x400).
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F3
Individual cells had a large vesicular nucleus and abundant eosinophils to clear the cytoplasm (Fig. 3a). Immunohistochemical tumor cell staining was positive for CD7 and CD19 (Fig. 3b, c) and negative for CD20.
PMC4508741_02
Axial T1-weighted MR image (a) showing a hypointensive lesion in the lateral left orbit, which was heterointensive on the axial T2-weighted image (b) and enhanced heterogeneously by Gd-DTPA (c). Axial contrast-enhanced T1-weighted image (d) showing another lesion in the left temporal bone. Coronal contrast-enhanced T1-weighted image (e) showing a third lesion in the left parietal bone, which was bigger than the others and had partially invaded the intracranium in contact with the superior sagittal sinus. Gd-DTPA: gadolinium diethylenetriaminopentaacetic acid, MR: magnetic resonance.
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F4
PET-CT showing high uptake at the left orbital (a), left temporal (b), and left parietal (c) tumors. PET-CT: positron emission tomography computed tomography.
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F5
PET-CT showed high uptake by the skull tumors (Fig. 5), several small lung tumors, and no uptake by other regions.
PMC4508741_03