PMC8168699_01
Preoperative, intraoperative, and postoperative imaging. (a) Head computed tomography (CT) at presentation indicating subarachnoid hemorrhage, (b) preoperative angiogram (anteroposterior view), (c) preoperative angiogram (oblique view), (d) preoperative 3D angiography of the neoplastic aneurysm, (e) intraoperative angiogram, (f) postoperative head CT.
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F1
Head computed tomography (CT) revealed a small volume subarachnoid hemorrhage within the sulci overlying the posterior left cerebral convexity [Figure 1a]. M4 segment of the left MCA [Figure 1b and c]. Mild stenosis of the distal parent vessel and branch vessel origins was also noted. The aneurysm was successfully clipped and resected, and the sample was sent for histopathology [Figure 1d and e]. A postoperative CT scan of the head demonstrated expected postoperative changes involving the parietal lobe [Figure 1f].
Pathology images. (a) Hematoxylin and eosin staining demonstrating a vessel with tumor cells within the lumen and wall, (b) immunohistochemical stain for cytokeratin AE1/AE3, demonstrating positivity in the tumor cells, (c) immunohistochemical stain showing positivity for Sox10, characteristic of triple-negative breast cancer.
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F2
Histopathological examination of the aneurysm sample confirmed triple-negative invasive ductal breast carcinoma [Figure 2].
Follow-up radiographic imaging. (a) Digital subtraction angiography (DSA) of a new pseudoaneurysm arising from a distal branch of the left callosomarginal artery (red arrow), (b) 3D DSA of the aneurysm (red arrow), (c) DSA of small pseudoaneurysm arising from a distal M2 anterior division branch of the right middle cerebral artery (red arrow).
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F3
In addition, there was a mixed fusiform and saccular pseudoaneurysm arising from a distal branch of the left callosomarginal artery with a saccular component measuring up to 2 mm in maximum dimension [Figure 3a and b], as well as a 1 mm saccular outpouching arising from a distal M2 anterior division branch of the right MCA, suspicious for an additional small pseudoaneurysm [Figure 3c].