PMC7568100_01
(a-d) Cranial angiomatoid fibrous histiocytoma. (a) T1 axial head magnetic resonance imaging (MRI). Homogeneously hypointense infratentorial 25.0 mm lesion; (b) T2 postcontrast MRI of the brain. Multilobulated enhancing mass at the lateral aspect of the tentorium on the left; (c) T1 coronal MRI of the brain. Homogenous lesion extending above and below the tentorium, possible occlusion of the transverse sinus as it is not visualized; (d) Axial FLAIR MRI of the brain.
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F1
MRI of the brain showed an isointense T1 and hyper-intense T2 avidly enhancing extra-axial mass near the posterior edge of the tentorium cerebelli on the left side extending superiorly and inferiorly to the tentorium [Figure 1]. Multiple small cystic foci were visualized within the mass, and a large amount of vasogenic edema above and below the tentorium with mass effect and mild midline shift of the third ventricle to the right was appreciated.
(a) Postoperative T1 precontrast magnetic resonance imaging and (b) T1 postcontrast MRI showing 95% debulking with a small focus of contrast enhancement anteriorly in operative bed suggesting possible residual tumor.
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F2
A multidisciplinary tumor board recommendation was for repeat MRI in 6 months [Figure 2].
(a-d) Microscopic analysis of tumor specimen. (a) Pale histiocytoid tumor cells (lower half) with peripheral inflammatory response and hemosiderin deposition (hematoxylin and eosin), (b) and (c) the neoplastic cells are strongly and diffusely immunoreactive to desmin and Cam 5.2 (Immunoperoxidase ), and (d) the neoplastic cells are negative for somatostatin receptor 2A.
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F3
Microscopic examination revealed a dural-based multinodular tumor with a fibrous capsule [Figure 3]. The neoplastic cells were negative for somatostatin receptor 2A, Stat 6, PR, CD163, CD20, Pax-5, CD3, CD138, MyoD-1, S-100, Myogenin, MyoD1, CD21, and ALK [Figure 3].