PMC3358955_01
The initial enhanced T1-weighted MR image. (a-c) Show an extra-axial mass lesion in the left frontal lobe. (d, e) Postoperative MR images revealing the remnant tumor beside the SSS. (f) Histopathological findings showed the diagnosis of HPC. (g-l) Additional gamma-knife irradiation was performed. Two-years after the operation, the remnant tumor showed a rapidly regrowth (g-i), and the patients underwent a second surgical intervention (j-l). An immunohistochemical analysis using CD34 was positive (m) and a histological examination revealed an anaplastic HPC with increasing mitotic cells (n)
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F1
On admission, magnetic resonance imaging revealed a well-demarked extra-axial mass lesion in the left frontal lobe [Figure 1a-c]. Partial invasion in the superior sagittal sinus (SSS) was observed on the gadolinium-enhanced T1-weighted sequences [Figure 1a-c]. After the surgical removal of the mass, a histological examination revealed HPC [Figure 1d-f]. After two years postoperatively, the remnant tumor underwent rapid regrowth [1g-i]; thus, necessitating a second surgical intervention  [Figure 1j-1]. Histological examination revealed an anaplastic HPC with increasing mitotic cells [Figure 1m and n].
Synospsis of the recurrence of the tumor. (a-f) The tumor recurred, with a tumor doubling time of 1-week. (g-i) The tumor recurrence necessitated a third operation. (j) A histological examination revealed further increased mitotic cells and an enlarged the necrotic component. (k) An immunohistological examination revealed CD34 positivity. (l) The MIB-1 index was almost 100%
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F2
In addition, the recurrent tumor displayed a tumor doubling time of one week [Figure 2a-f]. A third operation was done [Figure 2g-i]. A histological examination conducted after the third procedure revealed further increasing of mitotic cells and an enlarged necrotic component [Figure 2j]. Immunohistological findings showed that CD34 was positive, and the MIB-1 index was almost 100% [Figure 2k and l].