PMC4875976_01
Initial brain MRI. (a) Axial T1-weighted image with gadolinium, showing the enhancing left medullary lesion. (b) Coronal T1-weighted image with gadolinium showing the same medullary lesion.
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An initial MRI demonstrated a 1.9 x 0.8 x 1.0 cm contrast-enhancing mass in the left ventrolateral aspect of the medulla (Figure 1).
Brain MRI 2 weeks after the initial MRI. (a) Axial T1-weighted image with gadolinium, showing the enhancing left medullary lesion increased in size. (b) Coronal T1-weighted image with gadolinium showing the same medullary lesion increased in size.
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A repeat MRI revealed that the mass was larger, now 3.2 x 1.1 x 1.4 cm (Figure 2).
Histopathology of medullary tumor. (a) Multiple small fragments of the biopsy include one with significant necrosis, one with relatively high cell density, and one with considerable hemorrhage. H&E, original magnification 100x. (b) At high magnification, this portion of the biopsy shows tumor with moderate cell density bordering necrotic tumor. H&E, original magnification 400x. (c) Many of the tumor cells have cytoplasmic GFAP immunoreactivity, establishing their astrocytomatous phenotype. Original magnification 600x. (d) A Ki67 immunostain shows a proliferative index of up to about 25%, consistent with the diagnosis of a high-grade glioma. Original magnification 200x.
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A diagnosis of glioblastoma (WHO grade IV) was subsequently confirmed by the final pathology examination (Figures 3(a)-3(d)).
Brain MRI 10 months after surgery. (a) Axial T1-weighted image with gadolinium, showing progression of the enhancing left medullary lesion. (b) Coronal T1-weighted image with gadolinium showing the same medullary lesion.
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Recurrent headaches 10 months after surgery prompted a repeat MRI which demonstrated disease progression (Figure 4).