PMC4756249_01
PMC4756249_02
A-C: (A) Coronal T1-, (B) T2-, and (C) gadolinium-enhanced T1-weighted MRI of the brain demonstrating an intradiploic mass in the left parietal bone at 27 months old. D: Coronal bone-window of a CT scan demonstrating an osteolytic mass lesion eroding the inner and outer table. E: MRI showing that the mass increased rapidly at 32 months old. CT: computed tomography, MRI: magnetic resonance imaging.
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F1
At 27 months old, an MRI revealed a hypointense 40 x 10 x 35 mm spindle-shaped mass in the left parietal region that was hypointense centrally on T1-weighted images, and hyperintense peripherally on T2-weighted images (Fig. 1A, B). Contrast-enhanced MRI showed a well-defined homogeneous mass (Fig. 1C). A CT scan showed a mass located in the intradiploic space of the left parietal bone (Fig. 1D). At 32 months, an MRI showed that the mass had increased in size to 43 x 10 x 40 mm (Fig. 1E), and the child was admitted to our hospital for surgery.
Photomicrograph showing fibroblasts and spindle-shaped cells with elongated nuclei within a collagenous background matrix. Hematoxylin and eosin staining, original magnification (A) x100 and (B) x200. C: Photomicrograph obtained after immunostaining for beta-catenin showing strong nuclear and cytoplasmic staining in fibroblasts. Original magnification x100. D: Ki-67 staining showing a few cells with positive nuclei. Original magnification x100.
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F2
A histological examination revealed that the tumor consisted of fibroblasts with a few myxomatous satellite cells within a collagenous background matrix (Fig. 2A, B). Immunohistochemical analysis revealed that both the nucleus and cytoplasm of fibroblasts were strongly positive for beta-catenin (Fig. 2C). Ki-67 positive cells were rare (Fig. 2D), and cells were negative for S-100 protein.
A: Gadolinium-enhanced T1-weighted magnetic resonance imaging showing a thickened dura outside the range of the initial operation. B: The mass gradually increased again during 10 months. C: There is no evidence of recurrence at 12 months after the second surgery.
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F3
MRI 4 months after surgery revealed a thickened dura outside the range of the initial craniotomy (Fig. 3A) and a mass that had grown progressively (Fig. 3B). Since undergoing the second craniotomy 12 months ago, there have been no signs of recurrence on MRI (Fig. 3C) but she has repeated seizures and continues to need medical attention.