PMC6159139_01
Contrast-enhanced T1 weighted MRI with a solid cystic mass in the (a) right temporal lobe and (b) right side of the prepontine cistern with an associated cystic component extending towards the midline; (c,d) T2 weighted imaging of lesions demonstrated extremely high signal intensity. Arrows emphasize the locations of lesions.
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Subsequent contrast-enhanced T1 weighted MRI of the brain demonstrated extensive post-contrast nodular enhancement of the basimeninges associated with an approximately 5 x 4 cm solid and cystic mass in the right temporal lobe (Figure 1a). An additional elongated enhancing mass was seen on the right side of the prepontine cistern measuring 2.3 x 1.1 cm in size, with an associated cystic component that extended towards the midline from this mass (Figure 1b). On T2 weighted imaging, the cystic components of these lesions demonstrated extremely high signal intensity (Figure 1c,d) that was suppressed on fluid-attenuated inversion-recovery (FLAIR) imaging, while T1 weighted imaging demonstrated hypointense signal.
MRI views of the spinal axis showing diffuse nodular meningeal enhancement of the (a) cervical and (b) lumbar spine. Arrows emphasize the locations of lesions.
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Views of the spinal axis demonstrated diffuse nodular meningeal enhancement (Figure 2).
Histopathology showing (a) astrocytoma with protoplasmic features and (b) Ki-67 immunohistochemistry with labelling rate of approximately 5% suggestive of more aggressive behaviour.
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This time, histopathological analysis of the biopsy specimen showed an astrocytoma with protoplasmic features (Figure 3a). Immunohistochemistry for Ki-67 (a cell proliferation marker) showed a labelling rate of approximately 5%, which was somewhat higher than the 0-2% commonly seen in low-grade tumours, suggestive of more aggressive behaviour (Figure 3b).
Axial T1 weighted MRI showing disease progression, with enlargement of the cystic component of the temporal lobe lesion.
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However, his disease progressed (Figure 4) and did not respond to further medical or surgical management, and he ultimately passed away.