PMC9062938_01
Preoperative neuroimage of patient. We present preoperative computed tomography and MR in sequences T1, T2, FLAIR, and T1 with gadolinium and diffusion. MR disclosed an expansive right temporal lesion. It was solid-cystic, hyperintense at T1, and hypointense at T2, with heterogeneous enhancement after gadolinium injection.
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F1
A skull tomography computerized tomography (CT) was done and showed a right temporo-parieto-occipital hypodensity [Figure 1], associated with a temporo-occipital isointense lesion, suggestive of neoplastic lesion. He performed a magnetic resonance [MR-Figure 1] which disclosed an expansive right temporal lesion. T1, and hypointense at T2 [Figure 1], with heterogeneous enhancement after gadolinium injection. There was edema involvement of corpus callosum, thalamus, and ventricular ependymal walls [Figure 1].
MR spectroscopy evaluation showing reduction in N-acetyl aspartate levels with an increase in choline levels and an increase in lactate levels.
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F2
Spectroscopic analysis revealed a reduction in N-acetyl aspartate levels with an increase in choline levels and an increase in lactate levels [Figure 2].
MR perfusion evaluation displaying increased cerebral perfusion.
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F3
Perfusion study displayed increased cerebral perfusion in this region [Figure 3].
Histology image. In (a), histological section stained by H and E x40, brain parenchyma is shown, showing a moderate mixed inflammatory infiltrate with a foreign body-type giant cell reaction permeating capsulated structures. (b) This same cut, enlarged at 100x, revealing a moderate mixed inflammatory infiltrate and round to oval capsulated structures. In (c), a GomoriGrocott stain, enlarged by x40, reveals the silver impregnation, showing multiple capsulated structures. Finally, (d), in the same coloration, at 100x, it is possible to notice capsulated structures, round to oval with thin cell walls of variable size (3.5-8 mum in diameter). Arrows show inflammatory infiltrate and round to oval capsulated structures compatible with cryptococcoma.
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F4
In GomoriGrocott stain, it was possible to see multiple capsulated structures, round to oval with thin cell walls of variable size [3.5-8 mum in diameter - Figure 4].
Comparison of preoperative MR (left) and postoperative MR (right). MR revealed good surgical resection of lesion.
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F5
The patient underwent postoperative magnetic resonance with good surgical results ([Figure 5].