PMC6350034_01
Initial radiological findings. (A) Initial computed tomography (CT) scan revealing intracranial hemorrhage in the right temporal lobe (axial view). (B-E) Magnetic resonance (MR) imaging, taken at the following day of the CT scan, demonstrating no clear evidence of tumor mass (axial view. B; T1-weighted image, C; T1-weighted image with gadolinium-enhancement, D; T2-weighted image E; fluid attenuated inversion recovery image).
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F1
A computed tomography (CT) scan demonstrated intracranial hemorrhage in the right temporal lobe (Fig. 1A), and the patient was transferred to our hospital. Magnetic resonance (MR) imaging disclosed no enhanced or cystic mass to suggest tumor presence (Figs. 1B-1E).
Pre-operative radiological findings. (A) Angiogram, performed at 13 days after the hemorrhage, showing no abnormality. (B-D) Repeated MR imaging, taken at 2 months after the hemorrhage, demonstrating no tumor mass (axial view. B; T1-weighted image, C; T2-weighted image, D; fluid attenuated inversion recovery image).
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F2
An angiogram revealed no vascular disease including arteriovenous malformation, angioma or aneurysm (Fig. 2A). MR imaging and angiography had demonstrated no vascular disease and/or tumor mass (Figs. 2B-2D). MR imaging at 6 months after onset of the intracranial hemorrhage revealed a cystic mass lesion, with gadolinium-enhancement, in the right temporal lobe (Figs. 3A and 3B).
Pre and post-operative magnetic resonance imaging. (A and B) A cystic mass lesion, with gadolinium-enhancement, was found at 6 months after onset of the intracranial hemorrhage (axial view, A; T1-weighted image, B; T1-weighted image with gadolinium-enhancement). (C and D) The tumor was removed surgically (axial view, C; T1-weighted image, D; T1-weighted image with gadolinium-enhancement).
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MR imaging and angiography had demonstrated no vascular disease and/or tumor mass (Figs. 2B-2D). MR imaging at 6 months after onset of the intracranial hemorrhage revealed a cystic mass lesion, with gadolinium-enhancement, in the right temporal lobe (Figs. 3A and 3B). She therefore underwent surgical resection and the tumor was completely removed (Figs. 3C and 3D).
Photomicrographs obtained by hematoxylin and eosin (H&E) staining (A-D) and immunohistochemical staining (E and F). (A) Pleomorphic neoplastic cells and spindle-shaped cells surrounded by tumor vessels (original magnification x100, bar = 200 mum). (B) Microvascular proliferation and eosinophilic granular bodies (original magnification x200, bar = 100 mum). (C) Lymphocyte cells surrounded by tumor vessels (original magnification x400, bar = 50 mum). (D) Microvascular proliferation and xanthomatous neoplastic cells (original magnification x400, bar = 50 mum). (E) Photomicrograph showing representative GFAP immunostaining (original magnification x100, bar = 200 mum). (F) Photomicrograph showing representative silver staining (original magnification x100, bar = 200 mum).
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Pathological examinations of the tumor specimen demonstrated nuclear and cytoplasmic pleomorphism (Fig. 4A). Microvascular proliferation and bleeding scars were evident (Fig. 4B). The tumor revealed glial components including eosinophilic granular bodies, Rosenthal fibers and spindle-shaped tumor cells (Figs. 4A and 4B). Hemosiderin was present near the tumor vessels, and the tumor cells demonstrated cytoplasmic pleomorphism and xanthomatous changes (Figs. 4C and 4D). Glial fibrillary acid protein (GFAP) and S-100 protein were positive immunohistochemically (Fig. 4E). On silver staining, reticulin fibers were evident surrounded by tumor cells (Fig. 4F).