PMC9610691_01
T2-weighted axial (a and b) and sagittal (c and d) images of magnetic resonance imaging brain showing multifocal T2 hyperintense lesions demonstrating mass effect, involving the thalamus, and extending into the brainstem (white asterisk in D). Some of the lesions were cortical and subcortical in location (white arrows in a and c) and cystic changes were also present.
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F1
T2-weighted imaging [Figure 1]. There was infiltration of the corpus callosum and extension to the contralateral left side and patchy lace-like enhancement on postcontrast T1-weighted images [Figure 2].
Coronal FLAIR (a and b) and postcontrast T1 (c and d) images of magnetic resonance imaging brain showing diffusely infiltrative lesion involving the corpus callosum (black asterisk in a and b) and extending to the contralateral side. Patchy lace-like enhancement was seen (white arrows in c and d); however, most of the lesions were largely nonenhancing.
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F2
T2-weighted imaging [Figure 1]. There was infiltration of the corpus callosum and extension to the contralateral left side and patchy lace-like enhancement on postcontrast T1-weighted images [Figure 2].
Magnetic resonance spectroscopy: Frontal lesion showed relative reduction in NAA compared to creatine and an increase in choline compared to creatine. NAA is a marker for normal neurons and axons, creatine is an internal standard and an increase in choline reflects an increase in cellular division. No raised lipid/ lactate peak was noted.
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F3
Along with MR spectroscopy (MRS) findings [Figure 3], a radiological diagnosis of low-grade multifocal glioma was made.
(a) Sheets of round cells with moderate eosinophilic cytoplasm and scattered thin blood vessels, H&E, 20x. (b) Cytoplasmic GFAP positivity, 20x. (c) Intact alpha-thalassemia/ mental retardation syndrome, X-linked nuclear stain, 20x. (d) High-power view (H&E, 40x) showing characteristic chicken-wire vessel (black arrow).
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F4
Based on these combined features, diagnosis of oligodendroglioma, not otherwise specified, WHO Grade II was favored [Figure 4].
Plain computed tomography axial images (a and b) showing coarse calcifications within parts of the lesion (white arrows). Postcraniotomy and biopsy changes are also visible on the right side.
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F5
The CT scan showed diffuse brain edema and confirmed coarse calcifications within parts of the lesion [Figure 5].