PMC8571934_01
axial non-enhanced brain CT scan showing a left basifrontal tumor measuring 50 x 45 mm in diameter reaching the ipsilateral temporal lobe; this mass had a triple fleshy component (blue arrow), cystic (red arrows) and scattered foci of calcification (yellow arrows) in variable proportions; note the midline shift estimated at 6 mm without any uncal herniation
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F1
Diagnostic assessment: a non-enhanced brain CT scan (Figure 1) was performed immediately.
A) brain MRI in axial section showing a left basifrontal intra-axial lesion extended to the left polar temporal region, in hypointense on the T1-weighted sequences; B) in heterogeneous isosignal on the T2 sequences; C) not surrounded by an edematous reaction on FLAIR (fluid attenuated inversion recovery) sequence; D) enhancement after gadolinium injection is heterogeneous; E) note the heterogeneous hyper signal on the diffusion weighted images (DWI) without any hyperperfusion on perfusion sequences; F) cystic plaques and hypointense spots are seen on the gradient echo sequence; there was no intra-tumor bleeding on the susceptibility sequences
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F2
a thoraco-abdomino-pelvic CT scan in several coronal sections showing the absence of a primary lesion or any unusual enhancing mass
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F3
As part of the extension assessment, a thoraco-abdomino-pelvic computed tomography (CT) scan (Figure 3) was performed which failed to show any evidence of primary lesion or enhancing mass.
planar whole-body skeletal scan in anterior and posterior projections showing the absence of unusual increased 99mTc-MDP uptake in the whole skeleton; A) anterior and posterior blood pool whole body views; B) delayed anterior and posterior whole body bone scan
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F4
The whole body skeletal scintigraphy confirms the absence of any unusual increased tracer (technetium 99m-methyl diphosphonate: 99mTc-MDP) uptake in the whole skeleton (Figure 4).
axial non-enhanced postoperative CT scan showing a porencephalic cavity at the level of the tumor bed associated with pneumocephalus even subcutaneously; note the disappearance of midline shift and good decompression of healthy parenchyma
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F5
Postoperative CT scan at day 2 (Figure 5) showed a porencephalic cavity at the level of the tumor bed associated with pneumocephalus even subcutaneously and disappearance of the midline shift and good decompression of healthy parenchyma.
A) microscopic histopathological images showing a focal necrosis tumor proliferation, vaguely lobulated and crossed by fibrous septa (H & E 400x); this proliferation is of moderate cellularity made up essentially of small round monomorphic basophilic cells with a rounded or oval nucleus with a high nuclear/cytoplasmic ratio; focally, there was a transition between these undifferentiated embryonic cells with other neurocytically differentiated cells; the background of the proliferation is clearly fibrillary with presence of numerous Homer-Wright rosette images and pseudo-rosettes (H & E 400x); it is associated with micro calcifications and rare spumous histiocytes; B) microscopic immunohistochemistry (IHC) study showing that tumor cells were positive for INI-1, neurospecific enolase (NSE) (IHC for NSE 400x); C) synaptophysin (IHC for synaptophysin 400x)
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F6
Histopathological examination (Figure 6A) showed a focal necrosis tumor proliferation, vaguely lobulated and crossed by fibrovascular septa. Tumor cells were positive for INI-1, neurospecific enolase (NSE) (Figure 6B), Synaptophysin (Figure 6C), and CD 56 antibodies and were negative for epithelial membrane antigen (EMA), PS100, glial fibrillary acidic protein (GFAP), neurofilament and desmin.