PMC7513887_01
Preoperative axial (A), sagittal (B), and coronal (C) T1-weighted MRI with gadolinium enhancement showing a heterogeneous enhancing mass in the right frontal lobe. Axial (D) T1-weighted MRI with gadolinium enhancement performed 2 years after the first surgery showing no residual or recurrent tumors. Axial (E) T1-weighted MRI with gadolinium enhancement performed 6 years after the initial presentation showing the first recurrence.
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F1
She underwent magnetic resonance imaging (MRI) of the brain, which revealed a heterogeneous gadolinium-enhancing lesion in the right frontal lobe, with a maximum diameter of approximately 40 mm (Figure 1).
Photomicrographs (magnification x200) of oligodendroglial cells in the brain tumor (A-C) and the metastatic bone marrow tumor (D-F). Hematoxylin-eosin staining showed proliferation of tumor cells with relatively round nuclei and a loose, myxoid-like background (A, D). Normal hematopoietic tissue replaced by a malignant tumor (D). Immunohistochemical staining showed positive results for CD56 (B, E) and Olig2 (C, F). Scale bars: 100 mum.
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F2
Pathology at this time also showed anaplastic oligodendroglioma (Figure 2A-C). Because the patient presented with pancytopenia, a bone marrow sample was collected from her left iliac bone, which showed tumor components pathologically and immunohistochemically identical to the anaplastic oligodendroglioma of the brain (Figure 2D-F).
CT scan of the pelvis (A) showing an osteoblastic lesion in the left sacral wing (arrowhead). PET-CT scan (B, C) and bone scintigraphy (D) showed multiple high-uptake bony lesions throughout the axial and proximal appendicular skeleton (B, C: white arrows; D: black arrows).
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F3
A computed tomography (CT) scan revealed multiple osteoblastic lesions in her pelvis, bilateral femurs, sacrum, and left scapula (Figure 3A). CT scan (Figure 3B-D). Curiously, however, no recurrent intracranial lesions were detected on the brain MRI.