PMC4448053_01
MRI and microscopic photographs of the patient. a T2-weighted MRI revealed a remarkable midline shift caused by a mass lesion with an edema in the right frontal lobe. The lesion was >40 x 60 mm in size. b Gadolinium-enhanced T1-weighted MRI revealed a superficial extra-axial enhancement adjacent to the right frontal lobe. The abnormal enhancement was both pia-arachnoid, extending along the pial surface of the brain, and dura-arachnoid, extending along the inner margin of the skull (including the falx cerebri). c Hematoxylin-eosin staining of the specimen from the right frontal lobe showed inflammatory cells massively infiltrating the perivascular connective tissues of the subarachnoid space, forming necrotic granuloma with multinucleated giant cells (white arrowheads). A fresh hemorrhagic infarct is observed in the cerebral cortex, which was accompanied by severe congestion and edema. V = vein. d Veins (black arrowheads) were severely affected. However, the arteries were less affected in the same area (white arrowheads). Elastica-Goldner stain. Scale bars = 100 mum.
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F1
A brain MRI revealed a mass lesion in the right frontal lobe and hypertrophic mucosa in the paranasal sinuses (fig. 1a) in addition to a thickened and strongly enhanced dura mater surrounding the mass lesion (fig. 1b). The biopsied brain material from the surgery revealed a granulomatous inflammation with geographic necrosis and multinucleated giant cells in the perivascular area of the thickened dura mater and leptomeninges (fig. 1c, d).