PMC5417029_01
Histopathology: (A) Surgical specimens from the first operation stained with hematoxylin-eosin (x100), demonstrating the fasciculate pattern, mucoid regions, and bipolar neoplastic cells and some giant cells (arrow). B, Stained with hematoxylin-eosin (x400), absence of mitosis and cells with nuclear anaplasia. C, Negative representative results of p53 immunohistochemical staining. D, Surgical specimens from the second operation stained with hematoxylin-eosin (x100), showing hypercellularity, with small and anaplastic cells and necrosis with a palisade pattern (arrow). E, Stained with hematoxylin-eosin (x400), with mitosis (arrow) and endothelial proliferation. F, Positive representative results of p53 immunohistochemical staining (arrow).
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Although slight nuclear polymorphism and slight endothelial proliferation were observed, necrosis, mitosis, and microvascular proliferation were absent, there was a low Ki-67 proliferative index, and p53 was negative in immunostaining (less than 10% of cancer cells with positive nuclear staining; Figure 1A-C). In contrast to the pathology, 12 years prior, histopathological findings were compatible with glioblastoma, showing anaplastic and pleomorphic cells, necrosis, endothelial proliferation, a high proliferative index with Ki-67 immunostaining, and positive p53 (more than 50% of cancer cells with positive nuclear staining; Figure 1D-F).
Axial postcontrast computed tomography scan showing the local relapse, 12 years after the pilocytic astrocytoma diagnosis. A, Cystic right cerebellar tumor with a hemorrhagic component. B, Hydrocephalus caused by the lesion.
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This mass enhanced contrast and caused obstructive hydrocephalus (Figure 2A and B).
Axial postcontrast T1-weighted magnetic resonance imaging after adjuvant therapy showing abnormal leptomeningeal contrast enhancement.
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Two months after the end of this therapy, his magnetic resonance imaging showed dorsal leptomeningeal seeding (Figure 3).