PMC5466962_01
Axial (A) and sagittal (B) T1 post-contrast and T2 fluid attenuated inversion recovery (C) images of the tumor at initial presentation.
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F1
MRI of the total spine showed no evidence of metastatic disease. MRI of the brain revealed a heterogeneously enhancing pineal mass measuring 2.3 cm x 2.5 cm x 2.3 cm (Figure 1).
Hematoxylin and eosin stains of the tumor, showing necrosis at 20x (A), mitotic figures at 40x (B), and microvascular proliferation at 40x (C).
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F2
The pathology revealed a high-grade glioma composed of markedly atypical cells, many with giant nuclei and containing abundant mitotic activity (seven mitoses in three high-powered fields), multiple foci of microvascular proliferation, and areas of pseudopalisading necrosis, consistent with GBM, World Health Organization Grade IV (Figure 2).
Axial and sagittal views of the dose distribution of the radiotherapy plan with the dose-volume histogram.
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F3
The combined radiotherapy plan is displayed in Figure 3.
Axial (A) and sagittal (B) T1 post-contrast and T2 fluid attenuated inversion recovery (C) images of the tumor at last follow up, 166 weeks following the initiation of chemoradiation.
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F4
The MRI performed 146 weeks after the initial biopsy, when compared over multiple prior studies dating back to 111 weeks post-biopsy, showed subtle, progressive increase in size of the pineal mass from 11 mm x 11 mm to 14 mm x 11 mm and a confluent periventricular white matter T2/fluid attenuated inversion recovery hyperintensity that is non-specific and stable, this was redemonstrated in his MRI at 166 weeks after biopsy (Figure 4).