PMC5549497_01
MRI showing an expansile, poorly demarcated mass in the pons with minimal heterogenous enhancement and severe communicating hydrocephalus.
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MRI studies of his head again showed the expansile, poorly demarcated mass in the pons with minimal heterogenous enhancement and severe communicating hydrocephalus (Figure 1).
Upon opening the skull the brainstem was obscured by a large tumor with variegated appearance, soft somewhat gelatinous consistency, showing multiple hemorrhagic areas. (Brain is reflected posteriorly to expose the posterior cranial fossa; sella turcica with pituitary gland and transected optic nerves are seen at mid upper portion of the photograph.)
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The brainstem was occupied by a large tumor with variegated appearance and soft somewhat gelatinous consistency, showing multiple hemorrhagic areas (Figure 2).
Cut sections through the brainstem and cerebellum showing the neoplasm infiltrating the entire pons, extending into the midbrain, medulla, cerebellar peduncles, and caudal diencephalon. Specimen after formalin fixation.
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Cut sections through the brainstem and cerebellum disclosed the neoplasm that infiltrated the entire pons, extended into the midbrain, medulla, cerebellar peduncles, and caudal diencephalon (Figure 3).
(a) The majority of the neoplasm showed cells with uniform, round nuclear morphology, diffuse chromatin, scant cytoplasm, and characteristic thin-walled chicken-wire vasculature. (b) Extensively infiltrative growth pattern of tumor permeating the pons, 4th ventricle, midbrain, medulla, cerebellar white matter, posterior thalamus, and occipital white matter. (c) Hypercellular areas with foci of calcifications. (d) Immunohistochemical staining demonstrated abundant labeling for Ki-67.
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Histological sections stained with Luxol Fast Blue-Hematoxylin and Eosin demonstrated an anaplastic oligodendroglioma infiltrating the pons, 4th ventricle, midbrain, medulla, cerebellar white matter, posterior thalamus, and occipital white matter (Figure 4(b)). Cytologically, the majority of neoplastic cells had uniform, round nuclear morphology with diffuse chromatin, scant cytoplasm, scattered mitoses, foci of calcification (Figure 4(c)), and characteristic thin-walled chicken-wire vasculature (Figure 4(a)). III/IV) were associated with foci of increased nuclear pleomorphism, necrosis, endothelial proliferation, and hemorrhage. Immunohistochemical staining demonstrated abundant labeling for Ki-67 (Figure 4(d)), scattered neoplastic cells with immunoreactivity for synaptophysin, NeuN, neuron-specific enolase, or glial fibrillary acidic protein (GFAP).