PMC4508683_01
PMC4508683_02
Radiological pictures of the lesion. A: Computed tomography (CT) scan showed a large irregular heterogenous density area in the right frontal lobe under the old operative field and skull fix system (white solid arrow). B-D: Magnetic resonance imaging (MRI) revealed a two-centric large mixed intensity lesion in the right frontal lobe that showed rim-like irregular contrast enhancement with gadolinium at the site of the previous intracerebral hematoma. Hemorrhage and necrosis in lesions were also evident (black arrows).
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F1
An emergency CT scan revealed a large right frontal mass with hyperdense center with perilesional finger-like edema (Fig. 1A). Magnetic resonance imaging (MRI) showed a large mixed necrotic and hemorrhagic lesion in the right frontal region, likely to be high-grade glioma or malignant tumor which had a broad dural base and displaying irregularly circular enhancement (Fig. 1B-D). At surgery, a rich vascular tumor with cystic lesion and necrotic center was found; the tumor was localized precised beneath the material used for cranialplasty (Fig. 1A).
Photomicrographs of the lesion. A: [original magnification, x200; hematoxylin-eosin stain] demonstrate regions of necrosis (white arrows) surrounded by rings of pseudopalisading tumor cells (black arrows), which are in turn surrounded by abundant microvascular hyperplasia (arrowheads). B: [original magnification, x400; glial fibrillary acidic protein (GFAP) stain] demonstrate diffuse positivity. C: [original magnification, x400; Vimentin stain] demonstrate strongly positive expression. D: [original magnification, x400; IDH-1 stain] showed diffuse positive expression. E: [original magnification, x200; Ki-67 stain] note a high Ki-67 proliferation index with about 30% of the tumor cells showing nuclear staining. F: [original magnification, x400; neurofilament (NF) stain] showing negative result.
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F2
Immunohistochemical result: glial fibrillary acidic protein (GFAP) (+), Vim (+), Ki-67 (30%), IDH-1 (+), NF (-) (Fig. 2).