PMC7554362_01
An axial CT of the brain shows a mass like region in the posterior left basal ganglionic and left thalamic region (panel A). A T1-weighted MRI with gadolinium shows a hypodense expansile mass with patchy minimal enhancement (panel B). T2- weighted MRI demonstrates a hyperintense lesion with hypointense central region (panel C). Diffusion-weighted MR imaging (DWI) shows a central necrotic lesion with ring-enhancement is seen in the left basal region on DWI (panel D).
gr1.jpg
PMC7554362_01_gr1.jpg
fig0005
Further work-up included a CT scan of the head which revealed an extensive white matter hypodensity in the left frontal and temporal lobes including capsular white matter with a subtle ring-like region in the posterior left basal ganglionic/left thalamic region with a 5 mm left to right mid-line shift (Fig. 1). T2 signal intensity of left basal ganglia, left internal capsule and left thalamus without enhancement and with some hyperintense diffusion weighted imaging (DWI) signal intensity (Fig. 1). Repeat MRI imaging of the brain showed an expansile left basal ganglionic/thalamic mass now with expansion across midline with 6-7 mm of left to right midline shift again with patchy DWI signal intensity (Fig. 1).
Aseptate hyphae amidst inflammatory cells.
gr2.jpg
PMC7554362_01_gr2.jpg
fig0010
On-site evaluation of frozen section showed inflammatory changes and fungal (hyphal) elements (Figs. 2, 3).
Ribbon shaped, obtuse angle branching, pauci-septate hyphae.
gr3.jpg
PMC7554362_01_gr3.jpg
fig0015
On-site evaluation of frozen section showed inflammatory changes and fungal (hyphal) elements (Figs. 2, 3).