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Pre-operative imaging. Axial T1 weighted image post gadolinium enhancement (A), coronal T1 weighted image post gadolinium enhancement (B) showing a large extraaxial well-circumscribed mass lesion in the right frontal-temporal convexity, abutting the skull bone with good enhancement and dural tail sign (black arrow in Fig. 1A). MRA (C) showing a suspicious small aneurysm in bifurcation of the right middle cerebral artery (white arrow). CTA of brain coronal view (D), axial view (E), 3D reconstruction (F) showing a wide-based saccular aneurysm in bifurcation of the right middle cerebral artery abutting the tumor with dome tilting laterally, anteriorly and inferiorly.
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Incidentally, a suspicious small aneurysm in bifurcation of the right MCA was found (Fig. 1). CT angiography (CTA) of brain was further arranged which demonstrated a wide-based saccular aneurysm in bifurcation of the right MCA, ~4.7 mm in size, abutting the tumor with dome tilting laterally, anteriorly and inferiorly (Fig. 1).
Histology of the specimen. Tumor HE stain 100x (A) showing spindle cells in fascicular and storiform architecture with collagen fibers invested in between tumor cells, and round oval nuclei in haphazard pattern with limited intervening stroma. Tumor HE stain 200x (B) showing staghorn vessel. Tumor STAT6 stain (C) and CD34 stain (D) showing positive staining.
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Intracranial solitary fibrous tumor/hemangiopericytoma grade 2 was diagnosed based on the morphology of the tumor cells and the result of immunohistochemical stains (Fig. 2).
Post-operative imaging. CTA of brain coronal view (A), axial view (B), 3D reconstruction (C) showing the complete removal of the tumor and the complete surgical clipping of the aneurysm without residual lesions.
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His early post-operative CTA of brain (Fig. 3) showed the complete removal of the tumor and the complete surgical clipping of the aneurysm without residual lesions.