PMC2713887_01
A 23-year-old man with a longstanding history of seizure.. A. T1-weighed (490/14) axial MR image depicts a large thin-walled cyst, isointense to CSF, in left parietal lobe white matter. The solid portion (arrows), located in the cortex, shaws relatively well-defined, heterogeneous mixed signal intensity. Erosion of the overlying calvarium (arrowhead) has occurred.. B. In this T2-weighted (3500/99) axial MR image, the cystic portion isointense to CSF shows high signal intensity, while the solid portion shows heterogeneous high signal intensity (arrows).. C. FLAIR (9999/119) image more clearly demonstrates the heterogeneous high signal intensity of the solid portion (arrows).. D, E. Contrast-enhanced T1-weighed (490/14) axial (D) and sagittal (E) MR images show minimal enhancement of the solid portion (arrows).. F. Photomicrograph (H & E staining, x200) depicts ganglionic cells (arrows) among the small round cells.. G. Photomicrograph (synaptophysin staining, x200) reveals tumor cells embedded in a neurophil-like fibrillary background which is strongly immunoreactive for synaptophysin.
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T1-/ T2-weighted imaging, respectively, similar to those of cerebrospinal fluid (CSF) (Figs. 1A, B). The solid portion demonstrated heterogeneous mixed signal intensity and was located along the cortex, with erosion of the overlying calvarium. At FLAIR (fluid attenuated inversion recovery) imaging (Fig. 1C), the cystic portion also showed low signal intensity, similar to that of CSF, and heterogeneous high signal intensity of the solid portion was observed, with a lobulating contour. T1-weighted imaging revealed minimal enhancement of the solid portion (Figs. 1D, E), and there was no evidence of leptomeningeal or intraventricular seeding. The preoperative diagnosis was low-grade glioma, such as oligodendroglioma. Ganglioid differentiation was noted throughout the tumor and was represented by scattered individual ganglion cells, or groups of these, among small round cells (Fig. 1F). The tumor cells were embedded in a neurophil-like fibrillary background which was strongly immunoreactive for synaptophysin (Fig. 1G), and GFAP (glial fibrillary acidic protein) immunostaining disclosed that among them, numerous, large reactive astrocytes with stellate processes were present.