PMC3354360_01
Anteroposterior radiograph of the right hand shows multiple expansile, osteolytic lesions involving the metacarpals, proximal and middle phalanges of the right index and middle fingers. There is a pathological fracture (white arrow) involving the proximal phalanx of the right index finger
IJRI-22-58-g001.jpg
PMC3354360_01_IJRI-22-58-g001.jpg
F1
The lesions had been localized to the index and middle fingers of right hand in a ray distribution [Figure 1].
Initial noncontrast CT scan shows an ill-defined lesion (black arrow) in the right frontal lobe. There is no hemorrhage, calcification, perilesional edema, or significant mass effect
IJRI-22-58-g002.jpg
PMC3354360_01_IJRI-22-58-g002.jpg
F2
We obtained a noncontrast computed tomography (CT) scan [Figure 2], which showed a nonspecific hypodense lesion in the right insular cortex.
Noncontrast CT scan obtained 3 years later shows subdural hemorrhage (white arrowheads) along the left cerebral convexity, with associated mass effect. The hypodense lesion involving the right frontal lobe (black arrow) has increased in size
IJRI-22-58-g003.jpg
PMC3354360_01_IJRI-22-58-g003.jpg
F3
Noncontrast CT scan [Figure 3] was done and showed a subdural hematoma (SDH) over the left cerebral convexity.
MRI done 1 week after evacuation of the subdural hemorrhage. Coronal FLAIR MRI (A) shows areas of signal alteration involving the right frontal lobe (short arrow), cingulate gyrus (arrowhead), and left basifrontal region (long arrow). Axial T2W MRI (B) shows another lesion (arrow) in the region of the left precentral gyrus. Note the interval craniotomy
IJRI-22-58-g004.jpg
PMC3354360_01_IJRI-22-58-g004.jpg
F4
A subsequent magnetic resonance imaging (MRI) done 1 week later [Figure 4] showed an additional smaller lesion in the right cingulate gyrus.
Medium-power view (H and E, x20) shows areas of mildly increased cellularity composed of astrocytic and oligodendroglial cells (lower part of the image) as compared to normal brain parenchyma (upper part of the image)
IJRI-22-58-g005.jpg
PMC3354360_01_IJRI-22-58-g005.jpg
F5
The initial pathology report, based on hematoxylin and eosin (H&E) staining, showed mild focal increase in cellularity within the sampled tissue [Figure 5].