PMC3230756_01
The diffusely swollen mesencephalon, uncus and parahippocampal gyrus on FLAIR (A) and T2 MRI-sequences (B), as well as the absence of gadolinium enhancement (C and E) is compatible with the radiological criteria for gliomatosis cerebri. There is diffuse enlargement of the pons (D)
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Fig1
These radiological characteristics were compatible with gliomatosis cerebri (Fig. 1). 
A needle biopsy was taken from tumor in the right mesiotemporal region (green tract)
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Fig2
To establish a histopathological diagnosis, she had a frameless stereotactic needle biopsy of the right mesiotemporal region with a Sedan side cutting needle through a regular burrhole (Fig. 2).
Initial brain biopsy. The left hand panel shows hematoxilin-eosin-stained section of cortical tissue with slight increase in cellularity (objective x2.5). The cells are somewhat irregular, as is better appreciated in the right hand panel, a GFAP staining for astrocytic cells (objective x40), showing clear atypia of the positive-staining cells. Given the relative paucity of these cells and their diffuse spread throughout the biopsy a histopathological diagnosis of gliomatosis was made
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Fig3
GFAP positive staining cells (Fig. 3). Given the relative paucity of these cells and their diffuse spread throughout the biopsy, a diagnosis of gliomatosis of the astrocytic subtype (WHO grade 2) was made.
The subcutaneous lesion (blue arrow), in the biopsy tract is not continuous with the intracranial compartment. The hyperdensity in the pons is thought to be a tumor related bleeding, which was probably not biopsy related
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Fig4
However, three months later, the headaches progressed, accompanied by a subcutaneous swelling at the incision, due to which the patient was unable to wear her glasses (Fig. 4).
Resection specimen of skin and subcutaneous tissues. The inset in the top left hand corner shows a low-power view, showing epidermis and dermis. In the larger figure, the image is dominated by oligodendrocytes with a clear cytoplasm and slightly irregular nuclei; in addition, there is a component of large, multinucleated astrocytic cells, warranting the diagnosis of oligoastrocytoma in this specimen. Both figures are hematoxilin-eosin stained. (The inset is a x1.25 objective, the large figure a x40 objective)
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Fig5