PMC3097703_01
A coronal contrast-enhanced MRI of the brain demonstrating the heterogeneously enhancing left temporal lobe mass (glioblastoma multiforme) with an associated cystic component (arrow).
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F1
A contrast-enhanced MRI of the brain was performed in February 2004, showing a heterogeneously enhancing lesion in the left temporal lobe with an associated cystic component (Figure 1).
A contrast-enhanced T1 weighted sagittal MRI of the spine demonstrating multiple enhancing lesions in the vertebral bodies in keeping with bony metastases and cord compression at T7 level (arrow).
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F2
A subsequent MRI of the thoraco-lumbar spine demonstrated multiple areas of metastases with evidence of spinal cord compression at the T7 level (Figure 2).
An axial contrast-enhanced CT scan of the liver demonstrating multiple liver metastases of varying sizes (the largest marked with an asterisk).
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F3
The patient by this time had also complained of vague abdominal pains, and a CT scan of the abdomen and pelvis showed multiple massive hypodense liver lesions of varying sizes (Figure 3).
The H&E stained histopathological slide of the liver biopsy demonstrating a) abnormal sheets of small round 'blue' cells with high nucleocytoplasmic ratio and pleomorphism in keeping with glioblastoma multiforme metastases (slide magnification x200); b) the normal appearance of the hepatocytes obtained from a normal part of the liver tissue (slide magnification x500).
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F4
An ultrasound-guided core biopsy of one of these liver lesions was performed and was histopathologically confirmed to be that of liver tissue demonstrating abnormal sheets of small round 'blue' cells with high nucleocytoplasmic ratio and pleomorphism in keeping with glioblastome multiforme metastases (Figure 4a).