PMC6434061_01
Computed tomography showing a high-density lesion (14 x 18 x 12 mm3) at the left mesial temporal lobe. (A): soft tissue density image (B): bone density image.
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Computed tomography showed a mass lesion (14 x 18 x 12 mm3) with massive calcification at the mesial side of the left temporal lobe (Fig. 1).
Magnetic resonance imaging showing a mass lesion at the left mesial temporal lobe. The lesion is low intensity on the T1-weighted image (A), mixed intensity on the T2-weighted image (B), and low intensity on the susceptibility-weighted image (SWI) (C). There are no features of hippocampal sclerosis apparent on the coronal FLAIR image (D).
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T1 and T2-weighted imaging, and it showed markedly low intensity on susceptibility-weighted imaging (Fig. 2A-C). There were no features of hippocampal sclerosis apparent on FLAIR imaging (Fig. 2D). Fluorodeoxyglucose-positron emission tomography showed prominent hypo-metabolism in the lesion and relatively low accumulation at both mesial and lateral parts of the left temporal lobe compared with the right side (Fig. 3).
Fluorodeoxyglucose-positron emission tomography showing prominent hypo-metabolism in the lesion (red arrows) and relatively low metabolism at both mesial and lateral sides of the left temporal lobe compared with the right side of the hemisphere (white arrows).
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FLAIR imaging (Fig. 2D). Fluorodeoxyglucose-positron emission tomography showed prominent hypo-metabolism in the lesion and relatively low accumulation at both mesial and lateral parts of the left temporal lobe compared with the right side (Fig. 3).
Interictal electroencephalography showing a spike and wave pattern at F7, T3, T5, and T1 with the average (AV) reference (red arrows).
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Electroencephalography showed frequent spikes and waves at F7, T3, and T5 (Fig. 4).
Magnetoencephalography showing clustering dipole (red circles) accumulations with upper direction at the frontal base, not at the hippocampus.
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Magnetoencephalography showed dipoles clustering with upper direction at the frontal base, not at the hippocampus (Fig. 5).
Intraoperative view. The lesion is a stone-like yellow mass that is completely removed in one piece.
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The lesion was a stone-like yellow mass and was completely removed in one piece (Fig. 6).
The lesion consists of amorphous lamellar calcification, with eosinophilic matrix in the background on hematoxylin-eosin (HE) staining (A, B). The matrix (C) is positive for vimentin, S-100 protein (D), and glial fibrillary acidic protein (GFAP) (E), while it is mostly negative for epithelial membrane antigen (EMA) (F).
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There was no necrosis, microvascular proliferation, or mitotic activity. (Fig. 7A,B) On immunohistochemistry, the matrix was positive for vimentin (Fig. 7C); some calcification was positive for S-100 protein (Fig. 7D); matrix of the lesion was positive for glial fibrillary acidic protein (GFAP) (Fig. 7E), and epithelial membrane antigen (EMA) was mostly negative (Fig. 7F).
Computed tomography (A, B) and magnetic resonance images (C, D) taken after the operation showing gross total resection of the lesion and preservation of the hippocampus (D: FLAIR image).
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A follow-up MRI demonstrated the complete removal of the lesion (Fig. 8).