PMC4281457_01
Preoperative CT scan brain showing a calcified lesion in the right temporoparietal region.
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CT scan showed a contrast enhancing isodense space occupying lesion with areas of calcification in right frontal cortex with surrounding edema (Figure 1).
Gross post-op specimen.
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Few areas of calcification are also seen (Figure 2).
10x with mitosis.
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Hematoxylin and eosin stained tissue sections revealed a highly cellular neoplasm composed of predominantly spindle shaped cells with pleomorphic oval to elongated hyperchromatic nuclei (Figure 3).
SMA.
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Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
GFAP.
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Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
Mgen.
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Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
PAS.
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Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
S100.
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fig8
Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
EMA.
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fig9
Immunostaining for S100, epithelial membrane antigen, was found to be negative and glial fibrillary acidic protein was scanty positive; Ki67 proliferation index was 10-15% and P 53 protein was positive (Figures 4, 5, 6, 7, 8, and 9).
Post-op CT scan brain with residual disease.
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The patient was given external beam radiotherapy 66 Gy at 2 Gy in 33 fractions and 6 cycles of chemotherapy with temozolomide 200 mg per day for 5 days every 28 days (Figure 10). The post-treatment MRI scan showed a residual focal area of brain edema and granulomatous calcified lesion with reactivation 2.5 x 2.5 cm; the lesion is hypointense in T1W and hyper in T2W (Figure 10).
CT scan residual tumor 2012.
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He is on regular follow-up with us and has survived for 30 months (Figures 11 and 12).
CT scan brain with residual tumor in the right temporoparietal region May 2014.
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fig12
He is on regular follow-up with us and has survived for 30 months (Figures 11 and 12).