PMC6016224_01
(a) Brain computed tomography in December 2006 showed an enhanced brain tumor over the left temporal region with mass effect; (b) no obvious recurrent tumor was found by brain MRI in 2013; (c) recurrent tumor was found by MRI in 2014, before the second surgery; and (d) brain MRI in May 2015, before the third surgery, revealed tumor progression.
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fig1
This tumor was located at the left temporal lobe with upward extension to the left basal ganglion and periventricular region, causing perifocal edema and midline shift (Figure 1). The brain MRI in October 2014 revealed a progressive change of lesions, maximum 3.0 cm in diameter (Figure 1).
(a) Markedly increased cellularity of neoplastic astrocytes with nuclear pleomorphism and hyperchromasia (200x), (b) microvascular proliferation (200x), (c) necrosis (200x), and (d) increased proliferation index of tumor cells as revealed by Ki-67 immunostaining (16.3%) (100x).
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(a) Foci of oligodendroglial component featuring clear cytoplasm, round nuclei (200x). The neoplastic cells showed (b) necrosis (100x), (c) GFAP(+) (100x), (d) p53(+) (100x), and (e) IDH1(+) (100x).
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fig3
Neoplastic cells also showed isocitrate dehydrogenase 1(IDH1)(+), p53(diffuse +), and O6-methylguanine-DNA methyltransferase (MGMT)(-) as revealed by immunostaining (Figure 3).
(a) Neoplastic cells with nuclear pleomorphism, hyperchromatism, abundant mitosis, and apoptosis (200x). Immunohistochemistry revealed (b) focal weak positivity for GFAP (200x), (c) synaptophysin(+) (400x), and (d) CD56(+) (400x).
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In immunohistochemistry, the PNET-like component exhibited positivity for synaptophysin and CD56 and focal weak positivity for glial fibrillary acidic protein (GFAP) (Figure 4).