PMC3291707_01
Initial radiologic findings. CT showed the intracerebral hemorrhage of subacute stage on right parietal area (A). MRI demonstrates a heterogeneous mixed signal intensity lesion on T1 and T2-weighted images (B and C) with a small region of enhancement in right parietal region (D). CT: computed tomography, MRI: magnetic resonance imaging.
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F1
A computed tomography (CT) of the head showed the intracerebral hemorrhage of subacute stage on right parietal area (Fig. 1A). T1-weighted images with a small region of enhancement in right parietal region. The lesion showed heterogenous mixed signal intensity on T2-weighted images (Fig. 1B-D).
Pathologic findings. A: Highly cellular with cellular atypia and frequent mitosis (H&E, original magnification x400). B: Immunopositive for CD34 (original magnification x400). C: Immunopositive for actin (original magnification x400). D: Immunopositive for CD31 (original magnification x400). E: Ki-67 labeling index at 80% (original magnification x400).
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F2
The pathological diagnosis was angiosarcoma, which was highly cellular with cellular atypia and frequent mitosis (Fig. 2A). On immunohistochemistry, the tumor was positive for CD34, factor VIII, actin, CD31 and Ki-67 labeling index was high at 80% (Fig. 2B-E).
Follow-up radiologic findings. A and B: Three weeks later, CT and MRI show another intracerebral hemorrhage associated with enhancing lesion of right parietal area. C: Four weeks later, MRI shows the marginal enhanced lesion on post-resection cavity associated with perilesional edema. D: After WBRT two months later, MRI shows less than 1 cm-sized, four newly enhancing lesions. E: Two months later, there are newly developed lesions; 2.3 cm sized hemorrhagic mass lesion with heterogeneous enhancement in right cerebellar hemisphere. F: Six weeks later, MRI shows that the new multiple lesions are detected. CT: computed tomography, MRI: magnetic resonance imaging, WBRT: whole brain radiotherapy.
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F3
Brain CT and MRI showed another intracerebral hemorrhage associated with enhancing lesion of right parietal area (Fig. 3A, B). Brain MRI showed the marginal enhanced lesion on post-resection cavity associated with perilesional edema (Fig. 3C), which was operated again. Two months later, routine follow-up brain MRI showed less than 1 cm-sized, four newly enhancing lesions (Fig. 3D) and there was no recurrence on two post-resection cavity. GKS-treated enhanced lesions and there were newly developed lesions; 2.3 cm sized hemorrhagic mass lesion with heterogeneous enhancement in right cerebellar hemisphere (Fig. 3E) and multiple small lesions in the cerebral hemisphere. GKS was done for new lesions (marginal dose, 18-20 Gy; 50% isodose curve). Brain MRI showed that the newly multiple lesions were detected (Fig. 3F) with the decrease of previous GKS-treated lesions.