PMC6519298_01
A 17-year-old female with H3F3A G34R mutated infiltrative glioma. MRI of the brain with and without contrast at the time of presentation revealed (A) a T2 FLAIR hyperintense focus (arrow) with adjacent T2 FLAIR hyperintense cortical thickening. (B) T1 contrast-enhanced imaging revealed faint peripheral enhancement (arrow). Three-month follow-up imaging revealed (C) increase in the size of the T2 FLAIR hyperintense lesion long arrow with associated cortical thickening short arrow. (D) T1 contrast-enhanced imaging revealed a solid enhancing nodule (arrow).
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F1
This lesion faintly peripherally enhanced (Figure 1B). This was initially thought to be unrelated to her symptoms. Contrast-enhanced MRIs of the brain revealed the progression of her right paramedian motor cortex lesions which had increased in size with solid central enhancement seen of the larger lesion (Figures 1C,D). Figure 1) showed the progression of disease with an increase in size and number of multifocal enhancing osseous lesions of the spine (Figure 2C), MRI of the pelvis also showed new enhancing lesions. F18-FDG PET/CT was repeated now demonstrating FDG avidity of the increasing osseous lesions.
A 17-year-old female with H3F3A G34R mutated infiltrative glioma. MRI of the spine with and without contrast at the time of presentation was performed. (A) A sagittal T1 pre-contrast image of the lumbar spine shows no evidence of a marrow replacing lesion. (B) Follow-up imaging 3 months later reveals the development of rim-enhancing marrow replacing lesions (arrows) within the lumbar vertebral bodies on this sagittal T1 contrast-enhanced image. (C) Five months later there was a significant increase in the size and number of enhancing marrow replacing lesions (arrows) on this sagittal T1-post contrast fat saturated image.
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F2
A contrast-enhanced MRI of the spine was unremarkable at this time (Figure 2A). An MRI of the spine with contrast was performed demonstrating numerous new, subcentimeter enhancing osseous foci throughout her spine (Figure 2B). Figure 1) showed the progression of disease with an increase in size and number of multifocal enhancing osseous lesions of the spine (Figure 2C), MRI of the pelvis also showed new enhancing lesions. F18-FDG PET/CT was repeated now demonstrating FDG avidity of the increasing osseous lesions.
A 17-year-old female with H3F3A G34R mutated infiltrative glioma. 18F-FDG PET CT fused axial image of the superior bony pelvis reveals a hypermetabolic sclerotic lesion (maximum SUV of >6) within the left iliac bone (arrow).
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F3
An F-18 FDG PET/CT scan performed at this time revealed that a hypermetabolic sclerotic lesion in the left iliac bone and a smaller sclerotic lesion in the right iliac bone without definite hypermetabolism (Figure 3).
A 17-year-old female with H3F3A G34R mutated infiltrative glioma. An axial image from a CT of the chest with contrast in soft tissue window (A) reveals a destructive soft tissue lesion involving a lower right rib (arrow). The image in bone window (B) better demonstrates the rib destruction (white arrow) and also shows predominantly blastic lesions within the vertebra (black arrow).
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F4
A CT of the chest with contrast performed also at this admission revealed the interval development of a large soft tissue mass in the right lower lateral chest wall centered around a rib (Figure 4).
A 17-year-old female with H3F3A G34R mutated infiltrative glioma. A coronal image from a CT of the abdomen and pelvis with contrast in soft tissue window (A) and bone window (B) reveals a destructive lesion of the left iliac bone with large soft tissue component (long arrow), a destructive lesion centered around a right lower rib adjacent to a plural drainage catheter (short arrow), and iliac lymph node metastases (thin arrows).
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F5
The patient's metastatic disease continued to progress over the next 2 months with an CT of the abdomen and pelvis with contrast ~2 months after the last admission revealing diffuse osseous metastases throughout the bony pelvis and bilateral proximal femora (Figure 5).