PMC4214048_01
Preoperative enhanced parasagittal T1-WI MRI demonstrates extra-axial heterogeneously dumbbell-shaped enhancing tumor in the left middle fossa extending into infratemporal fossa.
CRIPA2014-153197.001.jpg
PMC4214048_01_CRIPA2014-153197.001.jpg
fig1
Magnetic resonance imaging (MRI) of the brain revealed a 40 x 25 x 40 mm isointense lesion that enhanced heterogeneously following intravenous Gadolinium administration enhancing lesion in the anterior part of left middle cranial fossa involving the anterior part of the temporal lobe and extends to the infratemporal fossa through foramen ovale (Figures 1, 2, and 3).
Axial T1-WI MRI demonstrating mass effect and infiltration to the temporal lobe with vasogenic edema.
CRIPA2014-153197.002.jpg
PMC4214048_01_CRIPA2014-153197.002.jpg
fig2
Magnetic resonance imaging (MRI) of the brain revealed a 40 x 25 x 40 mm isointense lesion that enhanced heterogeneously following intravenous Gadolinium administration enhancing lesion in the anterior part of left middle cranial fossa involving the anterior part of the temporal lobe and extends to the infratemporal fossa through foramen ovale (Figures 1, 2, and 3).
Coronal T1-WI MRI demonstrating middle cranial fossa tumor extending to the infratemporal region.
CRIPA2014-153197.003.jpg
PMC4214048_01_CRIPA2014-153197.003.jpg
fig3
Magnetic resonance imaging (MRI) of the brain revealed a 40 x 25 x 40 mm isointense lesion that enhanced heterogeneously following intravenous Gadolinium administration enhancing lesion in the anterior part of left middle cranial fossa involving the anterior part of the temporal lobe and extends to the infratemporal fossa through foramen ovale (Figures 1, 2, and 3).
Microphotograph shows anaplastic astrocytoma with numerous mitoses (Hematoxylin & Eosin, original magnification x20).
CRIPA2014-153197.004.jpg
PMC4214048_01_CRIPA2014-153197.004.jpg
fig4
The first component of temporal lobe specimen revealed a mitotically active malignant glial neoplasm, with no endothelial proliferations or necrosis (Figure 4).
Microphotograph demonstrating significant P53 immunopositivity of anaplastic astrocytoma.
CRIPA2014-153197.005.jpg
PMC4214048_01_CRIPA2014-153197.005.jpg
fig5
III). Immunohistochemistry study revealed a strong glial fibrillary acidic protein (GFAP) and P53 positivity (Figure 5).
Ki 67 proliferative index of 10% per 10 HPF in the anaplastic astrocytoma.
CRIPA2014-153197.006.jpg
PMC4214048_01_CRIPA2014-153197.006.jpg
fig6
Ki-67 proliferative index showed a mild to moderate (5-10% per 10 HPF) proliferation (Figure 6).
Microphotograph shows MTNST with extensive atypia, mitosis, and necrosis (Hematoxylin & Eosin, original magnification x20).
CRIPA2014-153197.007.jpg
PMC4214048_01_CRIPA2014-153197.007.jpg
fig7
The second component from the extradural specimen revealed a malignant spindle cell neoplasm arranged in a fascicular pattern and embedded in a loosely textured background, with apparent numerous mitosis and tumor necrosis (Figure 7).
P53 immunopositivity of MTNST was apparent.
CRIPA2014-153197.008.jpg
PMC4214048_01_CRIPA2014-153197.008.jpg
fig8
Immunohistochemically, the spindle cells were strongly positive for vimentin and S-100 proteins, and apparent P53 expression (Figure 8).
Ki 67 proliferative index of 10% per 10 HPF in MTNST.
CRIPA2014-153197.009.jpg
PMC4214048_01_CRIPA2014-153197.009.jpg
fig9
Ki-67 proliferative index showed a mild to moderate (5-10% per 10 HPF) proliferation (Figure 9).
Postoperative (24 hr) follow-up T1-WI parasagittal MRI demonstrates complete resection of tumor from the infratemporal region.
CRIPA2014-153197.010.jpg
PMC4214048_01_CRIPA2014-153197.010.jpg
fig10
Postoperative brain MRI scans demonstrated a complete resection of both tumors (Figures 10 and 11).
Postoperative (24 hr) follow-up T1-WI axial MRI demonstrates complete resection of tumor from the middle region.
CRIPA2014-153197.011.jpg
PMC4214048_01_CRIPA2014-153197.011.jpg
fig11
Postoperative brain MRI scans demonstrated a complete resection of both tumors (Figures 10 and 11).
Postoperative (8-month) follow-up T1-WI axial MRI demonstrates recurrent local tumor, likely from anaplastic astrocytoma component, and distant spread to the anterior part of corpus callosum.
CRIPA2014-153197.012.jpg
PMC4214048_01_CRIPA2014-153197.012.jpg
fig12
Brain MRI scans revealed left temporal leptomeningeal enhancement at resection cavity at the temporal and infratemporal regions, as well as new heterogeneous enhancing lesion at anterior part of corpus callosum; the latter is likely from the anaplastic astrocytoma component (Figure 12).