PMC7710476_01
Preoperative brain magnetic resonance imaging showing a mass lesion involving the optic chiasm and hypothalamus (arrows). (a and b) Coronal postcontrast, (c) sagittal postcontrast, and (d) axial T2-weighted images. (e) Schematic drawing demonstrating the enlarged optic chiasm due to tumor and the entry site through the exophytic part of the tumor in the right optic chiasm and lamina terminalis (dotted lines). OC: Optic chiasm, ONr: Right optic nerve, ONl: Left optic nerve, ICA: Internal carotid artery, MCA: Middle cerebral artery, ACA: Anterior cerebral artery.
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F1
T1-weighted images, hyperintense on T2-WI, and showed marked homogenous enhancement after the administration of contrast material [Figure 1]. The patient was operated by the right pterional craniotomy and transsylvian approach. Incision with knife was done on the right side of optic chiasm through the exophytic part of the tumor and tumor evacuation done from inside the chiasm [Figure 1e].
Histopathologic examination of the tumor revealed clusters of abnormal neurons which exhibit enlarged hyperchromatic nuclei and some are binucleated in H&E x10 (a) and H&E x40 (b). Between the neurons, there are dissecting fibrillary cells highlighted by GFAP (c). The abnormal neurons are negative for EMA (d) and positive for S-100 (e) and Synaptophysin (f).
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F2
KI67 was less than 1% [Figure 2].
Postoperative postcontrast brain magnetic resonance imaging 3 years after surgery showing small and stable remnant of the tumor. (a) Axial, (b) sagittal, (c and d) coronal images.
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F3
The low KI67 and the low grade of the tumor (WHO Grade I) influenced our decision to follow up the patient than subjection radiotherapy, and until this report it has been 3 years and 8 months with stable neurologic and radiologic findings of the patient [Figure 3].