PMC9634465_01
Brain MRI images, post-contrast axial T1. (A) This brain MRI image shows a homogeneously enhancing extra-axial mass with mass effect, post-operative changes, and a previous craniotomy. (B) This brain MRI image shows a multifocal recurrence of the tumor involving the left insular, parietal lobe, and left frontal horn. MRI, magnetic resonance imaging.
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Upon radiological investigations, she was found to have an extra-axial lesion in the left cerebral convexity (Figure 1). Further imaging revealed a local recurrence of the tumor (Figure 1A). Her latest brain MRI (almost 42 months from diagnosis) showed a multifocal recurrence of the tumor involving the left insular, parietal lobe, and left frontal horn (Figure 1B).
Histopathology of anaplastic meningioma (WHO grade 3). (A) The majority of the cells are pleomorphic, giving this tumor a sarcomatoid appearance (H&E, x40). (B) This image shows the pleomorphic cells, with a sarcomatoid appearance of this tumor in higher magnification (H&E, x100). (C,D) High mitotic activity (arrows), approximately 25 mitoses per 10 HPF (H&E, x100). (E) High Ki-67 (proliferative index) of >30% (Ki-67 staining, x100). Ki-67 from abcam (ab15580) was used. The staining procedure did not require any antigen retrieval. This is a rabbit polyclonal antibody, used it at 1:500 diluted in the blocking buffer. The techniques used in counting was the 'hot-spot' method and 'Eye-Balling' estimation in assessing Ki-67 nuclear staining of the tumor cells. WHO, World Health Organization; H&E, hematoxylin and eosin; HPF, high power field.
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The pathological analysis confirmed a WHO grade 3 anaplastic meningioma (Figure 2) with a high Ki-67 proliferative index of up to 30% and negative progesterone receptors.