PMC9905810_01
The serial perioperative imaging and tumor characteristics at second surgery. (A) The preoperative magnetic resonance imaging. White arrows indicate that the extracranial tumor is directly connected to the intracranial tumor via the channel of craniotomy defect. (B) The relative cerebral blood flow/volume maps based on CT perfusion images. White arrows indicate that the blood supply was significantly higher in the core region of extracranial tumor compared to the core region of intracranial tumor. (C) Corresponding apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps of the patient. (D) The scalp lesion before resection. (E) Representative image of the subcutaneous tumor. The white arrow indicates the core region of extracranial tumor. (F) Intraoperative picture under a surgical microscope. The white arrow indicates the core region of the intracranial tumor. (G) The postoperative magnetic resonance imaging (1 week after surgery).
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Computed tomography (CT) scan revealed a space-occupying lesion in the right temporal-occipital lobe, surrounded by significant edema ( Supplementary Figure 1A ). Postoperative magnetic resonance imaging (MRI) showed complete resection of the lesion (day 3 after surgery) ( Supplementary Figure 1B ). Tumor tissue showed pseudo-palisading necrosis and microvascular proliferation ( Supplementary Figure 1C ). MRI showed tumor local recurrence and invasion to subcutaneous tissue via the channel of craniotomy defect ( Figure 1A ). The relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps acquired from CT perfusion indicated that the blood supply was significantly higher in the core region of the extracranial tumor compared to the core region of the intracranial tumor ( Figure 1B ).  Figure 1C  shows the corresponding apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps of the tumor area. The extracranial mass is localized under the temporal scalp, and closely attached to the temporalis ( Figures 1D, E ). Under the light microscope, the intracranial tumor is roughly fish flesh-like, with a rich blood supply ( Figure 1F ). Postoperative MRI showed a complete resection of the tumor (1 week after surgery) ( Figure 1G ).  Supplementary Figure 2  showed the timeline of therapy and disease status of the patient.
Immunohistochemistry analysis of the extracranial tumor and intracranial tumor. (A) Representative immunohistochemical images of extracranial tumor and intracranial tumor in patient. (B) Quantification of the immunohistochemical stains. Scale bar = 200 mum. ***p < 0.001.
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Postoperative MRI showed a complete resection of the tumor (1 week after surgery) ( Figure 1G ).  Supplementary Figure 2  showed the timeline of therapy and disease status of the patient.