PMC10365112_01
MRI of the head on 2019-08-14. (A) T1 transverse view: patchy low signal mass with unclear margin in left thalamus and pons. (B) T2 transverse section: the lesions showed moderate and slightly high signal. (C) ADC showed limited diffusion; (D-F) transverse coronal sagittal enhancement: the lesions showed ring-shaped enhancement, with open ring sign; no obvious necrosis was found in the left thalamus and pons; the size of the lesion was about 25 x 23 x 21 mm.
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F1
The MRI in August 2019 (as shown in Figure 1) revealed that the left thalamus and pontine had medium-to-low T1WI signals and medium-to-slightly high T2WI signals, and the enhancement appeared ring-like, nodular and irregular.
Head MRI on 2019-09-03, compared with the anterior film (2019-08-14). (A) T2 transverse view: patchy medium and high signal masses can be seen in the left thalamus and pons, with smaller range and unclear edge. (B) T2 FLAAR lesions showed moderate and slightly high signal intensity. (C) DWI showed high signal intensity. (D) Transverse enhanced: the degree of enhancement of the lesions was less than before, showing nodular appearance, and no obvious necrosis was found in the lesions. The size of lesions was about 20 x 16 x 20 mm.
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F2
Surprisingly, a re-examination of the cranial MR findings in September 2019 (as shown in Figure 2) revealed that the extent of the left thalamic and pontine lesions was reduced compared to that on the initial images, and the margins were unclear.
Head MRI on 2019-10-08, compared with the front film (2019-09-03). (A) T1 transverse view: patchy medium high signal mass can be seen in the left thalamus and pons, the range is larger than the front, and the edge is not clear. (B) T2 transverse section: the lesions show moderate and slightly high signal. (C-E) Transverse coronal sagittal enhancement: the degree of enhancement of the lesion is higher than that of the previous film, and the lesion area is larger than the previous film, with obvious space occupying effect The size of the lesion was about 23 x 21 x 30 mm.
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F3
However, the cranial MR findings from October 2019 (as shown in Figure 3) showed that the left thalamus and pontine lesions were enlarged compared to those on the previous scan, and the edges were unclear.
During the operation on October 16, 2019, gray white lesions were found.
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F4
In October 2019, under general anesthesia, the patient underwent total tumor resection, resection of left thalamus and pons lesions (Figure 4).
Histological sections. 20 x Hematoxylin and eosin stained sections, which showed that the tumor cells were diffusely proliferated, with large, round, or oval nuclei, obvious nucleoli, visible mitosis, and more lymphocytes infiltrating in the stroma.
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F5
The postoperative pathological analysis (as shown in Figure 5) revealed that the tumor cells were diffusely proliferated, had large nuclei, were round or oval, and had obvious nucleoli, visible mitosis, and more lymphocyte infiltration in the interstitium.