PMC4720801_01
Chordoid glioma in 34-year-old man.. A. Axial unenhanced CT showing hyperattenuated mass compressing frontal horn of right lateral ventricle. Note small calcification (arrow) in periphery of mass. B. Sagittal T1-weighted (upper left panel) and axial T2-weighted (upper central panel) images showing isointense lobulated mass (arrows) relative to cerebral cortex in anterior third ventricle. Axial susceptibility-weighted image (upper right panel) showing no evidence of intratumoral hemorrhage. Sagittal (lower left panel), axial (lower central panel), and coronal (lower right panel) post-contrast T1-weighted images showing strong enhancing main tumor with lobulated margin (arrows) in anterior part of third ventricle and smaller enhancing masses (arrowheads) along wall of lateral ventricles and fourth ventricle. C. CBV map of perfusion MRI showing elevated CBV within tumor (arrows) in third ventricle. D. Photomicrograph of hematoxylin and eosin stained slide showing solid cellular components composed of clusters and cords of epithelioid tumor cells (arrows) within variable mucinous stroma (original magnification x 400). CBV = cerebral blood volume E, F. Photomicrographs of immunostained slides for GFAP (E) and CD 34 (F) showing diffuse and strong expression in tumor cells (dark yellow and brown colors) (original magnification x 400). GFAP = glial-fibrillary acid protein
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F1
A head CT scan revealed a large high attenuated mass with lobulated margins and small calcifications in the anterior 3rd ventricle (Fig. 1A). A brain MRI revealed a 3.1 x 4.2 x 4.5 cm well defined multi-lobulated tumor in the anterior third ventricle and suprasellar region displacing the right lateral ventricle superiorly (Fig. 1B). Perfusion MRI showed markedly elevated cerebral blood volume (CBV) within the tumors on CBV map (Fig. 1C). On histology, these tumors consisted of clusters and cords of oval-to-polygonal epithelioid cells with eosinophilic cytoplasm in a mucinous stroma (Fig. 1D). In addition, they were focally positive for epithelial membrane antigen (EMA) and S-100 protein (Fig. 1E, F) with a Ki-67 labeling index of less than 0.5%.