PMC3271620_01
Postcontrast axial MRI showing a large intra-axial space occupying lesion in the left temporal lobe with peripheral enhancement and peritumoral edema
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F1
Magnetic resonance imaging (MRI) revealed a well-circumscribed lesion in the left temporal lobe, which was isointense on T1-weighted images (T1WI), hypointense on T2WI with postcontrast enhancement [Figure 1].
Postcontrast axial CT scan showing a large recurrent tumor almost occupying the whole posterior part of the left temporal lobe
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F2
The lesion was isodense on plain images with postcontrast enhancement [Figure 2].
Postoperative contrast axial CT showing radical excision of tumor with enhancement along the tentorial leaflet
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F3
Postoperative CT showed residual tumor enhancement along the tentorial leaflet [Figure 3].
Photomicrographs show a high-grade tumor composed of polygonal tumor cells (b and c) admixed with spindle cells (a and d). Nuclear pleomorphism and mitoses seen. (H and E, a and b: x100; c and d: x200)
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F4
Histologically, the tumor showed heterogenous morphology with areas composed of polygonal to irregular-shaped tumor cells with moderate to abundant eosinophilc cytoplasm in a background of neurofibrillary matrix [Figure 4b and c] admixed with spindle cell areas [Figure 4a and d].
(a) Photomicrograph shows increase in intratumoral reticulin (reticulin stain, x100); (b) IHC; GFAP x100); (c) (IHC; p53 x100); and (d) IHC; MIB-1 x200): Photomicrographs of the immunohistochemistry, which is focal positive for glial fibrillary acidic protein (b), which is retic poor areas and suggest glial area and the tumor is diffusely positive for p53 protein (c). MIB-1 labeling index (d) is approximately 8%-10%
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F5
A special stain for reticulin [Figure 5a] showed focal presence of intratumoral fine to coarse reticulin fibers with areas of pericellular architecture. On immunohistochemistry, the tumor was focally positive for glial fibrillary acidic protein [GFAP; Figure 5b] in the regions of polygonal tumor cell areas and reticulin-poor areas. It was diffusely positive for p53 protein [Figure 5c] and showed high MIB-1 labeling index of 15%-20% [Figure 5d].
Postcontrast axial CT scan showing recurrent tumor in the left posterior temporal lobe extending into the posterior fossa and compressing the brain stem
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Repeat CT showed a large recurrence extending into the posterior fossa [Figure 6].