PMC5287951_01
Preoperative brain CT and MRI images. (A and B) Axial view, CT images. (C) Axial view, T1-weighed image (T1WI). (D) Axial view, T2WI. (E) Axial view, contrast-enhanced T1WI. (F) Sagittal view, T1WI. (G) Coronal view, contrast-enhanced T1WI. (H) Axial view, diffusion weighted imaging (DWI). The mass appeared iso-hypodense on brain computed tomography (CT), short signal on T1-weighted magnetic resonance images (T1WI) and long signal on T2WI. It was not easy to make an accurate diagnosis before surgery.
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F1
CT scan showed a dural-based, extraaxial, well-defined, iso-hypodense area measuring around 5.1 cm x 4.2 cm x 3.5 cm (proved to be sludged blood by pathological examination afterwards) with an inside oval hyperdense lesion near the lateral border adjacent to the skull (proved to be a cystic lesion postoperatively, Fig. 1A and B). T2WI. The peripheral cystic part mentioned above showed iso-long signal on T1WI and iso-short signal on T2WI, and was slightly enhanced after administration of gadolinium. The pathological field was surrounded by irregular edema (Fig. 1C-H).
Intraoperative pictures showing the tumor was grossly removed completely. Although the tumor was adherent to the arachnoid membrane and bled easily, the main tumor was separable from the brain parenchyma and grossly totally removed.
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F2
A left frontotemporal craniotomy was performed, and at the dural opening, a large, blackish, vascular, firm tumor with multiple small satellite lesions in the arachnoid membrane was observed (Fig. 2A) and the main tumor was found to be embedded in the left temporal lobe along the sylvian fissure, with the brain acquiring a dark black coloration. Although the tumor was adherent to the arachnoid membrane and bled easily, the main tumor was separable from the brain parenchyma and grossly totally removed (Fig. 2B-F).
Histopathological and immunohistochemical (IHC) examinations of the postsurgical specimen. (A) Hematein-Eosin staining. (B) HMB-45. (C) CD68. (D) Ki-67. (E) Melan A. (F) Oligo-2. (G) S-100 protein. (H) VEGF. (I) Vimentin.
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F3
These findings were suggestive of a cerebral melanoma (Fig. 3).
Postoperative brain CT and MRI images. (A and B) Axial view, CT images 1 day after surgery. (C-H) Nearly 5 months after surgery. (C) Axial view, T1-weighed image (T1WI). (D) Axial view, T2WI. (E) Axial view, contrast-enhanced T1WI. (F) Sagittal view, T1WI. (G) Coronal view, contrast-enhanced T1WI. (H) Axial view, diffusion weighted imaging (DWI).
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F4
For more than 11 months of follow-up, the patient recovered well without relevant sequelae or recurrences (Fig. 4).