PMC4323505_01
A CT scan reveals enhancing mass lesion with central necrosis and peripheral edema in the left pons compressing the fourth ventricle.
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F1
A computed tomography (CT) scan revealed enhancing mass lesion with central necrosis and peripheral edema in the left pons compressing the fourth ventricle (Fig. 1), and subsequent simple, diffusion, and perfusion MRI demonstrated a rim-enhancing about 1.8x1.7x2.0 cm sized, highly perfusing mass lesion with heterogeneous low or iso-signal intensity (Fig. 2), and also positron emission tomogram (PET) scans of the whole body comprising brainstem demonstrated a hot uptake of fluorodeoxy-glucose (FDG) on the brainstem lesion without having any evidences of systemic metastasis (Fig. 3).
Subsequent simple, diffusion, and perfusion MRI images demonstrate a rim-enhancing about 1.8x1.7x2.0 cm sized, highly perfusing mass lesion with heterogeneous low or iso-signal intensity.
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PMC4323505_01_jkns-57-50-g002.jpg
F2
A computed tomography (CT) scan revealed enhancing mass lesion with central necrosis and peripheral edema in the left pons compressing the fourth ventricle (Fig. 1), and subsequent simple, diffusion, and perfusion MRI demonstrated a rim-enhancing about 1.8x1.7x2.0 cm sized, highly perfusing mass lesion with heterogeneous low or iso-signal intensity (Fig. 2), and also positron emission tomogram (PET) scans of the whole body comprising brainstem demonstrated a hot uptake of fluorodeoxy-glucose (FDG) on the brainstem lesion without having any evidences of systemic metastasis (Fig. 3).
Gross total mass resection achieved with lateral suboccipital approach with the help of neuronavigation system and SSEP monitoring. SSEP : somatosensory evoked potential.
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F4
Gross total mass resection was achieved with lateral suboccipital approach with the help of neuronavigation system and somatosensory evoked potential monitoring (Fig. 4).
A : Granulomatous inflammations with Cryptococcus yeasts in the macrophages and multinucleated giant cells (H&E, x200). B : Many Cryp-tococcus yeasts capsules stained with mucicarmine (x200). C : Methenamine silver stains reveal numerous Cryptococcus yeasts (x200).
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F5
Pathologic report confirmed Cryptococcus neoformans (Fig. 5) and the patient was successively treated with Amphotericin antifungal medications.