PMC4505113_01
Left image: axial T2 FLAIR showing 2 cm x 2.3 cm left frontal mass with substantial edema. Middle image: sagittal T1 post-contrast image showing contrast enhancement in a "ring-like" pattern. Right image: axial T2 FLAIR showing residual changes consistent with partial resection of the previous ring-enhancing left frontal mass.
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F1
MRI of the brain, with and without contrast, showed a left frontal, ring-enhancing mass measuring 2 cm x 2.3 cm with substantial edema (Figure 1).
Pathological specimen of the left frontal lobe lesion. Left image: H&E section showing white matter with reactive gliosis (reactive astrocytes with abundant eosinophilic cytoplasm). Right image: Luxol fast blue showing absence of myelin.
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F2
Pathologic evaluation of the resected tissue demonstrated reactive gliosis with CD-68 macrophages most likely consistent with a demyelinating lesion (Figure 2).
(A) Sagittal T1 post-contrast showing large area of right occipitoparietal lesion with a ring-like enhancing pattern (left image) and axial T2 FLAIR MRI showing substantial peri-lesional edema (right image). (B) Sagittal T1 post-contrast MRI showing marked increase in the size of the right parietal lobe lesion with surrounding local edema and enhancement.
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F3
MRI of the brain now showed increased size of the right occipital and parietal lobe lesions, with a new area of occipitoparietal ring enhancement (Figure 3A). MRI of the brain revealed an increased area of enhancement in the deep, right parietal lobe with mass effect (Figure 3B).