PMC2797365_01
(a)-(d) Cranial MRI at initial presentation before surgical treatment of right frontal anaplastic oligodendroglioma. (a): axial T1-weighted contrast-enhanced MRI, (b) axial fluid-attenuated inversion recovery (FLAIR), and (c) sagittal T1-weighted contrast-enhanced MRI revealed a hyperintense lesion on the right cingulate gyrus with slight local mass effect (arrows). (d): T2-weighted axial MRI showing regular ventricular size. (e)-(f): MRI at second presentation 8 months after initial surgery. (e): sagittal T1-weighted contrast-enhanced MRI showing meningeal enhancement in the craniocervical junction (arrows). (f): Axial T2-weighted MRI showed marked ventricular enlargement.
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fig1
At the time of initial surgery, there were no signs of leptomeningeal tumor involvement or hydrocephalus (Figures 1(a) to 1(d)). T2WI suggesting transependymal absorption or tumor spreading (Figures 1(e) and 1(f)). There were no signs of local tumor recurrence. Meningeal contrast enhancement was detected around the medulla (arrow head in Figure 1(f)).
(a) Sagittal and (b) transversal T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the spine demonstrates meningeal enhancement along the lumbar spinal canal (arrows). Additional enhancement was seen in the cauda equine nerve roots. The biopsy was performed on level L 2/3 (long arrow in (a), level of (b)).
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fig2
The cauda equina fibers appeared thickened and clotted together (arrow head in Figures 2(a) and 2(b)).
(a) Histopathological image of the primary tumor showing moderate cellularity and a rounded, clear cytoplasm. Histological examination of the dura and the nerve roots revealed infiltration by cells of the anaplastic astrocytoma: (b) Hematoxylin-Eosin staining, magnification 250-fold. (c) Elastica-van-Gieson staining showed tumor cells within dural collagen fibers, magnification 500-fold.
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fig3
Histological examination confirmed tumor cell infiltration of the dura and nerve fibers by the known anaplastic oligodendroglioma (Figure 3).