PMC3680895_01
Axial T1-weighted (a) shows a hypointense tumor predominantly in the midline with a cystic component situated anteriorly and to the right abutting the brainstem. Axial (b) and sagittal (c) T2-weighted images demonstrate the poor demarcation of the tumor from the brainstem. Post contrast axial (d), coronal (e) and sagittal (f) T1-weighted images show the heterogeneous nature of the tumor with enhancement of the solid component and the cyst wall
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F1
Magnetic resonance imaging revealed a heterogeneously enhancing large solid-cystic tumor in the fourth ventricle compressing the cervicomedullary junction dorsally [Figure 1].
Histology. (a) Conventional H and E staining showing neoplasm with an admixture of glial cells and ganglion cells. The ganglion cells characteristically contain abundant eosinophilic cytoplasm and large vesicular nuclei with prominent nucleoli. The glial cells with small dark nuclei are seen scattered in between (x400). (b) The glial tumor cells strongly express glial fibrillary acidic protein (GFAP; x400); ganglion cell cytoplasm and intervening stroma demonstrating strong positivity for neurofilament protein and synaptophysin (c and d respectively; avidin biotin x400)
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F2
Histopathological examination [Figure 2] revealed a combination of neoplastic ganglion cells mixed with neoplastic astrocytic cells.